Extracorporeal Membrane Oxygenation for Refractory Asthma Exacerbations With Respiratory Failure

Zakrajsek, Jonathan K; Min, Sung‐Joon; Ho, P. Michael; Kiser, Tyree H.; Kannappan, A.; Sottile, Peter D.; Allen, Richard R.; Althoff, Meghan D.; Moss, Marc; Burnham, Ellen L.; Mikkelsen, Mark E.; Vandivier, R. William

doi:10.1016/j.chest.2022.09.029

Cited by 13 publications

(15 citation statements)

References 40 publications

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“…Further, hemorrhage was the most common ECMO-related complication in refractory asthma exacerbations. 15,16 Fortunately, our patient had no treatmentrelated complications. The condition of the patient at the early treatment stages was dangerous; however, satisfactory results were achieved with ECMO.…”

Section: Discussionmentioning

confidence: 66%

Successful treatment of near-fatal asthma with ECMO: A case report and literature review

Tian

Han

2023

Int J Artif Organs

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Near-fatal asthma (NFA) can lead to severe hypercapnia and sudden cardiac arrest; however, it can be reversed by extracorporeal membrane oxygenation (ECMO). We report a case of a 37-year-old male diagnosed with NFA. After fluid rehydaration, spasmolysis, and treatment with glucocorticoid and mechanical ventilation, the patient’s condition improved temporarily. However, his condition worsened rapidly, and the patient presented with progressive respiratory distress, a sharp increase in airway pressure, decreased tidal volume, and barotrauma. The patient was treated with venovenous ECMO in the prone position. Five days later, the patient was successfully weaned from ECMO. Hence, ECMO could be used for NFA at the right time to provide adequate gas exchange for patients in order to reduce lung damage and prevent death.

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Section: Discussionmentioning

confidence: 66%

Successful treatment of near-fatal asthma with ECMO: A case report and literature review

Tian

Han

2023

Int J Artif Organs

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“…Race and/or ethnicity was the primary study aim in five citations (13%). No statistical difference or mixed results were observed in 25 (64%) of studies (51, 52, 135–147). Studies with cardiac disease, arrest, transplant, or shock observed patients from diverse backgrounds having lower ECMO use in seven (28, 31, 129, 148–151) versus higher ECMO use in three (26, 89, 152).…”

Section: Resultsmentioning

confidence: 86%

“…Of 17 studies examining insurance status, one from South Korea showed higher ECMO use in patients with NHI versus “medical aid” (164). Of 16 U.S. studies, four found no difference (31, 139, 159, 165), 10 showed greater use in patients with private insurance (vs government insurance) (28, 89, 129, 132, 137, 148, 154, 160, 166) or any insurance (vs uninsured) (167). One obstetric study observed higher ECMO use with government insurance (155), and another showed lower ECMO use in insured patients with COVID-19 (138).…”

Section: Resultsmentioning

confidence: 99%

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

Moynihan

Dorste

Alizadeh

et al. 2023

Critical Care Medicine

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Objectives: To map the scope, methodological rigor, quality, and direction of associations between social determinants of health (SDoH) and extracorporeal membrane oxygenation (ECMO) utilization or outcomes. Data Sources: PubMed, Web of Science, Embase, and Cochrane Library databases were systematically searched for citations from January 2000 to January 2023, examining socioeconomic status (SES), race, ethnicity, hospital and ECMO program characteristics, transport, and geographic location (context) with utilization and outcomes (concept) in ECMO patients (population). Study Selection: Methodology followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping review extension. Two reviewers independently evaluated abstracts and full text of identified publications. Exclusion criteria included non-English, unavailable, less than 40 patients, and periprocedural or mixed mechanical support. Data Extraction: Content analysis used a standardized data extraction tool and inductive thematic analysis for author-proposed mediators of disparities. Risk of bias was assessed using the Quality in Prognosis Studies tool. Data Synthesis: Of 8,214 citations screened, 219 studies were identified. Primary analysis focuses on 148 (68%) including race/ethnicity/SES/payer variables including investigation of ECMO outcomes 114 (77%) and utilization 43 (29%). SDoH were the primary predictor in 15 (10%). Overall quality and methodologic rigor was poor with advanced statistics in 7%. Direction of associations between ECMO outcomes or utilization according to race, ethnicity, SES, or payer varied. In 38% adverse outcomes or lower use was reported in underrepresented, under-resourced or diverse populations, while improved outcomes or greater use were observed in these populations in 7%, and 55% had no statistically significant result. Only 26 studies (18%) discussed mechanistic drivers of disparities, primarily focusing on individual- and hospital-level rather than systemic/structural factors. Conclusions: Associations between ECMO utilization and outcomes with SDoH are inconsistent, complicated by population heterogeneity and analytic shortcomings with limited consideration of systemic contributors. Findings and research gaps have implications for measuring, analyzing, and interpreting SDoH in ECMO research and healthcare.

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“…Our study shows that the use of such low-flow systems can achieve improvement in blood gas parameters (both pH and pCO 2 ) within 6 hours of initiation of ECCO 2 R. Additionally, we saw trends in improvement associated with peak inspiratory pressures, minute ventilation, and respiratory rate, thus ensuring that we could achieve lower inflation pressures and power to help with better lung mechanics through low-flow ECCO 2 R. These results are similar to recently published cohorts describing the use of ECMO in status asthmaticus. 2,9 Improvement in ventilator and blood gas parameters after initiation of ECCO 2 R suggest that ECCO 2 R simultaneously allows less injurious ventilation, while minimizing the adverse effects of respiratory acidosis. This could be expected to lead to better patient outcomes because of the reduced incidence of ventilator associated lung injury and improved cardiovascular function.…”

Section: Discussionmentioning

confidence: 99%

“…1 In the setting of status asthmaticus, 10–25% of patients require intubation and mechanical ventilation, and in-hospital mortality can range up to 5%. 2 The cornerstone of therapy for status asthmaticus includes inhaled bronchodilators and intravenous corticosteroids. In the cases of escalating severity that require mechanical ventilation, deep sedation, and continuous neuromuscular blockade are necessary to achieve safe ventilation.…”

mentioning

confidence: 99%

Using a Low-Flow Extracorporeal Carbon Dioxide Removal (ECCO2R) System in the Management of Refractory Status Asthmaticus: A Case Series

Fox,

Mehkri,

Latifi

et al. 2023

ASAIO Journal

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Rescue treatments for status asthmaticus remain limited. Current literature has mainly focused on using extracorporeal membrane oxygenation (ECMO) as a primary modality of care for these patients. Low-flow extracorporeal CO2 removal (ECCO2R) systems are an attractive option to improve refractory hypercapnic respiratory acidosis because of status asthmaticus. This is a retrospective case series that describes the feasibility and efficacy of the use of a low-flow ECCO2R device, the Hemolung Respiratory Assist System, in patients with refractory hypercapnic respiratory failure because of status asthmaticus. Eight patients were treated with the Hemolung Respiratory Assist System in eight separate locations globally. Seven (88%) of the patients survived to discharge in this case series. Both CO2 and pH resolution were seen in 6 hours. None of the ECCO2R runs were stopped because of mechanical- or device-related complications. One patient necessitated transition to ECMO. Low-flow ECCO2R systems is an effective option for resolution of refractory hypercapnia in status asthmaticus. Use of these systems are also associated with a survival rate of close to 90% in patients with status asthmaticus.

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Extracorporeal Membrane Oxygenation for Refractory Asthma Exacerbations With Respiratory Failure

Cited by 13 publications

References 40 publications

Successful treatment of near-fatal asthma with ECMO: A case report and literature review

Successful treatment of near-fatal asthma with ECMO: A case report and literature review

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

Using a Low-Flow Extracorporeal Carbon Dioxide Removal (ECCO2R) System in the Management of Refractory Status Asthmaticus: A Case Series

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