Extracorporeal Membrane Oxygenation in COVID-19

Tisminetzky, Manuel; Ferreyro, Bruno L.; Fan, Eddy

doi:10.1016/j.ccc.2022.01.004

Cited by 5 publications

(7 citation statements)

References 75 publications

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“…Open access sent through a membrane lung, which acts as an interface for gas diffusion before returning to the venous system. 6 An alternative configuration uses a dual-lumen cannula inserted in a single internal jugular vein that provides both a conduit for drainage and return ECMO flow. 7 Although mechanical ventilation remains the main supportive strategy for patients with severe respiratory failure, V-V ECMO is essential for providing gas exchange when conventional mechanical ventilation is insufficient and mitigating ventilator-induced lung injury when lungprotective ventilation is not feasible.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…The basic components of an ECMO circuit consist of (1) a drainage cannula inserted into a central vein, (2) a pump coupled with (3) an oxygenator and (4) a return cannula inserted into a different central vein. Deoxygenated blood is withdrawn by the pump and sent through a membrane lung, which acts as an interface for gas diffusion before returning to the venous system 6. An alternative configuration uses a dual-lumen cannula inserted in a single internal jugular vein that provides both a conduit for drainage and return ECMO flow 7…”

Section: Introductionmentioning

confidence: 99%

“…Deoxygenated blood is withdrawn by the pump and sent through a membrane lung, which acts as an interface for gas diffusion before returning to the venous system. 6 An alternative configuration uses a dual-lumen cannula inserted in a single internal jugular vein that provides both a conduit for drainage and return ECMO flow. 7 …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Key performance indicators in extracorporeal membrane oxygenation (ECMO): protocol for a systematic review

Tisminetzky,

Nepomuceno,

Kung

et al. 2023

BMJ Open

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IntroductionExtracorporeal membrane oxygenation (ECMO) is an intervention used in critically ill patients with severe cardiopulmonary failure that is expensive and resource intensive and requires specialised care. There remains a significant practice variation in its application. This systematic review will assess the evidence for key performance indicators (KPIs) in ECMO.Methods and analysisWe will search Ovid MEDLINE, Ovid EMBASE, Cumulative Index to Nursing and Allied Health Literature and the Cochrane Library including the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials and databases from the National Information Center of Health Services Research and Health Care Technology, for studies involving KPIs in ECMO. We will rate methodological quality using the Newcastle-Ottawa Quality Assessment Scale. Randomized controlled trials (RCTs) will be evaluated with the Cochrane Risk of Bias tool, and qualitative studies will be evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN checklist). Grey literature sources will be searched for technical reports, practice guidelines and conference proceedings. We will identify relevant organisations, industry leaders and non-profit organisations that represent key opinion leads in the use of ECMO. We will search the Agency of Healthcare Research and Quality National Quality Measures Clearinghouse for ECMO-related KPIs. Studies will be included if they contain quality measures that occur in critically ill patients and are associated with ECMO. The analysis will be primarily descriptive. Each KPI will be evaluated for importance, scientific acceptability, utility and feasibility using the four criteria proposed by the US Strategic Framework Board for a National Quality Measurement and Reporting System. Finally, KPIs will be evaluated for their potential operational characteristics, their potential to be integrated into electronic medical records and their affordability, if applicable.Ethics and disseminationEthical approval is not required as no primary data will be collected. Findings will be published in a peer-reviewed journal and presented at academic.PROSPERO registration number9 August 2022. CRD42022349910.

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Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Key performance indicators in extracorporeal membrane oxygenation (ECMO): protocol for a systematic review

Tisminetzky,

Nepomuceno,

Kung

et al. 2023

BMJ Open

Self Cite

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“…A subset of these patients continue to have refractory respiratory failure despite lung protective mechanical ventilation, prone positioning, and neuromuscular blockade, and thus require other modes of oxygenation [ 8 , 9 , 10 , 11 ]. Veno-venous (V-V) ECMO is an extracorporeal technique that provides oxygenation and removal of carbon dioxide from the blood via two large bore venous cannulae, a membrane oxygenator, and roller pumps, and has consequently been used as a rescue therapy in appropriate, critically ill patients [ 12 , 13 ]. However, it is an invasive support that brings significant risk of complications and challenges [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Inflammatory Biomarkers Affecting Survival Prognosis in Patients Receiving Veno-Venous ECMO for Severe COVID-19 Pneumonia

et al. 2023

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Severe COVID-19 pneumonia in which mechanical ventilation is unable to achieve adequate gas exchange can be treated with veno-venous ECMO, eliminating the need for aggressive mechanical ventilation which might promote ventilator-induced lung injury and increase mortality. In this retrospective observational study, 18 critically ill COVID-19 patients who were treated using V-V ECMO during an 11-month period in a tertiary COVID-19 hospital were analyzed. Biomarkers of inflammation and clinical features were compared between survivors and non-survivors. Survival rates were compared between patients receiving ECMO and propensity matched mechanically ventilated controls. There were 7 survivors and 11 non-survivors. The survivors were significantly younger, with a higher proportion of females, higher serum procalcitonin at ICU admission, and before initiation of ECMO they had significantly lower Murray scores, PaCO2, WBC counts, serum ferritin levels, and higher glomerular filtration rates. No significant difference in mortality was found between patients treated with ECMO compared to patients treated using conventional lung protective ventilation. Hypercapnia, leukocytosis, reduced glomerular filtration rate, and increased serum ferritin levels prior to initiation of V-V ECMO in patients with severe COVID-19 pneumonia may be early warning signs of reduced chance of survival. Further multicentric studies are needed to confirm these findings.

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“…2 ECMO has become an important supportive measure for severe cardiopulmonary failure and is widely used in adults and children. ECMO also plays an important role in supporting patients with severe coronavirus disease (COVID-19), 3,4 and can be said to give these patients a second life.…”

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confidence: 99%

Management of massive airway hemorrhage associated with extracorporeal membrane oxygenation: A retrospective case series study

Zhou

Shi

Guo

2023

Health Science Reports

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Background and Aims: Extracorporeal membrane oxygenation (ECMO) is an important means of treating patients with respiratory failure. Massive airway hemorrhage is a rare complication of ECMO, with high mortality. The aim of this study was to provide a reference for improving the success rate of treatment of this complication by analyzing and summarizing patient clinical data.Methods: We searched PubMed, Medline, and EMBASE databases for case reports of massive airway bleeding associated with ECMO from January 2000 to January 2022 and included one case treated at our facility. All patients were disconnected from the ventilator, and the endotracheal tube was clamped during treatment, resulting in complete airway packing for hemostasis. The clinical data of these patients were analyzed.Results: Through searching and further screening, two works of literature reported four cases that met our inclusion criteria. Including our patient's case, five patients were included in this study (four adults and one neonate). The longest ECMO treatment time before bleeding was 14 days, and the shortest was 20 min. In all patients, conservative treatment was ineffective after a major airway hemorrhage.They were disconnected from the ventilator and the tracheal tube was clamped for 13-72 h. The four adult patients underwent bronchial artery embolization in the interventional radiology suite. All patients' bleeding stopped after treatment; they were successfully weaned off ECMO and discharged. Conclusions: Treatment measures to disconnect the ventilator and clamp the endotracheal tube with full support from ECMO are feasible for massive airway bleeding associated with ECMO. Early bronchial arteriography and embolization can prevent rebleeding.

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Extracorporeal Membrane Oxygenation in COVID-19

Cited by 5 publications

References 75 publications

Key performance indicators in extracorporeal membrane oxygenation (ECMO): protocol for a systematic review

Key performance indicators in extracorporeal membrane oxygenation (ECMO): protocol for a systematic review

Inflammatory Biomarkers Affecting Survival Prognosis in Patients Receiving Veno-Venous ECMO for Severe COVID-19 Pneumonia

Management of massive airway hemorrhage associated with extracorporeal membrane oxygenation: A retrospective case series study

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