How I wean patients from veno-venous extra-corporeal membrane oxygenation

Vasques, Francesco; Romitti, Federica; Gattinoni, Luciano; Camporota, Luigi

doi:10.1186/s13054-019-2592-5

Cited by 51 publications

(48 citation statements)

References 6 publications

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“…This study demonstrated that there is a substantial hospital mortality after weaning from postcardiotomy VA-ECMO and most of these patients die during the first five days after discontinuation of VA-ECMO therapy (Figure 2). In the absence of a standardized VA-ECMO weaning protocol [8], the present results suggest that treatment strategies at the time of discontinuation of this salvage therapy should be improved. In particular, there is a need for objective parameters indicating when and how to intervene to improve the cardiopulmonary and metabolic status of these critically ill patients and thereby to optimize the timing of weaning from VA-ECMO.…”

Section: Discussionmentioning

confidence: 82%

Prognostic Significance of Arterial Lactate Levels at Weaning from Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation

Biancari

Fiore

Jónsson

et al. 2019

JCM

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Background: The outcome after weaning from postcardiotomy venoarterial extracorporeal membrane oxygenation (VA-ECMO) is poor. In this study, we investigated the prognostic impact of arterial lactate levels at the time of weaning from postcardiotomy VA. Methods: This analysis included 338 patients from the multicenter PC-ECMO registry with available data on arterial lactate levels at weaning from VA-ECMO. Results: Arterial lactate levels at weaning from VA-ECMO (adjusted OR 1.426, 95%CI 1.157-1.758) was an independent predictor of hospital mortality, and its best cutoff values was 1.6 mmol/L (<1.6 mmol/L, 26.2% vs. ≥ 1.6 mmol/L, 45.0%; adjusted OR 2.489, 95%CI 1.374-4.505). When 261 patients with arterial lactate at VA-ECMO weaning ≤2.0 mmol/L were analyzed, a cutoff of arterial lactate of 1.4 mmol/L for prediction of hospital mortality was identified (<1.4 mmol/L, 24.2% vs. ≥1.4 mmol/L, 38.5%, p = 0.014). Among 87 propensity score-matched pairs, hospital mortality was significantly higher in patients with arterial lactate ≥1.4 mmol/L (39.1% vs. 23.0%, p = 0.029) compared to those with lower arterial lactate. Conclusions: Increased arterial lactate levels at the time of weaning from postcardiotomy VA-ECMO increases significantly the risk of hospital mortality. Arterial lactate may be useful in guiding optimal timing of VA-ECMO weaning.

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Section: Discussionmentioning

confidence: 82%

Prognostic Significance of Arterial Lactate Levels at Weaning from Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation

Biancari

Fiore

Jónsson

et al. 2019

JCM

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“…The natural history of COVID-19 pneumonia and the median time to resolution are currently unknown. All ECMO centres should have standardised ECMO weaning protocols, 48,49 and team members should be trained accordingly. A successful weaning trial should be accompanied by decannulation, and further rehabilitation should follow strict infection control measures with use of PPE or PAPR.…”

Section: Ecmo Weaning Decannulation and Rehabilitation Essential Elmentioning

confidence: 99%

Planning and provision of ECMO services for severe ARDS during the COVID-19 pandemic and other outbreaks of emerging infectious diseases

Ramanathan

Antognini

Combes

et al. 2020

The Lancet Respiratory Medicine

493

470

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“…Criteria for decannulation from VV-ECMO in this cohort included maintained fractional inspired oxygen < 0.5 and non-injurious ventilatory effort, with ECMO sweep gas turned off for at least 24 hours. The full protocol of weaning from VV-ECMO is described and available (23).…”

Section: Patientsmentioning

confidence: 99%

Veno-venous extracorporeal membrane oxygenation in coronavirus disease 2019: a case series

et al. 2020

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RationaleThe use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) in severe hypoxaemic respiratory failure from Coronavirus disease 2019 (COVID-19) has been described, but reported utilisation and outcomes are variable, and detailed information on patient characteristics is lacking. We aim to report clinical characteristics, management, and outcomes of COVID-19 patients requiring VV-ECMO, admitted over 2 months to a high-volume UK centre.MethodsPatient information, including baseline characteristics and clinical parameters, was collected retrospectively from electronic health records for COVID-19 VV-ECMO admissions between 3rd March and 2nd May 2020. Clinical management is described. Data are reported for survivors and non-survivors.ResultsWe describe 43 consecutive patients with COVID-19 who received VV-ECMO. Median age was 46 years [IQR 35.5–52.5], 76.7% were male. Median time from symptom onset to VV-ECMO was 14 days [IQR 11–17.5]. All patients underwent computed tomography imaging, finding extensive pulmonary consolidation in 95.3%, and pulmonary embolus in 27.9%. 79.1% received immunomodulation with methylprednisolone for persistent maladaptive hyperinflammatory state. Vasopressors were used in 86%, and 44.2% received renal replacement therapy. Median duration on VV-ECMO was 13 days [IQR 8–20]. Fourteen patients died (32.6%) and 29 survived (67.4%) to hospital discharge. Non-survivors had significantly higher d-dimer (38.2 versus 9.5 mg·L−1, Fibrinogen Equivalent Units; p=0.035) and creatinine (169 versus 73 umol·L−1; p=0.022) at commencement of ECMO.ConclusionsOur data supports the use of VV-ECMO in selected COVID-19 patients. The cohort was characterised by high degree of alveolar consolidation, systemic inflammation, and intravascular thrombosis.

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How I wean patients from veno-venous extra-corporeal membrane oxygenation

Cited by 51 publications

References 6 publications

Prognostic Significance of Arterial Lactate Levels at Weaning from Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation

Prognostic Significance of Arterial Lactate Levels at Weaning from Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation

Planning and provision of ECMO services for severe ARDS during the COVID-19 pandemic and other outbreaks of emerging infectious diseases

Veno-venous extracorporeal membrane oxygenation in coronavirus disease 2019: a case series

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