Long-term neurocognitive outcome is not worsened by of the use of venovenous ECMO in severe ARDS patients

Sylvestre, Aude; Adda, Mélanie; Maltese, François; Lannelongue, Ariane; Daviet, Florence; Parzy, Gabriel; Coiffard, Benjamin; Roch, Antoine; Loundou, Anderson; Baumstarck, Karine; Papazian, Laurent

doi:10.1186/s13613-019-0556-1

Cited by 35 publications

(48 citation statements)

References 39 publications

(49 reference statements)

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“…The most frequent risk factors for CMV and HSV reactivation in the ICU are patients severity, sepsis, prolonged MV [14], high-dose corticosteroid therapy, acute renal failure or massive transfusion [15], with a strong association for MV and sepsis [16]. Patients under veno-venous extracorporeal membrane oxygenation (VV ECMO) for severe ARDS [17] often combine several or all of these risk factors [18]. Despite the uncertainties regarding the exact role of Herpesviridae reactivation in immunocompetent critically ill patients, it might add to the pulmonary pathology in patients with ARDS.…”

Section: Introductionmentioning

confidence: 99%

Herpes simplex virus and Cytomegalovirus reactivation among severe ARDS patients under veno-venous ECMO

Hraiech

Bonnardel²,

Guervilly

et al. 2019

Ann. Intensive Care

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Background: Herpesviridae reactivation among non-immunocompromised critically ill patients is associated with impaired prognosis, especially during acute respiratory distress syndrome (ARDS). However, little is known about herpes simplex virus (HSV) and Cytomegalovirus (CMV) reactivation occurring in patients with severe ARDS under veno-venous extracorporeal membrane oxygenation (ECMO). We tried to determine the frequency of Herpesviridae reactivation and its impact on patients' prognosis during ECMO for severe ARDS.Results: During a 5-year period, 123 non-immunocompromised patients with a severe ARDS requiring a venovenous ECMO were included. Sixty-seven patients (54%) experienced HSV and/or CMV reactivation during ECMO course (20 viral co-infection, 40 HSV alone, and 7 CMV alone). HSV reactivation occurred earlier than CMV after the beginning of MV [(6-15) vs. 19 (13-29) days; p < 0.01] and after ECMO implementation [(2-8) vs. 14 (10-20) days; p < 0.01]. In univariate analysis, HSV/CMV reactivation was associated with a longer duration of mechanical ventilation [(22-52.5) vs. 17.5 (9-28) days; p < 0.01], a longer duration of .5) vs. 9 (5-14) days; p < 0.01], and a prolonged .5) vs. 16 (9-30) days; p < 0.01] and hospital stay [44 (29-63.5) vs. 24 (11-43) days; p < 0.01] as compared to non-reactivated patients. However, in multivariate analysis, viral reactivation remained associated with prolonged MV only. When considered separately, both HSV and CMV reactivation were associated with a longer duration of MV as compared to non-reactivation patients [29 (19.5-41) and 28 (20.5-37), respectively, vs. 17.5 (9-28) days; p < 0.05]. Co-reactivation patients had a longer duration of .3); p < 0.05] and ICU stay [51.5 (32.5-69) vs. 27.5 (17.75-35.5) and 29 (20-30.5), respectively] as compared to patients with HSV or CMV reactivation alone. In multivariate analysis, HSV reactivation remained independently associated with a longer duration of MV and hospital length of stay. Conclusions:Herpesviridae reactivation is frequent among patients with severe ARDS under veno-venous ECMO and is associated with a longer duration of mechanical ventilation. The direct causative link between HSV and CMV reactivation and respiratory function worsening under ECMO remains to be confirmed.

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Section: Introductionmentioning

confidence: 99%

Herpes simplex virus and Cytomegalovirus reactivation among severe ARDS patients under veno-venous ECMO

Hraiech

Bonnardel²,

Guervilly

et al. 2019

Ann. Intensive Care

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“…Post-intensive care syndrome is a described phenomenon in critically ill patients [ 65 ], and the neuropsychological impact of critical illness is also seen in ECMO patients with or without overt neurologic injury. Although their 36-Item Short Form Survey psychological domain is comparable to the general population [ 66 ], studies have identified that patients surviving to 6-month follow-up or longer have persistent emotional and mental health difficulties [ 61 , 66 – 68 , 69 •, 70 ]: depression (20–42%), anxiety (20–55%), and post-traumatic stress (PTS) symptoms (5–47%). The rates of psychological sequelae are unrelated to the duration of ECMO or length of follow-up [ 61 , 67 ].…”

Section: Neurocognitive Outcomes Following Ecmomentioning

confidence: 99%

Evaluation, Treatment, and Impact of Neurologic Injury in Adult Patients on Extracorporeal Membrane Oxygenation: a Review

Illum¹,

Odish²,

Minokadeh³

et al. 2021

Curr Treat Options Neurol

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Purpose Extracorporeal membrane oxygen (ECMO) is increasingly used as an advanced form of life support for cardiac and respiratory failure. Unfortunately, in infrequent instances, circulatory and/or respiratory recovery is overshadowed by neurologic injury that can occur in patients who require ECMO. As such, knowledge of ECMO and its implications on diagnosis and treatment of neurologic injuries is indispensable for intensivists and neurospecialists. Recent findingsThe most common neurologic injuries include intracerebral hemorrhage, ischemic stroke, seizure, cerebral edema, intracranial hypertension, global cerebral hypoxia/anoxia, and brain death. These result from events prior to initiation of ECMO, failure of ECMO to provide adequate oxygen delivery, and/or complications that occur during ECMO. ECMO survivors also experience neurological and psychological sequelae similar to other survivors of critical illness. Summary Since many of the risk factors for neurologic injury cannot be easily mitigated, early diagnosis and intervention are crucial to limit morbidity and mortality from neurologic injury during ECMO.

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“…The use of extracorporeal circulation (ECC), such as cardiopulmonary bypass (CPB) and veno‐arterial extracorporeal membrane oxygenation (V‐A ECMO), can be life‐saving because it provides appropriate oxygen delivery and blood flow rates to principal organs 1,2 . More recently, veno‐venous extracorporeal membrane oxygenation (V‐V ECMO) is commonly being used in the world to support patients with severe respiratory failure 3‐6 . However, V‐V ECMO is a new technology compared to V‐A ECMO and cardiopulmonary bypass, and there are few reports of basic research.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 More recently, venovenous extracorporeal membrane oxygenation (V-V ECMO) is commonly being used in the world to support patients with severe respiratory failure. [3][4][5][6] However, V-V ECMO is a new technology compared to V-A ECMO and cardiopulmonary bypass, and there are few reports of basic research. In particular, there is no basic research on biological reactions in V-V ECMO, despite the fact that V-V ECMO is traumatic to blood constituents and is an unphysiological condition.…”

Section: Introductionmentioning

confidence: 99%

Establishment of a novel miniature veno‐venous extracorporeal membrane oxygenation model in the rat

2020

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Recently, veno‐venous extracorporeal membrane oxygenation (V‐V ECMO) has been commonly used in the world to support patients with severe respiratory failure. However, V‐V ECMO is a new technology compared to veno‐arterial extracorporeal membrane oxygenation and cardiopulmonary bypass, and there are few reports of basic research. Although continuing research is desired, clinical research that standardizes conditions such as patients’ background characteristics is difficult. The purpose of this study was to establish a simple and stably maintainable miniature V‐V ECMO model to study the mechanisms of the biological reactions in circulation during V‐V ECMO. The V‐V ECMO system consisted of an original miniature membrane oxygenator, polyvinyl chloride tubing line, and roller pump. The priming volume of this system was only 8 mL. Polyethylene tubing was used to cannulate the right femoral vein as the venous return cannula for the V‐V ECMO system. A 16‐G cannula was passed through the right internal jugular vein and advanced into the right atrium as the conduit for venous uptake. The animals were divided into 2 groups: SHAM group and V‐V ECMO group. V‐V ECMO was initiated and maintained at 50‐60 mL/kg/min, and oxygen was added into the oxygenator during V‐V ECMO at a concentration of 100% (pump flow:oxygen = 1:10). Blood pressure was measured continuously, and blood cells were measured by blood collection. During V‐V ECMO, the blood pressure and hemodilution rate were maintained around 80 mm Hg and 20%, respectively. Hb was kept at >10 g/dL, and V‐V ECMO could be maintained without blood transfusion. It was possible to confirm oxygenation of and carbon dioxide removal from the blood. Likewise, the pH was adequately maintained. There were no problems with this miniature V‐V ECMO system, and extracorporeal circulation progressed safely. In this study, a novel miniature V‐V ECMO model was established in the rat. A miniature V‐V ECMO model appears to be very useful for studying the mechanisms of the biological reactions during V‐V ECMO and to perform basic studies of circulation assist devices.

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Long-term neurocognitive outcome is not worsened by of the use of venovenous ECMO in severe ARDS patients

Cited by 35 publications

References 39 publications

Herpes simplex virus and Cytomegalovirus reactivation among severe ARDS patients under veno-venous ECMO

Herpes simplex virus and Cytomegalovirus reactivation among severe ARDS patients under veno-venous ECMO

Evaluation, Treatment, and Impact of Neurologic Injury in Adult Patients on Extracorporeal Membrane Oxygenation: a Review

Establishment of a novel miniature veno‐venous extracorporeal membrane oxygenation model in the rat

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