Management benefits and safety of computed tomography in patients undergoing extracorporeal membrane oxygenation therapy: experience of a single centre

Jepson, S. L.; Harvey, Chris J.; Entwisle, James; Peek, Giles J.

doi:10.1016/j.crad.2010.05.007

Cited by 19 publications

(11 citation statements)

References 13 publications

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“…The use of portable miniaturized ECMO systems was also useful for safe intrahospital transportation at our institution for CT scan. Jepson et al [23] demonstrated that with an experienced team, CT imaging of patients on ECMO can be performed safely, providing valuable information for subsequent management of patients. Recently, several ECMO centers also reported the feasibility of interhospital transfer on ECMO for patients with H1N1 [7,24,25].…”

Section: Discussionmentioning

confidence: 98%

Portable miniaturized extracorporeal membrane oxygenation systems for H1N1-related severe acute respiratory distress syndrome: A case series

Roncon‐Albuquerque

Basílio

Figueiredo

et al. 2012

Journal of Critical Care

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Section: Discussionmentioning

confidence: 98%

Portable miniaturized extracorporeal membrane oxygenation systems for H1N1-related severe acute respiratory distress syndrome: A case series

Roncon‐Albuquerque

Basílio

Figueiredo

et al. 2012

Journal of Critical Care

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“…The potential clinical benefit of reducing in-hospital transport for diagnostic radiology, it can be particularly relevant in patients with ECMO. In these patients, in fact, transportation requires time and a significant commitment of resources, although it was proved feasible both for in-hospital [32,33] and for inter-hospital long distance transportations [34,35]. …”

Section: Discussionmentioning

confidence: 99%

Ventilatory and ECMO treatment of H1N1-induced severe respiratory failure: results of an Italian referral ECMO center

et al. 2011

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BackgroundSince the first outbreak of a respiratory illness caused by H1N1 virus in Mexico, several reports have described the need of intensive care or extracorporeal membrane oxygenation (ECMO) assistance in young and often healthy patients. Here we describe our experience in H1N1-induced ARDS using both ventilation strategy and ECMO assistance.MethodsFollowing Italian Ministry of Health instructions, an Emergency Service was established at the Careggi Teaching Hospital (Florence, Italy) for the novel pandemic influenza. From Sept 09 to Jan 10, all patients admitted to our Intensive Care Unit (ICU) of the Emergency Department with ARDS due to H1N1 infection were studied. All ECMO treatments were veno-venous. H1N1 infection was confirmed by PCR assayed on pharyngeal swab, subglottic aspiration and bronchoalveolar lavage. Lung pathology was evaluated daily by lung ultrasound (LUS) examination.ResultsA total of 12 patients were studied: 7 underwent ECMO treatment, and 5 responded to protective mechanical ventilation. Two patients had co-infection by Legionella Pneumophila. One woman was pregnant. In our series, PCR from bronchoalveolar lavage had a 100% sensitivity compared to 75% from pharyngeal swab samples. The routine use of LUS limited the number of chest X-ray examinations and decreased transportation to radiology for CT-scan, increasing patient safety and avoiding the transitory disconnection from ventilator. No major complications occurred during ECMO treatments. In three cases, bleeding from vascular access sites due to heparin infusion required blood transfusions. Overall mortality rate was 8.3%.ConclusionsIn our experience, early ECMO assistance resulted safe and feasible, considering the life threatening condition, in H1N1-induced ARDS. Lung ultrasound is an effective mean for daily assessment of ARDS patients.

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“…A differentiation is made between technical and patient-related systemic complications in the case of the following additional risks [9,20].…”

Section: Systemic Reaction To Extracorporeal Surfacesmentioning

confidence: 99%

“…Bleeding complications are the most common complications during ECMO/ECLS therapy [9,11,15]. The causes have a multifactorial genesis.…”

Section: Bleedingmentioning

confidence: 99%

“…A reduction of the ECLS flow of the pump or a complete pause by the cardiac technician can help to prevent arterial contrast enhancement phenomena [9,18,25] provided that the clinical condition of the patient will allow this for the duration of the examination. Alternatively, it is possible to inject the intravascular contrast agent directly into the arterial ECLS cannula connected to the membrane oxygenator.…”

Section: Arterial Pseudomembranementioning

confidence: 99%

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Extrakorporale Membranoxygenierung bei Erwachsenen – Varianten, Komplikationen unter Therapie und die Rolle der radiologischen Diagnostik

Beck¹,

Burg²,

Heindel³

et al. 2016

Fortschr Röntgenstr

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ABSTR ACTBackground Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) as respiratory and circulatory assist therapies are gaining in importance in the treatment of critically ill patients. Depending on the place of cannulation -veno-venous for ECMO and veno-arterial for ECLS -distinct changes in hemodynamics will occur. In this review we describe the different types of ECMO and ECLS systems, the typical cannula placement and frequent complications under therapy. The most suitable imaging modalities will be presented and typical hemodynamic pitfalls in contrast-enhanced computed tomography or angiography will be elucidated. MethodsThe review is based on a literature search in PubMed with the terms "ECMO" and/or "ECLS" and/or "extracorporeal life support" and/or "imaging" and/or "complications". Statistical data was taken from the ECMO register of the "Extracorporeal Life Support Organization (ELSO)".Results Critical illness-and therapy-associated complications are common so that imaging, particularly computed tomography, becomes increasingly important. Following veno-venous cannulation in ECMO, the normal sequential blood flow is preserved, so that no contrast enhancement irregularities should be expected when the right timing and an adequate amount of contrast agent are selected. After veno-arterial cannulation in ECLS, different artifacts like pseudo-filling defects, pseudomembranes and irregular/low contrast enhancement of heart and pulmonary vessels can be found, depending on the site of cannulation and the residual cardiac function.Key points ▪ Cannula placement is usually documented by radiography. This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

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Management benefits and safety of computed tomography in patients undergoing extracorporeal membrane oxygenation therapy: experience of a single centre

Cited by 19 publications

References 13 publications

Portable miniaturized extracorporeal membrane oxygenation systems for H1N1-related severe acute respiratory distress syndrome: A case series

Portable miniaturized extracorporeal membrane oxygenation systems for H1N1-related severe acute respiratory distress syndrome: A case series

Ventilatory and ECMO treatment of H1N1-induced severe respiratory failure: results of an Italian referral ECMO center

Extrakorporale Membranoxygenierung bei Erwachsenen – Varianten, Komplikationen unter Therapie und die Rolle der radiologischen Diagnostik

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