Management of Adult Patients Supported with Venovenous Extracorporeal Membrane Oxygenation (VV ECMO): Guideline from the Extracorporeal Life Support Organization (ELSO)

Tonna, Joseph E.; Abrams, Darryl; Brodie, Daniel; Greenwood, John C.; Mateo-Sidrón, Jose Alfonso Rubio; Usman, Asad; Fan, Eddy

doi:10.1097/mat.0000000000001432

Cited by 292 publications

(282 citation statements)

References 38 publications

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“…In our centre, in line with Extracorporeal Life Support Organization recommendations, prolonged mechanical ventilation is considered a relative contraindication for ECMO (>7 days), but we do not consider a specific time on mechanical ventilation as an absolute contraindication. 4 Data suggest that selected patients can benefit from ECMO even after prolonged periods of mechanical ventilation. 5 …”

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confidence: 99%

Cytokine adsorption and ECMO in patients with COVID-19 – Author's reply

Supady

2021

The Lancet Respiratory Medicine

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confidence: 99%

Cytokine adsorption and ECMO in patients with COVID-19 – Author's reply

Supady

2021

The Lancet Respiratory Medicine

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“…The reasons for conversion observed in this study were multifactorial and included inadequate drainage, inadequate perfusion and myocardial infarction followed by hypovolemic-, cardiogenic-and septic shock. As previously discussed, the cardiac involvement in COVID-19 has been highlighted in several studies although it is still partially underestimated in clinical practice as reflected by the recent guidelines [39].…”

Section: Discussionmentioning

confidence: 98%

Transition from Simple V-V to V-A and Hybrid ECMO Configurations in COVID-19 ARDS

et al. 2021

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In SARS-CoV-2 patients with severe acute respiratory distress syndrome (ARDS), Veno-Venous Extracorporeal Membrane Oxygenation (V-V ECMO) was shown to provide valuable treatment with reasonable survival in large multi-centre investigations. However, in some patients, conversion to modified ECMO support forms may be needed. In this single-centre retrospective registry, all consecutive patients receiving V-V ECMO between 1 March 2020 to 1 May 2021 were included and analysed. The patient cohort was divided into two groups: those who remained on V-V ECMO and those who required conversion to other modalities. Seventy-eight patients were included, with fourteen cases (18%) requiring conversions to veno-arterial (V-A) or hybrid ECMO. The reasons for the ECMO mode configuration change were inadequate drainage (35.7%), inadequate perfusion (14.3%), myocardial infarction (7.1%), hypovolemic shock (14.3%), cardiogenic shock (14.3%) and septic shock (7.1%). In multivariable analysis, the use of dobutamine (p = 0.007) and a shorter ICU duration (p = 0.047) predicted the conversion. The 30-day mortality was higher in converted patients (log-rank p = 0.029). Overall, only 19 patients (24.4%) survived to discharge or lung transplantation. Adverse events were more common after conversion and included renal, cardiovascular and ECMO-circuit complications. Conversion itself was not associated with mortality in the multivariable analysis. In conclusion, as many as 18% of patients undergoing V-V ECMO for COVID-19 ARDS may require conversion to advanced ECMO support.

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“…ECMO as a BTT was managed as recommended by the Extracorporeal Life Support Organization [15]. The indication for BTT was refractory hypoxemia, hypercarbia, or right heart failure despite optimal medical treatment in candidates for lung transplantation.…”

Section: Ecmo Protocolmentioning

confidence: 99%

“…The 41 patients successfully bridged to lung transplantation had a median bridging time of 13 days (IQR, [7][8][9][10][11][12][13][14][15][16][17][18][19]. Of these 41 patients, 21 (51.2%) required pre-transplant ECMO support for < 14 days (ST-BTT group) and 20 (48.8%) required for � 14 days (LT-BTT group) (Table 2).…”

Section: Comparison Of Variables Between the Short-and The Long-term Btt Groupsmentioning

confidence: 99%

“…The median bridging time in the BTT group was 13 days (interquartile range [IQR], 7-19 days). Although simplified acute physiologic score II was significantly higher in the BTT group (median, 35; IQR,(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)12; IQR,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) in non-BTT group; p<0.001), 1-year (73.2% vs. 80.6%; p = 0.361) and 5-year (61.5% vs. 61.5%; p = 0.765) post-transplant survival rates were comparable in both groups. Comparison of ST-and LT-BTT subgroups showed that 1-year (90.5% vs. 55.0%; p = 0.009) and 5-year (73.0% vs. 48.1%; p = 0.030) post-transplant survival rates were significantly higher in ST-BTT group.…”

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confidence: 99%

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Effects of the duration of bridge to lung transplantation with extracorporeal membrane oxygenation

Hong

Shim

et al. 2021

PLoS ONE

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Background Although bridge to lung transplantation (BTT) with extracorporeal membrane oxygenation (ECMO) is increasingly performed, the impact of BTT and its duration on post-transplant outcomes are unclear. Methods We retrospectively reviewed medical records of adult patients who underwent lung or heart-lung transplantation in our institution between January 2008 and December 2018. Data were compared in patients who did (n = 41; BTT) and did not (n = 36; non-BTT) require pre-transplant ECMO support. Data were also compared in patients who underwent short-term (<14 days; n = 21; ST-BTT) and long-term (≥14 days; n = 20; LT-BTT) BTTs. Results Among 77 patients included, 51 (66.2%) were male and median age was 53 years. The median bridging time in the BTT group was 13 days (interquartile range [IQR], 7–19 days). Although simplified acute physiologic score II was significantly higher in the BTT group (median, 35; IQR, 31–49 in BTT group vs. median, 12; IQR, 7–19 in non-BTT group; p<0.001), 1-year (73.2% vs. 80.6%; p = 0.361) and 5-year (61.5% vs. 61.5%; p = 0.765) post-transplant survival rates were comparable in both groups. Comparison of ST- and LT-BTT subgroups showed that 1-year (90.5% vs. 55.0%; p = 0.009) and 5-year (73.0% vs. 48.1%; p = 0.030) post-transplant survival rates were significantly higher in ST-BTT group. In age and sex adjusted model, the LT-BTT was an independent risk factor for 1-year post-transplant mortality (hazard ratio, 3.019; 95% confidence interval, 1.119–8.146; p = 0.029), whereas the ST-BTT was not. Conclusions Despite the severe illness, the BTT group showed favorable post-transplantation outcomes, particularly those bridged for less than 14 days.

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Management of Adult Patients Supported with Venovenous Extracorporeal Membrane Oxygenation (VV ECMO): Guideline from the Extracorporeal Life Support Organization (ELSO)

Cited by 292 publications

References 38 publications

Cytokine adsorption and ECMO in patients with COVID-19 – Author's reply

Cytokine adsorption and ECMO in patients with COVID-19 – Author's reply

Transition from Simple V-V to V-A and Hybrid ECMO Configurations in COVID-19 ARDS

Effects of the duration of bridge to lung transplantation with extracorporeal membrane oxygenation

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