Monitoring during extracorporeal membrane oxygenation

Douflé, Ghislaine; Ferguson, Niall D.

doi:10.1097/mcc.0000000000000309

Cited by 36 publications

(31 citation statements)

References 46 publications

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“…In contrast, acute myocarditis or myocardial infarction is associated with a noncompliant left ventricle and competent mitral valve. LV distension in this setting will result in a significant rise in intraventricular pressure and wall tension, which could be detrimental to the damaged myocardium, and reduced coronary blood flow, causing subendocardial myocardial ischemia [38]. Aortic regurgitation should always be kept into account in ECMO patients due to its potentially detrimental effects [39].…”

Section: Destination Of Va-ecmomentioning

confidence: 99%

Flow Optimization, Management, and Prevention of LV Distention during VA-ECMO

Amarelli¹,

Musumeci²,

Loforte³

et al. 2019

Advances in Extra-Corporeal Perfusion Therapies

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Cardiogenic shock (CS) still carries an unacceptably high mortality (30-60%), despite several therapeutic approaches; the SHOCK II trial questioned the benefit of intra-aortic balloon pump (IABP), while IMPRESS and CULPRIT-SHOCK trials confirmed heterogeneity in disease spectrum and patient selection for acute myocardial infarction-related CS requiring acute mechanical circulatory support (AMCS). The heterogeneity of devices employed as AMCS, including temporary micro-axial flow pumps (Impella), percutaneous bypass (TandemHeart), and extracorporeal life support (VA-ECMO), contributed to the actual dramatic scenario, where CS is defined clinically rather than hemodynamically. To date, the role of VA-ECMO is emerging as rapid strategy to mitigate mortality rates of severe refractory states, despite the lack of data regarding the best practices of management and flows control. VA-ECMO's flow represents the "dose" of treatment and higher flows are less tolerated percutaneously requiring, to prevent deleterious pulmonary edema and ventricular distention, additional approaches such as pulmonary, left atrial, or left ventricular unloading. Any efforts have to be directed to (1) determine adequate management of patients on VA-ECMO, (2) define the safer duration of VA-ECMO support, and (3) establish algorithms and techniques to predict and obtain stable weaning from ECMO or ensure fast transition to durable VAD and/or heart transplant.

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Section: Destination Of Va-ecmomentioning

confidence: 99%

Flow Optimization, Management, and Prevention of LV Distention during VA-ECMO

Amarelli¹,

Musumeci²,

Loforte³

et al. 2019

Advances in Extra-Corporeal Perfusion Therapies

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“…It is not unusual for depressed right ventricular function to improve after institution of VV-ECMO. Trans-esophageal echocardiography (TEE) assessment of the re-infusion cannula is helpful, the recommended position of the tip is in the RA just beyond the SVC/RA junction, a safe distance away from the intra-atrial septum and the tricuspid valve (8).…”

Section: Veno-venous Ecmomentioning

confidence: 99%

“…Monitoring of patients on ECMO has recently been expertly reviewed, with particular emphasis on the importance of echocardiography for cannula positioning (8). Arterial lines are best placed in the right arm to measure pressure and P a O 2 downstream from the right brachiocephalic artery, which correlates most closely with conditions in the right carotid artery and coronary arteries.…”

Section: Planning Thoracic Surgery Procedures With Ecls Supportmentioning

confidence: 99%

“…There is potential for the PA catheter balloon to be aspirated into and occlude drainage cannulae. Consideration should be given to cerebral saturation monitoring with near-infrared spectroscopy, as an indicator of cerebral hypoxia (8,90). In a short retrospective case series using this monitor, Wong et al found a 100% rate of cerebral desaturation on initiation of ECMO, 80% of which were reversible with changes in hemodynamic management (90).…”

Section: Planning Thoracic Surgery Procedures With Ecls Supportmentioning

confidence: 99%

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Principles and indications of extracorporeal life support in general thoracic surgery

McRae¹,

Perrot²

2018

J. Thorac. Dis.

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The role of extracorporeal life support (ECLS) has expanded rapidly over the past 15 years to become an important tool in advanced general thoracic surgery practice. Intra-operative and in some cases continued post-operative ECLS is redefining the scope of complex surgical care. ECLS encompasses a spectrum of temporary mechanical support that may remove CO 2 , oxygenate or provide hemodynamic support or a combination thereof. The most common modalities used in general thoracic surgery include extracorporeal membrane oxygenation (ECMO), interventional lung assist device (iLA ® Novalung ® , Heilbronn, Germany), and extracorporeal CO 2 removal (ECCO 2 R). The ECMO and Novalung ® devices can be used in different modes for the short term or long-term support depending on the situation. In this review, the principles and current applications of ECLS in general thoracic surgery are presented.

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“…This is a report of the initial experience at the first ECMO center in Lebanon; the course of five patients is described, focusing on the monitoring considerations. 1–4 Lessons learnt help improve patient ECMO care, safety, and outcome. Methods: Two adult cases treated with veno-arterial (VA) ECMO for refractory cardiac failure, and three neonates (two veno-arterial and one veno-venous (VV) ECMO) treated for refractory respiratory failure were retrospectively reviewed with special focus on both medical and mechanical complications.…”

mentioning

confidence: 99%