Monitoring of adult patient on venoarterial extracorporeal membrane oxygenation in intensive care medicine

Merkle, Julia; Azizov, Farid; Fatullayev, Javid; Weber, Carolyn; Maier, Janina; Eghbalzadeh, Kaveh; Sabashnikov, Anton; Pfister, Roman; Wahlers, Thorsten; Michels, Guido

doi:10.21037/jtd.2018.10.29

Cited by 14 publications

(8 citation statements)

References 26 publications

(35 reference statements)

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“…Although we did not routinely use Swan-Ganz catheters in the past, it might be a promising tool to invasively evaluate LV preload (pulmonary capillary wedge pressure) and RV afterload (mean pulmonary artery pressure) during weaning [57,58]. Issues remain the unreliability of the acquired parameters due to the presence of suction applied by the venous ECMO cannula, which might be negligible at a VA-ECMO flow at 1.5 L/min [5].…”

Section: Va-ecmo Weaning-university Of Munich Cardiologic Icu Weanimentioning

confidence: 99%

Update on Weaning from Veno-Arterial Extracorporeal Membrane Oxygenation

Lüsebrink

Stremmel

Stark

et al. 2020

JCM

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Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides temporary cardiac and respiratory support and has emerged as an established salvage intervention for patients with hemodynamic compromise or shock. It is thereby used as a bridge to recovery, bridge to permanent ventricular assist devices, bridge to transplantation, or bridge to decision. However, weaning from VA-ECMO differs between centers, and information about standardized weaning protocols are rare. Given the high mortality of patients undergoing VA-ECMO treatment, it is all the more important to answer the many questions still remaining unresolved in this field Standardized algorithms are recommended to optimize the weaning process and determine whether the VA-ECMO can be safely removed. Successful weaning as a multifactorial process requires sufficient recovery of myocardial and end-organ function. The patient should be considered hemodynamically stable, although left ventricular function often remains impaired during and after weaning. Echocardiographic and invasive hemodynamic monitoring seem to be indispensable when evaluating biventricular recovery and in determining whether the VA-ECMO can be weaned successfully or not, whereas cardiac biomarkers may not be useful in stratifying those who will recover. This review summarizes the strategies of weaning of VA-ECMO and discusses predictors of successful and poor weaning outcome.

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Section: Va-ecmo Weaning-university Of Munich Cardiologic Icu Weanimentioning

confidence: 99%

Update on Weaning from Veno-Arterial Extracorporeal Membrane Oxygenation

Lüsebrink

Stremmel

Stark

et al. 2020

JCM

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“…Likewise, parameters such as mixed venous oxygen saturation were commonly used on intensive care units [ 8 ]. However, they cannot accurately determine tissue hypoxia.…”

Section: Discussionmentioning

confidence: 99%

“…Tissue microdialysis was not conducted due to its invasiveness and costs. Main characteristics, criteria and technique of vaECMO assistance in neonatal and pediatric patients have been published in detail in previous studies [7][8][9][10][11]. Target activated clotting time was 160-180 s, whereas activated partial thromboplastin time (aPTT) was maintained by 60-80 s., based on daily controls if there was no active bleeding tendency.…”

Section: Methodsmentioning

confidence: 99%

Impact of Lactate Clearance on Early Outcomes in Pediatric ECMO Patients

et al. 2021

Self Cite

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Background and Objectives: Pediatric extracorporeal membrane oxygenation (ECMO) support is often the ultimate therapy for neonatal and pediatric patients with congenital heart defects after cardiac surgery. The impact of lactate clearance in pediatric patients during ECMO therapy on outcomes has been analyzed. Materials andMethods: We retrospectively analyzed data from 41 pediatric vaECMO patients between January 2006 and December 2016. Blood lactate and lactate clearance have been recorded prior to ECMO implantation and 3, 6, 9 and 12 h after ECMO start. Receiver operating characteristic (ROC) analysis was used to identify cut-off levels for lactate clearance. Results: Lactate levels prior to ECMO therapy (9.8 mmol/L vs. 13.5 mmol/L; p = 0.07) and peak lactate levels during ECMO support (10.4 mmol/L vs. 14.7 mmol/L; p = 0.07) were similar between survivors and nonsurvivors. Areas under the curve (AUC) of lactate clearance at 3, 9 h and 12 h after ECMO start were significantly predictive for mortality (p = 0.017, p = 0.049 and p = 0.006, respectively). Cut-off values of lactate clearance were 3.8%, 51% and 56%. Duration of ECMO support and respiratory ventilation was significantly longer in survivors than in nonsurvivors (p = 0.01 and p < 0.001, respectively). Conclusions: Dynamic recording of lactate clearance after ECMO start is a valuable tool to assess outcomes and effectiveness of ECMO application. Poor lactate clearance during ECMO therapy in pediatric patients is a significant marker for higher mortality.

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“…Emerging technologies are increasingly being used to monitor CS patients who are receiving MCS and this may become routine in the future. 21…”

Section: General Principlesmentioning

confidence: 99%

Intensive Care Management of the Cardiogenic Shock Patient

Uddin

Anandanadesan

Trimlett

et al. 2022

US Cardiology Review

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Optimal management of patients with cardiogenic shock requires a detailed and systematic assessment of all organ systems, balancing the risks and benefits of any investigation and intervention, while avoiding the complications of critical illness. Overall prognosis depends upon a number of factors, including that of the underlying cardiac disease and its potential reversibility, the severity of shock, the involvement of other organ systems, the age of the patient and comorbidities. As with all intensive care patients, the mainstay of management is supportive, up to and including implementation and management of a number of devices, including acute mechanical circulatory support. The assessment and management of these most critically ill patients therefore demands in-depth knowledge and skill relating to cardiac intensive care, extending well beyond standard intensive care or cardiology practice.

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Monitoring of adult patient on venoarterial extracorporeal membrane oxygenation in intensive care medicine

Cited by 14 publications

References 26 publications

Update on Weaning from Veno-Arterial Extracorporeal Membrane Oxygenation

Update on Weaning from Veno-Arterial Extracorporeal Membrane Oxygenation

Impact of Lactate Clearance on Early Outcomes in Pediatric ECMO Patients

Intensive Care Management of the Cardiogenic Shock Patient

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