Nosocomial Infections in Adult Cardiogenic Shock Patients Supported by Venoarterial Extracorporeal Membrane Oxygenation

Schmidt, Matthieu; Bréchot, Nicolas; Hariri, Sarah; Guiguet, Marguerite; Luyt, Charles Edouard; Makri, Ralouka; Leprince, Pascal; Trouillet, Jean‐Louis; Pavie, Alain; Chastre, Jean; Combes, Alain

doi:10.1093/cid/cis783

Cited by 246 publications

(284 citation statements)

References 38 publications

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“…Rizik od infekcije povećava se trajanjem potpore ECMO-om zbog prisutnosti intravaskularnih kanila, a teško stanje bolesnika, kojemu je najčešće potrebna dugotrajna potpora, dodatno povećava ovaj rizik 38 .…”

Section: Complications Related To the Patientunclassified

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Extracorporeal Membrane Oxygenation in Adults

Bačić

Tomulić

Medved

et al. 2017

Cardiologia Croatica

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SAŽETAK: Izvantjelesna membranska oksigenacija (engl. Extracorporeal Membrane Oxygenation, ECMO) postupak je izvantjelesne mehaničke cirkulacijske ili respiracijske potpore koji se primjenjuje primarno u bolesnika sa životno ugrožavajućim oblicima zatajivanja rada srca ili pluća. Dva su osnovna oblika ECMO potpore: vensko-venski (V-V) i vensko-arterijski (V-A) ECMO. V-V ECMO osigurava funkciju izmjene plinova u krvi i primjenjuje se u slučaju teške reverzibilne respiracijske insuficijencije. V-A ECMO podržava funkciju rada srca i pluća, a, osim pri reverzibilnim oblicima oštećenja srčane funkcije, može se rabiti i pri njezinu ireverzibilnom oštećenju, kao premoštenje do transplantacije srca ili ugradnje uređaja za mehaničku cirkulacijsku potporu. ECMO je invazivan i tehnički složen postupak koji se obavlja u kritično bolesnih pa stoga nosi visok rizik od pojave komplikacija. Rezultati liječe-nja ECMO-om razlikuju se ovisno o indikaciji za sam postupak. Bolesnici u kojih je ECMO primijenjen radi respiracijske potpore imaju bolje ishode u usporedbi s onima s kardiogenim šokom ili zastojem srca. Iako nedostaju dokazi temeljeni na velikim randomiziranim studijama koji bi poduprli njegovu primjenu, ECMO je u kliničkoj praksi spasonosna metoda liječenja u dobro odabranih, kritičnih bolesnika. SUMMARY:Extracorporeal membrane oxygenation (ECMO) is a procedure that provides extracorporeal mechanical circulatory or respiratory support and is used primarily in patients with life-threatening forms of heart or respiratory failure. There are two basic types of ECMO support: veno-venous (VV) and veno-arterial (VA) ECMO. VV ECMO ensures blood gas exchange and is applied in cases of severe reversible respiratory insufficiency. VA ECMO supports the function of the heart and lungs; other than in reversible forms of damaged heart function, it can also be used in irreversible forms of heart failure as a bridge to heart transplantation or to the implantation of mechanical circulatory support device. ECMO is an invasive and technically complex procedure that is performed in critically ill patients and thus has a high risk of complications. Results of ECMO treatment vary depending on the indications for the procedure itself. Patients in whom ECMO was applied for respiratory support show better outcomes compared with those with cardiogenic shock or cardiac arrest. Despite a lack of evidence based on large randomized studies to support its application, in clinical practice ECMO represents a life-saving method of treatment in well-selected critical patients.KLJUČNE RIJEČI: izvantjelesna membranska oksigenacija, kardiogeni šok, respiracijska insuficijencija.

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Section: Complications Related To the Patientunclassified

“…The risk of infection rises with the duration of ECMO support due to the presence of intravascular cannulae, and the critical condition of patients who most commonly need long-term support further exacerbates this risk 38 .…”

Section: Rezultati Liječenjamentioning

confidence: 99%

Extracorporeal Membrane Oxygenation in Adults

Bačić

Tomulić

Medved

et al. 2017

Cardiologia Croatica

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“…The multiple punctate hemorrhages are typical of ECMO related CNS injury [6,7]. There are several trials reporting the incidence of nosocomial infection as high as 64% while on ECMO support [8], but fortunately we had sent every alternate day blood cultures, which were sterile.…”

Section: Citationmentioning

confidence: 99%

VA-ECMO in Landouzy Sepsis or Tubercular Septic Shock

2017

JACCOA

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Landouzy-Sepsis (Sepsis tuberculosa acutissima) is a rare presentation of disseminated tuberculosis as shock and multi-organ failure. The condition if not treated promptly causes rapid death in an immunocompromised patient. We report one such case with refractory shock, ARDS, renal failure and liver dysfunction treated with peri-arrest VA-ECMO at our centre. The use of VA-ECMO have been explained in several scenarios for maintaining oxygenation and perfusion in cases of irreversible cardio-respiratory failure. In a developing country like ours, cost of initiating ECMO support has to be contemplated. We were successful in convincing the family to consent for the procedure and we initiated VA-ECMO on this patient after proper counseling of the family regarding possible outcome.

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“…ECMO support may also cause frequent, severe and potentially life-threatening complications (Table 2), such as bleeding, infections, intravascular hemolysis, thrombocytopenia or consumption coagulopathy [26,[33][34][35][36].…”

Section: Ecmo and Ards: Retrospective Series Using The Latest Technologymentioning

confidence: 99%

Extracorporeal Gas Exchange for Acute Respiratory Failure in Adult Patients: A Systematic Review

Schmidt

Hodgson

2015

Annual Update in Intensive Care and Emergency Medicine

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Nosocomial Infections in Adult Cardiogenic Shock Patients Supported by Venoarterial Extracorporeal Membrane Oxygenation

Abstract: Cardiogenic shock patients who received the latest generation VA-ECMO still had a high risk of developing NIs, particularly VAP. Strategies aimed at preventing these infections may improve the outcomes of these critically ill patients.

Cited by 246 publications

References 38 publications

Extracorporeal Membrane Oxygenation in Adults

Extracorporeal Membrane Oxygenation in Adults

VA-ECMO in Landouzy Sepsis or Tubercular Septic Shock

Extracorporeal Gas Exchange for Acute Respiratory Failure in Adult Patients: A Systematic Review

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