Perioperative Management of Adult Surgical Patients on Extracorporeal Membrane Oxygenation Support

Odonkor, Patrick; Stansbury, Lynn G.; García, José Pérez; Rock, Peter; Deshpande, Seema; Grigore, Alina M.

doi:10.1053/j.jvca.2012.09.023

Cited by 28 publications

(31 citation statements)

References 76 publications

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“…Previous studies have shown the importance of maintaining euvolemia, good tissue oxygenation, and normothermia perioperatively. 28 In the current study, the requirement of blood transfusion was independently associated with mortality. This is consistent with our previous study, which demonstrated the importance of careful surgical hemostasis and limiting blood products in patients supported with ECMO undergoing NCSPs.…”

Section: Commentmentioning

confidence: 47%

Examining Noncardiac Surgical Procedures in Patients on Extracorporeal Membrane Oxygenation

Taghavi¹,

Jayarajan²,

Mangi³

et al. 2015

ASAIO Journal

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As extracorporeal membrane oxygenation (ECMO) is increasingly used for patients with cardiac and/or pulmonary failure, the need for noncardiac surgical procedures (NCSPs) in these patients will continue to increase. This study examined the NCSP required in patients supported with ECMO and determined which variables affect outcomes. The National Inpatient Sample Database was examined for patients supported with ECMO from 2007 to 2010. There were 563 patients requiring ECMO during the study period. Of these, 269 (47.8%) required 380 NCSPs. There were 149 (39.2%) general surgical procedures, with abdominal exploration/bowel resection (18.2%) being most common. Vascular (29.5%) and thoracic procedures (23.4%) were also common. Patients requiring NCSP had longer median length of stay (15.5 vs. 9.2 days, p = 0.001), more wound infections (7.4% vs. 3.7%, p = 0.02), and more bleeding complications (27.9% vs. 17.3%, p = 0.01). The incidences of other complications and inpatient mortality (54.3% vs. 58.2%, p = 0.54) were similar. On logistic regression, the requirement of NCSPs was not associated with mortality (odds ratio [OR]: 0.91, 95% confidence interval [CI]: 0.68-1.23, p = 0.17). However, requirement of blood transfusion was associated with mortality (OR: 1.70, 95% CI: 1.06-2.74, p = 0.03). Although NCSPs in patients supported with ECMO does not increase mortality, it results in increased morbidity and longer hospital stay.

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Section: Commentmentioning

confidence: 47%

Examining Noncardiac Surgical Procedures in Patients on Extracorporeal Membrane Oxygenation

Taghavi¹,

Jayarajan²,

Mangi³

et al. 2015

ASAIO Journal

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“…It is also used for adult respiratory distress syndrome, as a bridge for lung transplant and primary graft failure after transplant, during severe pneumonia and sepsis, for reversible respiratory failure (eg, aspiration pneumonia, asthma, near drowning, and Wegener granulomatosis), and for respiratory support. 1,3 Extracorporeal membrane oxygenation support can be used in various modalities. For venoarterial ECMO, blood is drawn from the venous system, oxygenated, and pumped into the arterial circulation.…”

Section: Discussionmentioning

confidence: 99%

“…For venovenous ECMO, blood is drained and returned to the venous system, providing complete or partial support of the diseased lungs as long as cardiac output is sufficient. 3 Extracorporeal membrane oxygenation support has very sophisticated advantages for patients with cardiopulmonary insufficiencies and yet has some complications (Table 3). Left ventricular distention is a key complication recognized during the use of ECMO, frequently requiring interventions for left ventricular decompression.…”

Section: Discussionmentioning

confidence: 99%

“…Interventional modalities for LVD include intraaortic balloon pump (to increase coronary perfusion, improve contractility, and reduce afterload), atrial septostomy, trans-septal left atrial drain, or other devices such as the Impella (Abiomed, Danvers, MA, USA). 3 Surgical modalities to treat LVD include direct insertion of a left ventricular vent from a small left thoracotomy and conversion of peripheral ECMO to central ECMO. For central ECMO, a vent can be inserted in the left ventricle by opening the previous incision.…”

Section: Discussionmentioning

confidence: 99%

“…In all circumstances, the left ventricular vent is connected to the venous line. 3 During a 6-year period, we applied venoarterial ECMO to 4 patients, with 2 developing LVD. We performed conversion of ECMO site in our first patient and balloon interatrial septostomy in the second.…”

Section: Discussionmentioning

confidence: 99%

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Gültekin

Ersoy²,

Akkaya³

et al. 2016

Exp Clin Transplant

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Objectives: Left ventricular distention can be recognized during the use of venoarterial extracorporeal membrane oxygenation as a key complication. Left ventricular decompression may decrease pulmonary pressure, minimize ventricular distention, and allow myocardial recovery. Materials and Methods: We applied venoarterial extracorporeal membrane oxygenation to 4 patients while on a wait list for cardiac transplant. Results: Two patients with severe heart failure developed high end-diastolic pressures leading to left ventricular distention. We used atrial venting methods to decrease the pressure. Conclusions: Here, we discussed the strategies to manage ventricular distention by conservative, interventional, and surgical means.

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Peripheral Veno-arterial Extracorporeal Membrane Oxygenation for Treatment of Ischemic Shock

Singh

Spielvogel

Lansman

2016

Translational Research in Coronary Artery Disease

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Perioperative Management of Adult Surgical Patients on Extracorporeal Membrane Oxygenation Support

Cited by 28 publications

References 76 publications

Examining Noncardiac Surgical Procedures in Patients on Extracorporeal Membrane Oxygenation

Examining Noncardiac Surgical Procedures in Patients on Extracorporeal Membrane Oxygenation

Untitled

Peripheral Veno-arterial Extracorporeal Membrane Oxygenation for Treatment of Ischemic Shock

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