Update on Safety Equipment for Extracorporeal Life Support (ECLS) Circuits

Riley, Jeffrey B.; Scott, Phillip D.; Schears, Gregory J.

doi:10.1177/1089253209347895

Cited by 25 publications

(14 citation statements)

References 36 publications

(29 reference statements)

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“…More recently, however, thanks to improvements in technology, safety profile and manageability of extracorporeal life support strategies [ 16 , 17 ], ECMO has been reintroduced in some centers as an option for patients with severe respiratory failure awaiting lung transplant [ 4 , 10 , 13 , 18 – 22 ]. The number of lung transplant candidates who could benefit from ECMO is now significantly larger [ 13 , 19 , 20 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal life support as bridge to lung transplantation: a systematic review

et al. 2015

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IntroductionPatients with acute respiratory failure requiring respiratory support with invasive mechanical ventilation while awaiting lung transplantation are at a high risk of death. Extracorporeal membrane oxygenation (ECMO) has been proposed as an alternative bridging strategy to mechanical ventilation. The aim of this study was to assess the current evidence regarding how the ECMO bridge influences patients’ survival and length of hospital stay.MethodsWe performed a systematic review by searching PubMed, EMBASE and the bibliographies of retrieved articles. Three reviewers independently screened citation titles and abstracts and agreement was reached by consensus. We selected studies enrolling patients who received ECMO with the intention to bridge lung transplant. We included randomized controlled trials (RCTs), case–control studies and case series with ten or more patients. Outcomes of interest included survival and length of hospital stay. Quantitative data summaries were made when feasible.ResultsWe identified 82 studies, of which 14 were included in the final analysis. All 14 were retrospective studies which enrolled 441 patients in total. Because of the broad heterogeneity among the studies we did not perform a meta-analysis. The mortality rate of patients on ECMO before lung transplant and the one-year survival ranged from 10% to 50% and 50% to 90%, respectively. The intensive care and hospital length of stay ranged between a median of 15 to 47 days and 22 to 47 days, respectively. There was a general paucity of high-quality data and significant heterogeneity among studies in the enrolled patients and technology used, which confounded analysis.ConclusionsIn most of the studies, patients on ECMO while awaiting lung transplantation also received invasive mechanical ventilation. Therefore, whether ECMO as an alternative, rather than an adjunction, to invasive mechanical ventilation is a better bridging strategy to lung transplantation still remains an unresolved issue. ECMO support as a bridge for these patients could provide acceptable one-year survival. Future studies are needed to investigate ECMO as part of an algorithm of care for patients with end-stage lung disease.

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Section: Introductionmentioning

confidence: 99%

Extracorporeal life support as bridge to lung transplantation: a systematic review

et al. 2015

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“…Its role extends even further as an adjunct to cardiopulmonary resuscitation (CPR) 4 , as well as high risk percutaneous cardiac interventions 5 . Improvements in equipment, patient selection and a better understanding of extracorporeal circuit technology have resulted in some centres reporting significantly improved outcomes [6][7][8] . The Conventional Ventilation or ECMO for Severe Adult Respiratory Failure (CESAR) trial 9 , and the Australian and New Zealand Intensive Care Society ECMO investigator study into Influenza A (H1N1) 10 , have demonstrated its usefulness in the advanced management of respiratory failure unresponsive to maximal conventional therapy [11][12][13][14] .…”

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confidence: 99%

Increased Sedation Requirements in Patients Receiving Extracorporeal Membrane Oxygenation for Respiratory and Cardiorespiratory Failure

Shekar

Roberts

Mullany

et al. 2012

Anaesth Intensive Care

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Critically ill patients receiving extracorporeal membrane oxygenation (ECMO) are often noted to have increased sedation requirements. However, data related to sedation in this complex group of patients is limited. The aim of our study was to characterise the sedation requirements in adult patients receiving ECMO for cardiorespiratory failure. A retrospective chart review was performed to collect sedation data for 30 consecutive patients who received venovenous or venoarterial ECMO between April 2009 and March 2011. To test for a difference in doses over time we used a regression model. The dose of midazolam received on ECMO support increased by an average of 18 mg per day (95% confidence interval 8, 29 mg, P=0.001), while the dose of morphine increased by 29 mg per day (95% confidence interval 4, 53 mg, P=0.021) The venovenous group received a daily midazolam dose that was 157 mg higher than the venoarterial group (95% confidence interval 53, 261 mg, P=0.005). We did not observe any significant increase in fentanyl doses over time (95% confidence interval 1269, 4337 μg, P=0.94). There is a significant increase in dose requirement for morphine and midazolam during ECMO. Patients on venovenous ECMO received higher sedative doses as compared to patients on venoarterial ECMO. Future research should focus on mechanisms behind these changes and also identify drugs that are most suitable for sedation during ECMO.

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“…Membrane oxygenators and pumps are the main elements of the ECMO system, and outcomes depend on them. Impressive technical progress has been made in pumps, oxygenators, and coatings for artificial surfaces, leading to greater biocompatibility and a lower rate of procedure‐related complications (3,4). Oxygenators have primarily used the silicone rubber membrane, then the microporous polypropylene hollow‐fiber membrane, and recently the polymethylpentene (PMP) membrane.…”

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confidence: 99%

Clinical Evaluation of Two Different Extracorporeal Membrane Oxygenation Systems: A Single Center Report

Yu¹,

Long²,

Hei³

et al. 2011

Artificial Organs

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Refinements in extracorporeal membrane oxygenation (ECMO) equipment, including heparin-coated surfaces, centrifugal pump, membrane oxygenator, and more biocompatible pump-oxygenator circuits, have reduced procedure-related complications and have made ECMO a safe and effective therapy for critical patients. The aim of this study was to evaluate the performance of two different ECMO circuit systems in a clinical setting and compare their outcomes. From December 2004 to December 2009, 121 patients required ECMO for primary or postcardiotomy cardiogenic shock at our heart center. We used the Medtronic circuit system in our earlier series (Group M, n = 64), and from July 2007, ECMO was carried out mainly with the Quadrox D PLS circuit system (Group Q, n = 56). We retrospectively summarized and analyzed the data of these patients. The evaluation was based on the comparison between properties of the membrane oxygenators and pumps, anticoagulation therapy, circuit-related complications, and clinical outcomes. Support pump flow rates, platelet counts, and trans-membrane pressure drops (TMPDs) of preoxygenator and postoxygenator pressures were compared between two groups at the time of support established (T1) and support established for 24 h (T2). There were no significant differences between the two groups with regard to patient characteristics and pre-ECMO data. The support pump flow rates and platelet counts at different times were comparable in the two groups. The cannulation technique, ECMO duration, and mean heparin dosage were similar in both groups. There were also no significant differences between the groups in mortality or complications related to bleeding and organ dysfunction. Compared with the M group, the Q group experienced less mechanical failure of the ECMO circuit. The Quadrox PLS circuit system showed less circuit thrombus formation (P < 0.045), less plasma leakage (P < 0.001), and less need for replacement of oxygenators (P < 0.001). Furthermore, frequency of hemolysis during ECMO was significantly lower (P < 0.045). In addition, at T1 and T2, TMPDs were significantly lower in the Q group. Our results suggest that both ECMO circuit systems provide similar effects for safe clinical application, but the Quadrox PLS ECMO circuit system demonstrated partially improved biocompatibility in terms of improved cell preservation, lower TMPDs, less plasma leakage, and thrombus formation.

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Update on Safety Equipment for Extracorporeal Life Support (ECLS) Circuits

Cited by 25 publications

References 36 publications

Extracorporeal life support as bridge to lung transplantation: a systematic review

Extracorporeal life support as bridge to lung transplantation: a systematic review

Increased Sedation Requirements in Patients Receiving Extracorporeal Membrane Oxygenation for Respiratory and Cardiorespiratory Failure

Clinical Evaluation of Two Different Extracorporeal Membrane Oxygenation Systems: A Single Center Report

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