Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for emergency cardiac support

Sun, Terri; Guy, Andrew; Sidhu, Amandeep S.; Finlayson, Gordon N.; Grunau, Brian; Ding, Lillian; Harle, Saida; Dewar, Leith; Cook, R.C.M.; Kanji, Hussein D.

doi:10.1016/j.jcrc.2017.10.011

Cited by 34 publications

(30 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The most recent report describes overall ECMO use, with the number of centers utilizing ECMO increasing. Adults receiving ECMO for cardiac support from 1989-2015 show 41% survival to hospital discharge, with survival only increasing to 42% in the year 2015 (21). In our analysis, we report a 39% survival to hospital discharge, which includes patients where VA-ECMO was applied during or immediately after in-house cardiac arrest, and those who were transferred from an outside hospital where VA-ECMO was initiated.…”

Section: Va-ecmo Survivalmentioning

confidence: 87%

Adult cardiac veno-arterial extracorporeal life support (VA-ECMO): prevention and management of acute complications

Koerner¹,

Harper²,

Gordon³

et al. 2019

Ann. Cardiothorac. Surg.

View full text Add to dashboard Cite

Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been shown to be a viable and effective treatment for patients suffering from refractory cardiogenic shock (rCS), which is associated with high mortality rates. Although ECMO therapy used as short-term mechanical circulatory support (MCS) has shown tremendous growth in its application over the past decade, the complication and mortality rates remain high. This retrospective study analyzes complications associated with VA-ECMO support, evaluates the use of defined protocols at a single center, and examines factors that may contribute to patient complication and mortality. Methods: This retrospective analysis included 184 patients who were supported with ECMO from September 2014 through March 2018 at Integris Baptist Medical Center (IBMC). Descriptive statistics were generated to analyze baseline characteristics, demographics, complications, and outcomes. Results: Acute myocardial infarct (AMI) was the primary etiology of this cohort (N=40; 22%). The mean age was 55±15 (median 56, range 15-84) years. All patients were inotrope and/or vasopressor dependent prior to ECMO initiation. Mean time on ECMO support was 7.8±7.9 days with median time of 6 days. Total patient days on support were 1,430. Most ECMO cannulations, 97 (52%) were performed within Integris Baptist Medical Center, with 48% done outside the hospital; 38% were performed outside of the hospital by the IBMC ECMO team, and 10.5% were performed by an outside team. Bleeding was noted to be the most common VA ECMO complication [N=41; 22.3%; 0.028 events per patient day (EPPD)]. Conclusions: A dedicated 24/7 ECMO service using a multidisciplinary team (MDT) and defined protocols in a single center is able to effectively reduce complications due to VA-ECMO support in the sickest of the sick VA-ECMO patients.

show abstract

Section: Va-ecmo Survivalmentioning

confidence: 87%

Adult cardiac veno-arterial extracorporeal life support (VA-ECMO): prevention and management of acute complications

Koerner¹,

Harper²,

Gordon³

et al. 2019

Ann. Cardiothorac. Surg.

View full text Add to dashboard Cite

show abstract

“…Extracorporeal membrane oxygenation (ECMO) is a temporary method for restoring blood flow and extracorporeal gas exchange while the heart and/or the lungs rest until the decision for definitive treatment is made [1]. Since Bartlett et al first used ECMO successfully in a newborn with respiratory failure in 1975, it has been a widespread utility in acute cardiac failure and respiratory failure due to Acute Respiratory Distress Syndrome (ARDS) [2][3][4]. Thus, ECMO became a vital part of the clinical practices of cardiovascular surgery and anesthesiology.…”

Section: Introductionmentioning

confidence: 99%

Emergency department extracorporeal membrane oxygenation may also include noncardiac arrest patients

Özlüer¹,

Avcil²,

Ege³

et al. 2021

Turk J Med Sci

View full text Add to dashboard Cite

Background/aim: The primary purpose of this study is to report the experience on the extracorporeal membrane oxygenation (ECMO) process for patients in the critical care unit (CCU) of an Emergency Department of a tertiary hospital in Turkey, from cannulation to decannulation, including follow-up procedures. Materials and Methods: This retrospective, observational study included eight patients who received Extracorporeal Membrane Oxygenation from Jan 2018-Jan 2020. We evaluated the demographics, indications for ECMO, laboratory values, Respiratory ECMO Survival Prediction, Survival After Veno-Arterial ECMO and ECMOnet scores, the management process, and patient outcomes. Blood gas analyses from after the first hour of ECMO initiation and the re-evaluation of the patients' Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores at the 24 th hour of ECMO were recorded. Results: The mean age was 52.7 ± 14.2 years. The median duration of the ECMO run was 81 (min-max: 4-267) hours, and the mean length of CCU stay was 10.2 ± 6.7 days. Of the 8 patients studied, 5 (62.5%) had veno-arterial and 3 (37.5%) had veno-venous ECMO. Three patients were successfully weaned (37.5%). The overall survival-to-discharge rate was 25%. Carbon dioxide levels were significantly decreased 1 hour after ECMO initiation (p=0.038) as well as the need for vasopressors. Lactate levels were lower in decannulated patients. Changes in the 2 APACHE II score were more consistent with the clinical deterioration in patients than were SOFA score changes. Conclusions: In the early phase of ECMO, vital signs improve, and the need for vasopressors and carbon dioxide levels decreases. Thus, CCUs in Emergency Departments with ECMO capabilities could potentially be designed, and emergency department ECMO algorithms could be tailored for critically ill in addition to outof-hospital cardiac arrest (OHCA) patients.

show abstract

“…Patients who have an IHCA are more likely to survive to discharge because advanced diagnostic tools and interventions are readily available. 1 However, the necessary time that it takes to identify and then treat a reversible cause of cardiogenic shock means that patients are at increased risk of hypoxic brain injury or death. 2,3 Extracorporeal membranous oxygenation (ECMO) facilitates artificial heart and lung function.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 Extracorporeal membranous oxygenation (ECMO) facilitates artificial heart and lung function. [1][2][3][4] Thus, ECMO could be a promising adjunct to routine advanced cardiac life support by bridging patients to the identification and definitive treatment of a reversible cause of shock. [1][2][3][4][5][6] Nevertheless, despite the potential benefits of extracorporeal cardiopulmonary resuscitation (ECPR), the use of ECMO in New Zealand thus far has mainly been veno-venous ECMO for severe respiratory failure.…”

Section: Introductionmentioning

confidence: 99%

Eligibility criteria for extracorporeal cardiopulmonary resuscitation at Auckland City Hospital: A retrospective cohort study

Iwashita

Waqanivavalagi

Merz

et al. 2020

Emerg Medicine Australasia

View full text Add to dashboard Cite

Objective: Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising adjunct to routine advanced cardiac life support. Growing worldwide interest in ECPR-use has seen more tertiary centres offering ECPR programmes. New Zealand's nationwide extracorporeal membranous oxygenation service is provided at Auckland City Hospital (ACH). Despite the potential benefits of ECPR, it is currently only offered on an ad hoc basis. It remains unknown whether ACH would manage sufficient numbers of patients to warrant an ECPR programme. Methods: A 12-month retrospective cohort study of the medical records of patients who were managed for cardiac arrest in the resuscitation room of the ED was conducted. Patient characteristics and clinical outcomes were analysed descriptively and audited against a unique set of criteria for a hypothetical ECPR programme. Results: Between 1 July 2018 and 30 June 2019, 286 patients died or had a cardiac arrest for which they were managed at ACH. Sixty-five of these patients had an in-hospital cardiac arrest in the ED. Seven (10.8%) of these patients were deemed eligible for hypothetical ECPR. Only one of these seven patients survived to hospital discharge with full neurological recovery. Conclusions: An ECPR programme at ACH using standardised and agreed criteria may benefit a small number of patients and improve rates of survival to hospital discharge with preservation of neurological function. An ECPR guideline would help clarify for referring services cases that are appropriate for extracorporeal membranous oxygenation consideration, rather than discussing on an ad hoc basis.

show abstract

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for emergency cardiac support

Cited by 34 publications

References 34 publications

Adult cardiac veno-arterial extracorporeal life support (VA-ECMO): prevention and management of acute complications

Adult cardiac veno-arterial extracorporeal life support (VA-ECMO): prevention and management of acute complications

Emergency department extracorporeal membrane oxygenation may also include noncardiac arrest patients

Eligibility criteria for extracorporeal cardiopulmonary resuscitation at Auckland City Hospital: A retrospective cohort study

Contact Info

Product

Resources

About