Extracorporeal membrane oxygenation (ECMO): extended indications for artificial support of both heart and lungs (original) (raw)
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Indian Journal of Surgery
Extracorporeal membrane oxygenation (ECMO) is a modality utilized for partially or completely supporting the cardiac and/or pulmonary function. There are multiple vascular access techniques depending upon the necessity and the mode of ECMO used. ECMO has evolved over the years as an integral part of the cardiac care discipline. Historically, this lifesaving modality began as an extension of cardiopulmonary bypass and was associated with adverse outcomes. Currently, ECMO has evolved as an accepted and viable solution to patients with severe cardiac/respiratory/cardiorespiratory failure that is refractory to conservative management. The outcomes of patients on ECMO are dependent on multiple factors originating from demographic and pathophysiological status of patients as well as the control of homeostasis during ECMO within the acceptable range. Various studies have been published by many practitioners over past decades since the dawn of ECMO era. A brief review of such experience is summated, and a conclusion is derived about the clinical course of the patients on ECMO, while adding the author's experience about the same in a tertiary care large-volume center.
Extracorporeal membrane oxygenation (ECMO) as lung or heart assist
Acta Anaesthesiologica Scandinavica, 1996
Extracorporeal membrane oxygenation (ECMO) may serve as extracorporeal lung assist (ECLA) in patients with acute respiratory tailure (ARF) or as extracorporeal heart assist (ECHA) in patients with low output syndrome (LOS) after open heart surgery. From 1988 to 1992 seven patients underwent ECMO in our hospital; four suffered from ARF and three from LOS. Various bypass techniques were employed. Two ARF patients, aged 58 and 18 years, had veno-venous bypass; in the latter, ECMO was reinstituted as a veno-arterial bypass one week after weaning. In a three-year-old boy, the ECMO outflow tubing was primarily connected to the pulmonary artery, and shortly afterwards relocated to the common carotid artery. In a 31-year-old man with ARF, and three LOS patients, a 56-year-old woman, and hvo men aged 68 and 70 years, ECMO was veno-arterial with direct access to the ascending aorta. A heparin-coated system w,ib used, and all but one patient, who was treated with warfarin, received a daily low dose of heparin, which was withdrawn atter from one to nine days.
Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 2017
Extracorporeal membrane oxygenation (ECMO) provides mechanical pulmonary and circulatory support for patients with shock refractory to conventional medical therapy. In this study we aim to describe the indications, clinical characteristics, complications and mortality associated with use of ECMO in a single tertiary hospital. We conducted a retrospective observational cohort study of all patients supported with ECMO in two different intensive care units (general and cardiac), from the first patient cannulated in April 2011 up to October 2016. Overall, 48 patients underwent ECMO: 29 venoarterial ECMO (VA-ECMO) and 19 venovenous ECMO (VV-ECMO). In VA-ECMO, acute myocardial infarction was the main reason for placement. The most frequent complication was lower limb ischemia and the most common organ dysfunction was acute renal failure. In VV-ECMO, acute respiratory distress syndrome after viral infection was the leading reason for device placement. Access site bleeding and hematologic d...
The Annals of Thoracic Surgery, 2012
Background. Indications for extracorporeal membrane oxygenation (ECMO) use in lung transplantation are (1) temporary assistance as a bridge to transplantation, (2) stabilization of hemodynamics during transplantation in place of cardiopulmonary bypass, and (3) treatment of severe lung dysfunction and primary graft failure after transplantation. This study compares the survival of lung transplant recipients requiring ECMO support with survival of patients without ECMO.
Extracorporeal membrane oxygenation
F1000prime reports, 2013
Extracorporeal membrane oxygenation (ECMO) is an advanced form of life support technology whereby venous blood is oxygenated outside of the body and returned to the patient. ECMO was initially used as last-resort rescue therapy for patients with severe respiratory failure. Over the last four decades, it has developed into a safe, standard therapy for newborns with progressive cardiorespiratory failure, as a resuscitation therapy after cardiac arrest, and in combination with other treatments such as hypothermia and various blood filtration therapies. ECMO has also become routine for children and adults with all forms of cardiogenic shock and is also routine in early graft failure after transplantation. The one area of ongoing debate is the role of ECMO in adults with hypoxemic respiratory failure. As ECMO equipment becomes safer, earlier use improves patient outcomes. Several modifications of the two basic venovenous and venoarterial ECMO systems are now occurring, as are many minor ...
Respiratory failure and extracorporeal membrane oxygenation
Seminars in pediatric surgery, 2008
Conventional treatment of respiratory failure involves positive pressure ventilation with high concentrations of inspired oxygen. If adequate gas exchange still cannot be achieved extracorporeal membrane oxygenation (ECMO) may be an option. The general indication for ECMO for respiratory insufficiency is a reversible pulmonary disease, which cannot be managed by conventional means. ECMO is a modified heart-lung machine. Blood is withdrawn from a central vein in the patient and pumped through an artificial oxygenator back to the patient, either to a central artery (veno-arterial ECMO) or to a central vein (veno-venous ECMO). Total gas exchange can be achieved through the extracorporeal system, and the lungs do not have to be subjected to high-pressure ventilation. To date over 21,500 neonates have been treated with ECMO with an overall survival to hospital discharge of 76%. Meconium aspiration syndrome carries the highest survival (94%), whereas congenital diaphragmatic hernia on ECM...
Extracorporeal Membrane Oxygenation in the Perioperative Care of Lung Transplantation
Clinical Pulmonary Medicine, 2013
Extracorporeal membrane oxygenation (ECMO) is a temporary artificial support in cases of ineffective oxygenation due to severe lung dysfunction, severe circulatory failure, or both. Lung transplantation (LTx) has become a life-saving procedure for patients suffering from endstage lung diseases. Its indications have progressively broadened over time and outcome has steadily improved. Unfortunately, still a considerable number of patients die on the waiting list before transplantation. Moreover, postoperative complications can be life threatening. The present article reviews the published literature about the implementation of ECMO in the perioperative care of the LTx patient. This progressively developed technique of vital support is a feasible therapeutic option in cases of terminal respiratory failure before transplant, thus being a bridge to it, and in the management of severe immediate postoperative complications. First, we present a historic view of the role of ECMO support in acute respiratory failure, with critical discussion of the only 3 published clinical trials on ECMO in adult patients. Then, the interactions between ECMO and LTx are examined. Larger case series about ECMO bridging to LTx are reviewed, with particular focus on the awake ECMO strategy. Finally, evidence for ECMO support in the intraoperative and postoperative care of LTx is discussed.
Extracorporeal membrane oxygenation circulatory support after cardiac surgery
Transplantation Proceedings, 2004
Objectives. Postcardiotomy acute severe heart failure cannot be managed by medical treatment alone and most often requires some form of mechanical support. In this study we evaluate the efficacy of postoperative extracorporeal membrane oxygenation (ECMO) support following surgery for congenital heart disease (CHD) in infants and children. Methods. Over a 6-year period from October 1997 to October 2003, 10 patients aged 5 days to 28.5 months (median 3 months) who underwent surgical procedures for CHD received postoperative mechanical support for failing cardiac function despite optimal medical therapy. In 3 patients ECMO was instituted in the operating room (OR) and in 7 patients this was introduced in the intensive care unit (ICU) 2 to 48 (median 20) hours postoperatively. Results. Four patients (40%) were successfully weaned, while support was withdrawn in the remaining 6 due to irreversible vital organ damage. Following successful weaning, one of the survivors died 8 hours later from barotrauma and intrapulmonary hemorrhage, and another died 4 months later from persistent heart failure. The other two patients remain well in NYHA class II. Conclusions. Despite the adverse effects of ECMO, the methodology provided the necessary support and allowed the failing heart to recover in a number of patients where inotropic support alone proved inadequate.