Practice Patterns and Outcome of Extracorporeal Membrane Oxygenation Therapy for Severe Acute Respiratory Distress Syndrome in Indian ICUs (original) (raw)
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Acta anaesthesiologica Scandinavica, 2018
Extracorporeal Membrane Oxygenation in severe ARDS unresponsive to conventional protective ventilation is associated with elevated costs, resource and complications, and appropriate risk stratification of candidate patients could be useful to recognize those more likely to benefit from ECMO. We aimed to derive a new outcome prediction score for patients retrieved by our ECMO team from peripheral centers, including systematic echocardiographic evaluation before ECMO start. Sixty-nine consecutive patients with refractory ARDS requiring ECMO transferred from peripheral centers to our ICU (a tertiary ECMO referral center), from 1 October 2009 to 31 December 2015, were assessed. All patients were transported on ECMO (distance, median 77, range 4-456 km) The mortality rate was 41% (28/69). Our new risk score included age ≥ 42 years, BMI < 31 kg/m2 , RV dilatation, and pH < 7.35. The proposed cut off (Youden's index method) of nine had a sensitivity of 96% and a specificity of 30...
Integrative Journal of Medical Sciences, 2021
Management of acute respiratory distress syndrome due to viral outbreak includes lower tidal volumes, lower inspiratory pressure, prone ventilation and conservative fluid management. Extracorporeal membrane oxygenation (ECMO) has been proposed as rescue therapy in critically ill patients.However, in the absence of larger studies, the role of ECMO in reducing patient mortality rates remains unclear, since studies that reported such effect, both during the current as well as during previous outbreaks, were based on small sample sizes and their results are inconsistent. Furthermore, the use of ECMO might even be contraindicated in the presence of some conditions. Recurring to it has therefore to be discussed by qualified multi-disciplinary teams and based on a case by case strategy.
The International Journal of Artificial Organs, 2014
Purpose Veno-venous extracorporeal membrane oxygenation (vv-ECMO) is pivotal in the treatment of patients suffering from acute respiratory distress syndrome (ARDS). Comparative data with different oxygenator models have not yet been reported. The aim of this retrospective investigation was therefore to assess whether different oxygenator types might influence changing frequency, infection incidence, and mortality in patients on vv-ECMO. Methods 42 patients undergoing vv-ECMO between 1998 and 2009 were identified. In 20 out of these patients, a polypropylene (PP) microporous hollow fiber membrane oxygenator, and in 22 patients a nonmicroporous polymethylpentene (PMP) diffusion membrane oxygenator was used. Infection incidence, changing frequency, and mortality were documented. Results In the PMP group, an oxygenator change was necessary less often than in the PP group (p<0.001). The incidence of bacterial, viral, or fungal growth was similar in the groups, thus independent of the ...
Acta Anaesthesiologica Scandinavica, 2013
OBJECTIVES: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been recently considered and used for patients with post-acute myocardial infarction mechanical complications (post-AMI MC); however, information in this respect is scarce. The purpose of this study was to evaluate the in-hospital outcomes of patients with post-AMI MC submitted to VA-ECMO, and enrolled in the Extracorporeal Life Support Organizations (ELSO)'s data Registry. METHODS: This was a retrospective review of the ELSO Registry to identify adult (>18 years old) patients with post-AMI MC who underwent VA-ECMO support between 2007 and 2018. The primary end point of this study was in-hospital survival. ECMO complications were also evaluated. RESULTS: The patient cohort available for this study included 158 patients. The median age was 62.4 years (range 20-80). The most common post-AMI MC was ventricular septal rupture (n = 102; 64.5%), followed by papillary muscle rupture (n = 42; 26.6%) and ventricular free-wall rupture (n = 14; 8.9%). Approximately a quarter of patients (n = 41; 25.9%) had cardiac arrest before VA-ECMO institution. The median duration of VA-ECMO was 5.9 days (range 1 h-40.3 days). ECMO complications occurred in 119 patients (75.3%). Overall, survival to hospital discharge for the entire patient cohort was 37.3%. Patients who had ventricular septal rupture as primary diagnosis had higher inhospital mortality (n = 66; 64.7%). CONCLUSIONS: In patients with post-AMI MC, VA-ECMO provides haemodynamic stabilizations and carries a potential to reverse otherwise lethal course. ECMO complications, however, remain an important limitation. Further investigations are required to better evaluate the efficacy and safety of ECMO in this context.
Annals of Intensive Care
Background The high-quality evidence on managing COVID-19 patients requiring extracorporeal membrane oxygenation (ECMO) support is insufficient. Furthermore, there is little consensus on allocating ECMO resources when scarce. The paucity of evidence and the need for guidance on controversial topics required an international expert consensus statement to understand the role of ECMO in COVID-19 better. Twenty-two international ECMO experts worldwide work together to interpret the most recent findings of the evolving published research, statement formulation, and voting to achieve consensus. Objectives To guide the next generation of ECMO practitioners during future pandemics on tackling controversial topics pertaining to using ECMO for patients with COVID-19-related severe ARDS. Methods The scientific committee was assembled of five chairpersons with more than 5 years of ECMO experience and a critical care background. Their roles were modifying and restructuring the panel’s questions ...
37th International Symposium on Intensive Care and Emergency Medicine (part 2 of 3)
Critical Care, 2017
Introduction: Ventricular septal rupture (VSR) is an unusual mechanical complication of myocardial infarction (MI) in the era of reperfusion therapy, but the mortality rate of patients who present with cardiogenic shock (CS) remains extremely high. Whereas current American and European guidelines recommend urgent surgical repair regardless of hemodynamic status, promising outcomes have been repeatedly reported with the use of circulatory support, enabling hemodynamic stabilization and delaying repair after consolidation of the infarct scar. Therefore, we analyzed our experience with the use of Veno-Arterial Extracorporeal Membrane Oxygenation (V-A ECMO) in post-infarction VSR. Methods: We conducted a retrospective search of institutional database of all patients presenting with post-infarction VSR from January 2007 to June 2016. Data of 33 consecutive patients were retrospectively reviewed and analyzed. Results: In our center, 7 out of 33 patients with post-MI VSR and refractory CS (despite vasopressor and intraaortic balloon pump therapy) received V-A ECMO support. V-A ECMO improved end-organ perfusion with lower lactate levels 24 hours after implantation (7.514 vs. 1.514, p < 0.005), normalized arterial pH (7.25 vs. 7.40, p < 0.036), improved mean arterial pressure (64 mm/Hg vs. 83 mm/Hg, p < 0.001) and lowered heart rate (115/min vs. 68/min, p < 0.001) in all patients. Mean duration of ECMO support was 12 days, 5 out of 7 patients underwent surgical repair, 4 were successfully weaned from ECMO, 3 survived 30 days and 2 survived more than 1 year. The most frequent complication (5 patients) as well as the cause of death (3 patients) was bleeding. Conclusions: Our experience suggest that V-A ECMO support in patients with VSR and refractory CS improves end-organ perfusion, provides hemodynamic stabilization and increases time for cardiovascular team decision. Bleeding complications are an important limitation of this method.