1,097 results on '"Extracorporeal membrane oxygenation"'
Search Results
102. The need to define 'who' rather than 'if' for ECMO in COVID-19
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Stephen Whebell, Joe Zhang, Rebecca Lewis, Michael Berry, Stephane Ledot, Andrew Retter, and Luigi Camporota
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Respiratory Distress Syndrome ,Extracorporeal Membrane Oxygenation ,SARS-CoV-2 ,COVID-19 ,Humans ,Critical Care and Intensive Care Medicine - Published
- 2022
103. The physiological underpinnings of life-saving respiratory support
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Irene Telias, Laurent J. Brochard, Simone Gattarello, Hannah Wunsch, Detajin Junhasavasdikul, Karen J. Bosma, Luigi Camporota, Daniel Brodie, John J. Marini, Arthur S. Slutsky, and Luciano Gattinoni
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Respiratory Distress Syndrome ,Extracorporeal Membrane Oxygenation ,Ventilator-Induced Lung Injury ,Iatrogenic Disease ,Humans ,Critical Care and Intensive Care Medicine ,Respiratory Insufficiency ,Respiration, Artificial - Abstract
Treatment of respiratory failure has improved dramatically since the polio epidemic in the 1950s with the use of invasive techniques for respiratory support: mechanical ventilation and extracorporeal respiratory support. However, respiratory support is only a supportive therapy, designed to "buy time" while the disease causing respiratory failure abates. It ensures viable gas exchange and prevents cardiorespiratory collapse in the context of excessive loads. Because the use of invasive modalities of respiratory support is also associated with substantial harm, it remains the responsibility of the clinician to minimize such hazards. Direct iatrogenic consequences of mechanical ventilation include the risk to the lung (ventilator-induced lung injury) and the diaphragm (ventilator-induced diaphragm dysfunction and other forms of myotrauma). Adverse consequences on hemodynamics can also be significant. Indirect consequences (e.g., immobilization, sleep disruption) can have devastating long-term effects. Increasing awareness and understanding of these mechanisms of injury has led to a change in the philosophy of care with a shift from aiming to normalize gases toward minimizing harm. Lung (and more recently also diaphragm) protective ventilation strategies include the use of extracorporeal respiratory support when the risk of ventilation becomes excessive. This review provides an overview of the historical background of respiratory support, pathophysiology of respiratory failure and rationale for respiratory support, iatrogenic consequences from mechanical ventilation, specifics of the implementation of mechanical ventilation, and role of extracorporeal respiratory support. It highlights the need for appropriate monitoring to estimate risks and to individualize ventilation and sedation to provide safe respiratory support to each patient.
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- 2022
104. Respiratory indications for ECMO: focus on COVID-19
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Alexander Supady, Alain Combes, Ryan P. Barbaro, Luigi Camporota, Rodrigo Diaz, Eddy Fan, Marco Giani, Carol Hodgson, Catherine L. Hough, Christian Karagiannidis, Matthias Kochanek, Ahmed A. Rabie, Jordi Riera, Arthur S. Slutsky, and Daniel Brodie
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Respiratory Distress Syndrome ,Extracorporeal Membrane Oxygenation ,COVID-19 ,Humans ,Bayes Theorem ,Critical Care and Intensive Care Medicine ,Respiratory Insufficiency ,Pandemics - Abstract
Extracorporeal membrane oxygenation (ECMO) is increasingly being used for patients with severe respiratory failure and has received particular attention during the coronavirus disease 2019 (COVID-19) pandemic. Evidence from two key randomized controlled trials, a subsequent post hoc Bayesian analysis, and meta-analyses support the interpretation of a benefit of ECMO in combination with ultra-lung-protective ventilation for select patients with very severe forms of acute respiratory distress syndrome (ARDS). During the pandemic, new evidence has emerged helping to better define the role of ECMO for patients with COVID-19. Results from large cohorts suggest outcomes during the first wave of the pandemic were similar to those in non-COVID-19 cohorts. As the pandemic continued, mortality of patients supported with ECMO has increased. However, the precise reasons for this observation are unclear. Known risk factors for mortality in COVID-19 and non-COVID-19 patients are higher patient age, concomitant extra-pulmonary organ failures or malignancies, prolonged mechanical ventilation before ECMO, less experienced treatment teams and lower ECMO caseloads in the treating center. ECMO is a high resource-dependent support option; therefore, it should be used judiciously, and its availability may need to be constrained when resources are scarce. More evidence from high-quality research is required to better define the role and limitations of ECMO in patients with severe COVID-19.
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- 2022
105. ECMO for COVID-19 patients in Europe and Israel
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Lorusso, Roberto, Combes, Alain, Coco, Valeria Lo, De Piero, Maria Elena, Belohlavek, Jan, Delnoij, Thijs, van der Horst, Iwan, Miranda, Dinis Reis, van der Linden, Marcel, van der Heijden, JJ, Scholten, Erik, van Belle-van Haren, Nicole, Lagrand, Wim, de Jong, Sytse, Candura, Dario, Maas, Jacinta, van den Berg, MJ van Gijlswijk, Malfertheiner, Maximilian, Dreier, Esther, Mueller, Thomas, Boeken, Udo, Akhyari, Payam, Lichtenberg, Artur, Saeed, Diyar, Thiele, Holger, Baumgaertel, Matthias, Schmitto, Jan D, Mariani, Silvia, Thielmann, Matthias, Brenner, Thorsten, Benk, Cristoph, Czerny, Martin, Kalbhenn, Johannes, Maier, Sven, Schibilsky, David, Staudacher, Dawid L, Henn, Philipp, Iuliu, Torje, Muellenbach, Ralf, Reyher, Christian, Rolfes, Caroline, Zacharowski, Kai, Lotz, Gosta, Sonntagbauer, Michael, Kersten, Alexander, Karagiannidis, Christian, Schafer, Simone, Fichte, Julia, Hopf, Hans-Bernd, Samalavicius, Robertas, Lorini, Luca, Ghitti, Davide, Grazioli, Lorenzo, Loforte, Antonio, Baiocchi, Massimo, Checco, Erika Dal, Pacini, Davide, Meani, Paolo, Cappai, Antioco, Russo, Claudio Francesco, Bottiroli, Maurizio, Mondino, Michele, Ranucci, Marco, Fina, Dario, Ballotta, Andrea, Scandroglio, Anna Mara, Zangrillo, Alberto, Pieri, Marina, Nardelli, Pasquale, Fominskiy, Evgeny, Landoni, Giovanni, Fanelli, Vito, Brazzi, Luca, Montrucchio, Giorgia, Sales, Gabriele, Simonetti, Umberto, Urbino, Rosario, Livigni, Sergio, Degani, Antonella, Raffa, Giuseppe, Pilato, Michele, Martucci, Gennaro, Arcadipane, Antonio, Chiarini, Giovanni, Latronico, Nicola, Cattaneo, Sergio, Puglia, Carmine, Reina, Gianfranco, Sponga, Sandro, Livi, Ugolino, Foti, Giuseppe, Giani, Marco, Rona, Roberto, Avalli, Leonello, Bombino, Michela, Costa, Maria Cristina, Carozza, Roberto, Donati, Abele, Piciche, Marco, Favaro, Alessandro, Salvador, Loris, Danzi, Vinicio, Zanin, Anita, Condello, Ignazio, Fiore, Flavio, Moscarelli, Marco, Nasso, Giuseppe, Speziale, Giuseppe, Sandrelli, Luca, Montalto, Andrea, Musumeci, Francesco, Circelli, Alessandro, Gamberini, Emiliano, Russo, Emanuele, Benni, Marco, Agnoletti, Vanni, Rociola, Ruggero, Milano, Aldo D, Grasso, Salvatore, Civita, Antonio, Murgolo, Francesco, Pilato, Emanuele, Comentale, Giuseppe, Montisci, Andrea, Alessandri, Francesco, Tosi, Antonella, Pugliese, Francesco, Carelli, Simone, Grieco, Domenico Luca, Antonelli, Massimo, Ramoni, Enrico, Di Nardo, Matteo, Maisano, Francesco, Bettex, Dominique, Weber, Alberto, Grunenfelder, Jurg, Consiglio, Jolanda, Hansjoerg, Jenni, Haenggi, Matthias, Agus, Gianluca, Doeble, Thomas, Zenklusen, Urs, Bechtold, Xavier, Stockman, Bernard, De Backer, Daniel, Giglioli, Simone, Meyns, Bart, Vercaemst, Leen, Herman, Greet, Meersseman, Philippe, Vandenbriele, Christophe, Dauwe, Dieter, Vlasselaers, Dirk, Raes, Matthias, Debeuckelaere, Gerdy, Rodrigus, Inez, Biston, Patrick, Piagnerelli, Michael, Peperstraete, Harlinde, Germay, Olivier, Vandewiele, Korneel, Vandeweghe, Dimitri, Witters, Ine, Havrin, Sven, Bourgeois, Marc, Taccone, Fabio Silvio, Nobile, Leda, Lheureux, Olivier, Brasseur, Alexandre, Creteur, Jacques, Defraigne, Jean-Olivier, Misset, Benoit, Courcelle, Romain, Timmermans, Philippe, Lehaen, Jeroen, Frederik, Bonte, Riera, Jordi, Castro, Miguel angel, Gallart, Elisabet, Martinez-Martinez, Maria, Argudo, Eduard, Garcia-de-Acilu, Marina, de Pablo Sanchez, Raul, Ortiz, Aaron Blandino, Cabanes, Mari-Paz Fuset, Higa, Karina Osorio, Cassina, Albert Miralles, Berbel, Daniel Ortiz, Sanchez-Salado, Jose Carlos, Arnau, Blasco-Lucas, de Gopegui, Pablo Ruiz, Ricart, Pilar, Sandoval, Elena, Veganzones, Javier, Millan, Pablo, de la Sota, Perez, Santa Teresa, Patricia, Alcantara, Sara, Alvarez, Jorge Duerto, Gonzalez, Anxela Vidal, Lopez, Marta, Gordillo, Antonio, Naranjo-Izurieta, Jose, Costa, Ricardo Gimeno, Albacete Moreno, Carlos L, de Ayala, Jose angel, Blanco-Schweizer, Pablo, Andres, Nicolas Hidalgo, Boado, Victoria, Martinez, Jose Maria Nunez, Casal, Vanesa Gomez, Garcia, Esperanza Fernandez, Martin-Villen, Luis, Climent, Joaquin Colomina, Pinto, Luis F, Leprince, Pascal, Lebreton, Guillaume, Juvin, Charles, Schmidt, Matthieu, Pineton, Marc, Folliguet, Thierry, Saiydoun, Gabriel, Gaudard, Philippe, Colson, Pascal, Obadia, Jean-Francois, Pozzi, Matteo, Fellahi, Jean Luc, Yonis, Hodane, Richard, Jean Christophe, Parasido, Alessandro, Verhoye, Jean-Philippe, Flecher, Erwan, Ajrhourh, Lucrezia, Nesseler, Nicolas, Mansour, Alexandre, Guinot, Pierre-Gregoire, Zarka, Jonathan, Besserve, Patricia, Makhoul, Maged, Bolotin, Gil, Kassif, Yigal, Soufleris, Dimitros, Schellongowski, Peter, Bonaros, Nikolaos, Krapf, Christoph, Ebert, Kathrin, Mair, Peter, Kothleutner, Florian, Kowalewsky, Mariusz, Christensen, Steffen, Pedersen, Finn Moller, Balik, Martin, Blaha, Jan, Lips, Michal, Otahal, Michal, Camporota, Luigi, Daly, Kathleen, Agnew, Nicola, Barker, Julian, Head, Laura, Garcia, Miguel, Ledot, Stephane, Aquino, Verna, Lewis, Rebecca, Worthy, Jennifer, Noor, Hamza, Scott, Ian, O'Brien, Serena, Conrick-Martin, Ian, Carton, Edmund, Gillon, Stuart, Flemming, Lucy, Broman, Lars Mikael, Grins, Edgars, Ketskalo, Michail, Tsarenko, Sergey, Popugaev, Konstantin, Minin, Sergei, Kornilov, Igor, Skopets, Alexander, Kornelyuk, Roman, Turchaninov, Alexandr, Gorjup, Vojka, Shelukhin, Daniil, Dsouki, Youssef El, Sargin, Murat, Kaygin, Mehmet Ali, Liana, Shestakova, Puss, Severin, Soerensen, Gro, Magnus, Rosen, Kanetoft, Mikael, Watson, Pia, Redfors, Bengt, Krenner, Niklas, Velia Antonini, M, Barrett, Nicholas A, Belliato, Mirko, Davidson, Mark, Finney, Simon, Fowles, Jo-Anne, Halbe, Maximilian, Hennig, Felix, Jones, Tim, Pinto, Luis, Smith, Jonathan, Roeleveld, Peter, Swol, Justyna, Maastricht University Medical Centre (MUMC), Maastricht University [Maastricht], Cardiovascular Research Institute Maastricht (CARIM), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Sorbonne Université - Faculté de Médecine (SU FM), Sorbonne Université (SU), First Faculty of Medicine Charles University [Prague], Intensive Care Medicine, AII - Inflammatory diseases, ANS - Neuroinfection & -inflammation, EuroECMO COVID-19 Working Group, Euro-ELSO Steering Committee, Lorusso, Roberto, Combes, Alain, Coco, Valeria Lo, De Piero, Maria Elena, Belohlavek, Jan (EuroECMO COVID-19, Workinggroup, Euro-ELSO Steering, Committee), Zangrillo, A, Landoni, G, CTC, MUMC+: MA Med Staf Spec CTC (9), RS: Carim - V04 Surgical intervention, MUMC+: MA Alg Ond Onderz CTC (9), Lorusso, R, Combes, A, Coco, V, De Piero, M, Belohlavek, J, Delnoij, T, van der Horst, I, Miranda, D, van der Linden, M, van der Heijden, J, Scholten, E, van Belle-van Haren, N, Lagrand, W, de Jong, S, Candura, D, Maas, J, van den Berg, M, Malfertheiner, M, Dreier, E, Mueller, T, Boeken, U, Akhyari, P, Lichtenberg, A, Saeed, D, Thiele, H, Baumgaertel, M, Schmitto, J, Mariani, S, Thielmann, M, Brenner, T, Benk, C, Czerny, M, Kalbhenn, J, Maier, S, Schibilsky, D, Staudacher, D, Henn, P, Iuliu, T, Muellenbach, R, Reyher, C, Rolfes, C, Zacharowski, K, Lotz, G, Sonntagbauer, M, Kersten, A, Karagiannidis, C, Schafer, S, Fichte, J, Hopf, H, Samalavicius, R, Lorini, L, Ghitti, D, Grazioli, L, Loforte, A, Baiocchi, M, Checco, E, Pacini, D, Meani, P, Cappai, A, Russo, C, Bottiroli, M, Mondino, M, Ranucci, M, Fina, D, Ballotta, A, Scandroglio, A, Pieri, M, Nardelli, P, Fominskiy, E, Fanelli, V, Brazzi, L, Montrucchio, G, Sales, G, Simonetti, U, Urbino, R, Livigni, S, Degani, A, Raffa, G, Pilato, M, Martucci, G, Arcadipane, A, Chiarini, G, Latronico, N, Cattaneo, S, Puglia, C, Reina, G, Sponga, S, Livi, U, Foti, G, Giani, M, Rona, R, Avalli, L, Bombino, M, Costa, M, Carozza, R, Donati, A, Piciche, M, Favaro, A, Salvador, L, Danzi, V, Zanin, A, Condello, I, Fiore, F, Moscarelli, M, Nasso, G, Speziale, G, Sandrelli, L, Montalto, A, Musumeci, F, Circelli, A, Gamberini, E, Russo, E, Benni, M, Agnoletti, V, Rociola, R, Milano, A, Grasso, S, Civita, A, Murgolo, F, Pilato, E, Comentale, G, Montisci, A, Alessandri, F, Tosi, A, Pugliese, F, Carelli, S, Grieco, D, Antonelli, M, Ramoni, E, Di Nardo, M, Maisano, F, Bettex, D, Weber, A, Grunenfelder, J, Consiglio, J, Hansjoerg, J, Haenggi, M, Agus, G, Doeble, T, Zenklusen, U, Bechtold, X, Stockman, B, De Backer, D, Giglioli, S, Meyns, B, Vercaemst, L, Herman, G, Meersseman, P, Vandenbriele, C, Dauwe, D, Vlasselaers, D, Raes, M, Debeuckelaere, G, Rodrigus, I, Biston, P, Piagnerelli, M, Peperstraete, H, Germay, O, Vandewiele, K, Vandeweghe, D, Witters, I, Havrin, S, Bourgeois, M, Taccone, F, Nobile, L, Lheureux, O, Brasseur, A, Creteur, J, Defraigne, J, Misset, B, Courcelle, R, Timmermans, P, Lehaen, J, Frederik, B, Riera, J, Castro, M, Gallart, E, Martinez-Martinez, M, Argudo, E, Garcia-de-Acilu, M, de Pablo Sanchez, R, Ortiz, A, Cabanes, M, Higa, K, Cassina, A, Berbel, D, Sanchez-Salado, J, Arnau, B, de Gopegui, P, Ricart, P, Sandoval, E, Veganzones, J, Millan, P, de la Sota, P, Santa Teresa, P, Alcantara, S, Alvarez, J, Gonzalez, A, Lopez, M, Gordillo, A, Naranjo-Izurieta, J, Costa, R, Albacete Moreno, C, de Ayala, J, Blanco-Schweizer, P, Andres, N, Boado, V, Martinez, J, Casal, V, Garcia, E, Martin-Villen, L, Climent, J, Pinto, L, Leprince, P, Lebreton, G, Juvin, C, Schmidt, M, Pineton, M, Folliguet, T, Saiydoun, G, Gaudard, P, Colson, P, Obadia, J, Pozzi, M, Fellahi, J, Yonis, H, Richard, J, Parasido, A, Verhoye, J, Flecher, E, Ajrhourh, L, Nesseler, N, Mansour, A, Guinot, P, Zarka, J, Besserve, P, Makhoul, M, Bolotin, G, Kassif, Y, Soufleris, D, Schellongowski, P, Bonaros, N, Krapf, C, Ebert, K, Mair, P, Kothleutner, F, Kowalewsky, M, Christensen, S, Pedersen, F, Balik, M, Blaha, J, Lips, M, Otahal, M, Camporota, L, Daly, K, Agnew, N, Barker, J, Head, L, Garcia, M, Ledot, S, Aquino, V, Lewis, R, Worthy, J, Noor, H, Scott, I, O'Brien, S, Conrick-Martin, I, Carton, E, Gillon, S, Flemming, L, Broman, L, Grins, E, Ketskalo, M, Tsarenko, S, Popugaev, K, Minin, S, Kornilov, I, Skopets, A, Kornelyuk, R, Turchaninov, A, Gorjup, V, Shelukhin, D, Dsouki, Y, Sargin, M, Kaygin, M, Liana, S, Puss, S, Soerensen, G, Magnus, R, Kanetoft, M, Watson, P, Redfors, B, Krenner, N, Velia Antonini, M, Barrett, N, Belliato, M, Davidson, M, Finney, S, Fowles, J, Halbe, M, Hennig, F, Jones, T, Smith, J, Roeleveld, P, Swol, J, Lorusso R., Combes A., Coco V.L., De Piero M.E., and Belohlavek J, EuroECMO COVID-19 WorkingGroup, and Euro-ELSO Steering Committee, Pacini D
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2019-20 coronavirus outbreak ,medicine.medical_specialty ,Letter ,Coronavirus disease 2019 (COVID-19) ,Pain medicine ,medicine.medical_treatment ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,[SDV]Life Sciences [q-bio] ,MEDLINE ,610 Medicine & health ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,covid, ecmo, respiratory failure ,0302 clinical medicine ,Critical Care Medicine ,General & Internal Medicine ,Anesthesiology ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Israel ,ComputingMilieux_MISCELLANEOUS ,Science & Technology ,business.industry ,COVID-19 ,030208 emergency & critical care medicine ,3. Good health ,Europe ,Emergency medicine ,Human medicine ,ECMO ,business ,Life Sciences & Biomedicine ,Human - Abstract
ispartof: INTENSIVE CARE MEDICINE vol:47 issue:3 pages:344-348 ispartof: location:United States status: published
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- 2021
106. Extracorporeal membrane oxygenation in patients with severe respiratory failure from COVID-19
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Sobaata Chaudhry, Megan L. Krajewski, Mark E. Anderson, Sara Mirza, Tanveer Shaukat, Adam E. Green, Anip Bansal, Matthew W. Semler, David E. Leaf, David M. Charytan, Stop-Covid Investigators, Shahzad Shaefi, Anand Srivastava, Miguel A. Hernán, Keith M. Wille, Vasil Peev, Harkarandeep Singh, Brian O’Gara, Andrew J Admon, Salim S. Hayek, Shruti Gupta, Wei Wang, Samantha K Brenner, Tanya S. Johns, Amanda K. Leonberg-Yoo, Kusum S. Mathews, Ariel Mueller, and Justin Arunthamakun
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Adult ,Male ,VV-ECMO ,ARDS ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Original ,medicine.medical_treatment ,Severe respiratory failure ,Critical Care and Intensive Care Medicine ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology ,medicine ,Extracorporeal membrane oxygenation ,Humans ,In patient ,Mortality ,Respiratory Distress Syndrome ,Critically ill ,business.industry ,COVID-19 ,030208 emergency & critical care medicine ,Middle Aged ,medicine.disease ,Treatment Outcome ,surgical procedures, operative ,030228 respiratory system ,Respiratory failure ,Anesthesia ,Female ,business ,Cohort study - Abstract
Purpose Limited data are available on venovenous extracorporeal membrane oxygenation (ECMO) in patients with severe hypoxemic respiratory failure from coronavirus disease 2019 (COVID-19). Methods We examined the clinical features and outcomes of 190 patients treated with ECMO within 14 days of ICU admission, using data from a multicenter cohort study of 5122 critically ill adults with COVID-19 admitted to 68 hospitals across the United States. To estimate the effect of ECMO on mortality, we emulated a target trial of ECMO receipt versus no ECMO receipt within 7 days of ICU admission among mechanically ventilated patients with severe hypoxemia (PaO2/FiO2
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- 2021
107. Correction to: Bleeding and thrombotic events in adults supported with venovenous extracorporeal membrane oxygenation: an ELSO registry analysis.
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Nunez, Jose I., Gosling, Andre F., O'Gara, Brian, Kennedy, Kevin F., Rycus, Peter, Abrams, Darryl, Brodie, Daniel, Shaefi, Shahzad, Garan, A. Reshad, and Grandin, E. Wilson
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EXTRACORPOREAL membrane oxygenation , *HEMORRHAGE - Abstract
Correction to: Intensive Care Med https://doi.org/10.1007/s00134-021-06593-x Figures 2 has been published incorrect. BTEs, bleeding and thrombotic events; Oxy/pump failure, oxygenator/pump failure Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Correction to: Bleeding and thrombotic events in adults supported with venovenous extracorporeal membrane oxygenation: an ELSO registry analysis. [Extracted from the article]
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- 2022
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108. Extracorporeal life support for adults with acute respiratory distress syndrome
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Daniel Brodie, Niall D. Ferguson, Kathryn M Rowan, Antonio Pesenti, Kiran Shekar, Alain Combes, Arthur S. Slutsky, John F. Fraser, Eddy Fan, Marco Ranieri, Carol L. Hodgson, Matthieu Schmidt, Samir Jaber, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Australian and New Zealand Intensive Care-Research Centre, Monash University, Melbourne, University of Toronto, Toronto, ON, University Health Network, Toronto, ON, University of Queensland [Brisbane], Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), University of Milan, University of Bologna, Clinical Trials Unit, Intensive Care National Audit and Research Centre (ICNARC), London, the Prince Charles Hospital, Brisbane, QLD, Interdepartmental Division of Critical Care Medicine, Departments of Medicine and Physiology and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Center for Acute Respiratory Failure, NewYork-Presbyterian Hospital, New York, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Università degli Studi di Milano = University of Milan (UNIMI), University of Bologna/Università di Bologna, The Prince Charles Hospital, and MORNET, Dominique
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Adult ,Extracorporeal Circulation ,ARDS ,[SDV]Life Sciences [q-bio] ,medicine.medical_treatment ,Review ,Acute respiratory failure ,Critical Care and Intensive Care Medicine ,Extracorporeal ,03 medical and health sciences ,Plateau pressure ,Mechanical ventilation ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,Tidal Volume ,Extracorporeal membrane oxygenation ,Humans ,Medicine ,ComputingMilieux_MISCELLANEOUS ,Tidal volume ,Outcome ,Respiratory Distress Syndrome ,business.industry ,030208 emergency & critical care medicine ,medicine.disease ,Respiration, Artificial ,Cannula ,3. Good health ,[SDV] Life Sciences [q-bio] ,030228 respiratory system ,Anesthesia ,Breathing ,business - Abstract
Extracorporeal life support (ECLS) can support gas exchange in patients with the acute respiratory distress syndrome (ARDS). During ECLS, venous blood is drained from a central vein via a cannula, pumped through a semipermeable membrane that permits diffusion of oxygen and carbon dioxide, and returned via a cannula to a central vein. Two related forms of ECLS are used. Venovenous extracorporeal membrane oxygenation (ECMO), which uses high blood flow rates to both oxygenate the blood and remove carbon dioxide, may be considered in patients with severe ARDS whose oxygenation or ventilation cannot be maintained adequately with best practice conventional mechanical ventilation and adjunctive therapies, including prone positioning. Extracorporeal carbon dioxide removal (ECCO2R) uses lower blood flow rates through smaller cannulae and provides substantial CO2 elimination (~ 20–70% of total CO2 production), albeit with marginal improvement in oxygenation. The rationale for using ECCO2R in ARDS is to facilitate lung-protective ventilation by allowing a reduction of tidal volume, respiratory rate, plateau pressure, driving pressure and mechanical power delivered by the mechanical ventilator. This narrative review summarizes physiological concepts related to ECLS, as well as the rationale and evidence supporting ECMO and ECCO2R for the treatment of ARDS. It also reviews complications, limitations, and the ethical dilemmas that can arise in treating patients with ECLS. Finally, it discusses future key research questions and challenges for this technology.
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- 2020
109. ECMO for severe ARDS: systematic review and individual patient data meta-analysis
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David Hajage, Alain Combes, Darryl Abrams, Diana Elbourne, Giles J. Peek, Agnès Dechartres, Matthieu Schmidt, and Pollyanna Hardy
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Risk ,ARDS ,medicine.medical_specialty ,Randomization ,Original ,Individual patient data meta-analysis ,medicine.medical_treatment ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,Internal medicine ,Anesthesiology ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Randomized Controlled Trials as Topic ,Respiratory Distress Syndrome ,Cross-Over Studies ,Acute respiratory distress syndrome ,business.industry ,Adult patients ,030208 emergency & critical care medicine ,Patient data ,medicine.disease ,Respiration, Artificial ,Confidence interval ,3. Good health ,surgical procedures, operative ,030228 respiratory system ,Meta-analysis ,Relative risk ,business - Abstract
Purpose To assess the effect of venovenous extracorporeal membrane oxygenation (ECMO) compared to conventional management in patients with severe acute respiratory distress syndrome (ARDS). Methods We conducted a systematic review and individual patient data meta-analysis of randomised controlled trials (RCTs) performed after Jan 1, 2000 comparing ECMO to conventional management in patients with severe ARDS. The primary outcome was 90-day mortality. Primary analysis was by intent-to-treat. Results We identified two RCTs (CESAR and EOLIA) and combined data from 429 patients. On day 90, 77 of the 214 (36%) ECMO-group and 103 of the 215 (48%) control group patients had died (relative risk (RR), 0.75, 95% confidence interval (CI) 0.6–0.94; P = 0.013; I2 = 0%). In the per-protocol and as-treated analyses the RRs were 0.75 (95% CI 0.6–0.94) and 0.86 (95% CI 0.68–1.09), respectively. Rescue ECMO was used for 36 (17%) of the 215 control patients (35 in EOLIA and 1 in CESAR). The RR of 90-day treatment failure, defined as death for the ECMO-group and death or crossover to ECMO for the control group was 0.65 (95% CI 0.52–0.8; I2 = 0%). Patients randomised to ECMO had more days alive out of the ICU and without respiratory, cardiovascular, renal and neurological failure. The only significant treatment-covariate interaction in subgroups was lower mortality with ECMO in patients with two or less organs failing at randomization. Conclusions In this meta-analysis of individual patient data in severe ARDS, 90-day mortality was significantly lowered by ECMO compared with conventional management. Electronic supplementary material The online version of this article (10.1007/s00134-020-06248-3) contains supplementary material, which is available to authorized users.
- Published
- 2020
110. Changes in cerebral hemodynamics after veno-venous extracorporeal membrane oxygenation implementation
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Anna Maria Bombardieri, Filippo Annoni, Francesco Partipilo, and Fabio Silvio Taccone
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Extracorporeal Membrane Oxygenation ,Hemodynamics ,Humans ,Respiratory Insufficiency ,Critical Care and Intensive Care Medicine - Published
- 2022
111. How to manage anticoagulation during extracorporeal membrane oxygenation
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Jerrold H, Levy, Thomas, Staudinger, and Marie E, Steiner
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Extracorporeal Membrane Oxygenation ,Heparin ,Anticoagulants ,Humans ,Blood Coagulation - Published
- 2022
112. Bleeding and thrombotic events in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study
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Alexandre, Mansour, Erwan, Flecher, Matthieu, Schmidt, Bertrand, Rozec, Isabelle, Gouin-Thibault, Maxime, Esvan, Claire, Fougerou, Bruno, Levy, Alizée, Porto, James T, Ross, Marylou, Para, Sabrina, Manganiello, Guillaume, Lebreton, André, Vincentelli, Nicolas, Nesseler, and Yannick, Fedun
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Cohort Studies ,Extracorporeal Membrane Oxygenation ,Anticoagulants ,COVID-19 ,Humans ,Hemorrhage ,Thrombosis ,Intracranial Hemorrhages ,Retrospective Studies - Abstract
To describe bleeding and thrombotic events and their risk factors in patients receiving extracorporeal membrane oxygenation (ECMO) for severe coronavirus disease 2019 (COVID-19) and to evaluate their impact on in-hospital mortality.The ECMOSARS registry included COVID-19 patients supported by ECMO in France. We analyzed all patients included up to March 31, 2022 without missing data regarding bleeding and thrombotic events. The association of bleeding and thrombotic events with in-hospital mortality and pre-ECMO variables was assessed using multivariable logistic regression models.Among 620 patients supported by ECMO, 29% had only bleeding events, 16% only thrombotic events and 20% both bleeding and thrombosis. Cannulation site (18% of patients), ear nose and throat (12%), pulmonary bleeding (9%) and intracranial hemorrhage (8%) were the most frequent bleeding types. Device-related thrombosis and pulmonary embolism/thrombosis accounted for most of thrombotic events. In-hospital mortality was 55.7%. Bleeding events were associated with in-hospital mortality (adjusted odds ratio (adjOR) = 2.91[1.94-4.4]) but not thrombotic events (adjOR = 1.02[0.68-1.53]). Intracranial hemorrhage was strongly associated with in-hospital mortality (adjOR = 13.5[4.4-41.5]). Ventilation duration before ECMO ≥ 7 days and length of ECMO support were associated with bleeding. Thrombosis-associated factors were fibrinogen ≥ 6 g/L and length of ECMO support.In a nationwide cohort of COVID-19 patients supported by ECMO, bleeding incidence was high and associated with mortality. Intracranial hemorrhage incidence was higher than reported for non-COVID patients and carried the highest risk of death. Thrombotic events were less frequent and not associated with mortality. Length of ECMO support was associated with a higher risk of both bleeding and thrombosis, supporting the development of strategies to minimize ECMO duration.
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- 2022
113. The ICM research agenda on extracorporeal life support.
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Combes, Alain, Brodie, Dan, Chen, Yih-Sharng, Fan, Eddy, Henriques, José, Hodgson, Carol, Lepper, Philipp, Leprince, Pascal, Maekawa, Kunihiko, Muller, Thomas, Nuding, Sebastian, Ouweneel, Dagmar, Roch, Antoine, Schmidt, Matthieu, Takayama, Hiroo, Vuylsteke, Alain, Werdan, Karl, Papazian, Laurent, Henriques, José P S, and Lepper, Philipp M
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EXTRACORPOREAL membrane oxygenation , *ADULT respiratory distress syndrome treatment , *CARDIAC resuscitation , *CARDIOGENIC shock , *PHYSICAL therapy , *LUNG transplantation , *ARTIFICIAL respiration , *PATIENTS , *CATASTROPHIC illness , *ACUTE diseases , *LUNG injuries , *CARDIAC arrest , *CLINICAL trials , *LONGITUDINAL method , *MEDICAL protocols , *MEDICAL research , *HEALTH outcome assessment , *RETROSPECTIVE studies , *THERAPEUTICS ,RESPIRATORY insufficiency treatment - Abstract
Purpose: This study aimed to concisely describe the current standards of care, major recent advances, common beliefs that have been contradicted by recent trials, areas of uncertainty, and clinical studies that need to be performed over the next decade and their expected outcomes with regard to extracorporeal membrane oxygenation (ECMO).Methods: Narrative review based on a systematic analysis of the medical literature, national and international guidelines, and expert opinion.Results: The use of venovenous ECMO (VV-ECMO) is increasing in the most severe forms of acute lung injury. In patients with cardiogenic shock, short-term veno-arterial ECMO (VA-ECMO) provides both pulmonary and circulatory support. Technological improvements and recently published studies suggest that ECMO is able to improve patients' outcomes. There are, however, many uncertainties regarding the real benefits of this technique both in hemodynamic and respiratory failure, the territorial organization to deliver ECMO, the indications and the use of concomitant treatments.Conclusions: Although there have been considerable advances regarding the use of ECMO in critically ill patients, the risk/benefit ratio remains underinvestigated. ECMO indications, organization of ECMO delivery, and use of adjuvant therapeutics need also to be explored. Ongoing and future studies may be able to resolve these issues. [ABSTRACT FROM AUTHOR]- Published
- 2017
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114. Post-ECMO decannulation right atrial fibrin sheath.
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Gonzalez-Ciccarelli LF, Bartz R, and Varelmann D
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- Humans, Retrospective Studies, Heart Atria diagnostic imaging, Extracorporeal Membrane Oxygenation, Atrial Fibrillation
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- 2023
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115. Venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock post-cardiac arrest.
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de Chambrun, Marc Pineton, Bréchot, Nicolas, Lebreton, Guillaume, Schmidt, Matthieu, Hekimian, Guillaume, Demondion, Pierre, Trouillet, Jean-Louis, Leprince, Pascal, Chastre, Jean, Combes, Alain, Luyt, Charles-Edouard, and Pineton de Chambrun, Marc
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CARDIOGENIC shock , *EXTRACORPOREAL membrane oxygenation , *CARDIAC arrest , *CARDIOPULMONARY resuscitation , *INTENSIVE care units , *THERAPEUTICS - Abstract
Purpose: To describe the characteristics, outcomes, and risk factors associated with poor outcome of venoarterial extracorporeal membrane oxygenation (VA-ECMO)-treated patients with refractory shock post-cardiac arrest.Methods: We retrospectively analyzed data collected prospectively (March 2007-January 2015) in a 26-bed tertiary hospital intensive care unit. All patients implanted with VA-ECMO for refractory cardiogenic shock after successful resuscitation from cardiac arrest were included. Refractory cardiac arrest patients, given VA-ECMO under cardiopulmonary resuscitation, were excluded.Results: Ninety-four patients received VA-ECMO for refractory shock post-cardiac arrest. Their hospital and 12-month survival rates were 28 and 27 %, respectively. All 1-year survivors were cerebral performance category 1. Multivariable analysis retained INR >2.4 (OR 4.9; 95 % CI 1.4-17.2), admission SOFA score >14 (OR 5.3; 95 % CI 1.7-16.5), and shockable rhythm (OR 0.3; 95 % CI 0.1-0.9) as independent predictors of hospital mortality, but not SAPS II, out-of-hospital cardiac arrest score, or other cardiac arrest variables. Only 10 % of patients with an admission SOFA score >14 survived, whereas 50 % of those with scores ≤14 were alive at 1 year. Restricting the analysis to the 67 patients with out-of-hospital cardiac arrest of coronary cause yielded similar results.Conclusion: Among 94 patients implanted with VA-ECMO for refractory cardiogenic shock post-cardiac arrest resuscitation, the 24 (27 %) 1-year survivors had good neurological outcomes, but survival was significantly better for patients with admission SOFA scores <14, shockable rhythm, and INR ≤2.4. VA-ECMO might be considered a rescue therapy for patients with refractory cardiogenic shock post-cardiac arrest resuscitation. [ABSTRACT FROM AUTHOR]- Published
- 2016
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116. Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis.
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Ouweneel, Dagmar, Schotborgh, Jasper, Limpens, Jacqueline, Sjauw, Krischan, Engström, A., Lagrand, Wim, Cherpanath, Thomas, Driessen, Antoine, Mol, Bas, Henriques, José, Ouweneel, Dagmar M, Schotborgh, Jasper V, Sjauw, Krischan D, Engström, A E, Lagrand, Wim K, Cherpanath, Thomas G V, Driessen, Antoine H G, de Mol, Bas A J M, and Henriques, José P S
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- *
CARDIOGENIC shock , *CARDIAC arrest , *THERAPEUTICS , *EXTRACORPOREAL membrane oxygenation , *CARDIOPULMONARY resuscitation , *MYOCARDIAL infarction , *SYSTEMATIC reviews , *META-analysis , *TREATMENT effectiveness , *RETROSPECTIVE studies - Abstract
Purpose: Veno-arterial extracorporeal life support (ECLS) is increasingly used in patients during cardiac arrest and cardiogenic shock, to support both cardiac and pulmonary function. We performed a systematic review and meta-analysis of cohort studies comparing mortality in patients treated with and without ECLS support in the setting of refractory cardiac arrest and cardiogenic shock complicating acute myocardial infarction.Methods: We systematically searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the publisher subset of PubMed updated to December 2015. Thirteen studies were included of which nine included cardiac arrest patients (n = 3098) and four included patients with cardiogenic shock after acute myocardial infarction (n = 235). Data were pooled by a Mantel-Haenzel random effects model and heterogeneity was examined by the I 2 statistic.Results: In cardiac arrest, the use of ECLS was associated with an absolute increase of 30 days survival of 13 % compared with patients in which ECLS was not used [95 % CI 6-20 %; p < 0.001; number needed to treat (NNT) 7.7] and a higher rate of favourable neurological outcome at 30 days (absolute risk difference 14 %; 95 % CI 7-20 %; p < 0.0001; NNT 7.1). Propensity matched analysis, including 5 studies and 438 patients (219 in both groups), showed similar results. In cardiogenic shock, ECLS showed a 33 % higher 30-day survival compared with IABP (95 % CI, 14-52 %; p < 0.001; NNT 13) but no difference when compared with TandemHeart/Impella (-3 %; 95 % CI -21 to 14 %; p = 0.70; NNH 33).Conclusions: In cardiac arrest, the use of ECLS was associated with an increased survival rate as well as an increase in favourable neurological outcome. In the setting of cardiogenic shock there was an increased survival with ECLS compared with IABP. [ABSTRACT FROM AUTHOR]- Published
- 2016
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117. Protein C zymogen in severe sepsis: a double-blinded, placebo-controlled, randomized study.
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Pappalardo, Federico, Crivellari, Martina, Di Prima, Ambra, Agracheva, Nataliya, Celinska-Spodar, Malgorzata, Lembo, Rosalba, Taddeo, Daiana, Landoni, Giovanni, Zangrillo, Alberto, and Di Prima, Ambra L
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- *
SEPSIS , *PROTEIN C , *ZYMOGENS , *SEPTICEMIA treatment , *EXTRACORPOREAL membrane oxygenation , *PATIENTS , *FIBRINOLYTIC agents , *APACHE (Disease classification system) , *BLOOD proteins , *CHI-squared test , *COMPARATIVE studies , *CYTOPLASM , *LENGTH of stay in hospitals , *INTENSIVE care units , *INTRAVENOUS therapy , *RESEARCH methodology , *MEDICAL cooperation , *RESEARCH , *SEPTIC shock , *EVALUATION research , *RANDOMIZED controlled trials , *TREATMENT effectiveness , *BLIND experiment - Abstract
Purpose: To determine whether protein C zymogen (protein C concentrates or human protein C) improves clinically relevant outcomes in adult patients with severe sepsis and septic shock.Methods: This is a randomized, double-blind, placebo-controlled, parallel-group trial that from September 2012 to June 2014 enrolled adult patients with severe sepsis or septic shock and high risk of death and of bleeding (e.g., APACHE II greater than 25, extracorporeal membrane oxygenation or disseminated intravascular coagulopathy). All patients completed their follow-up 90 days after randomization and data were analyzed according to the intention-to-treat principle. Follow-up was performed at 30 and 90 days after randomization. The primary endpoint was a composite outcome of prolonged intensive care unit (ICU) stay and/or 30-day mortality. Secondary endpoints included mortality.Results: The study was stopped early in a situation of futility for the composite outcome of prolonged ICU stay and/or 30-day mortality that was 79 % (15 patients) in the protein C zymogen group and 67 % (12 patients) in the placebo group (p = 0.40) and for a concomitant safety issue: ICU mortality was 79 % (15 patients) in the protein C zymogen group vs 39 % (7 patients) in the placebo group (p = 0.020), and 30-day mortality was 68 vs 39 % (p = 0.072).Conclusion: Protein C zymogen did not improve clinically relevant outcomes in severe sepsis and septic shock adult patients. Given its high cost and the potential increase in mortality, the use of this drug in adult patients should be discouraged. [ABSTRACT FROM AUTHOR]- Published
- 2016
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118. Associations between ventilator settings during extracorporeal membrane oxygenation for refractory hypoxemia and outcome in patients with acute respiratory distress syndrome: a pooled individual patient data analysis : Mechanical ventilation during ECMO.
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Serpa Neto, Ary, Schmidt, Matthieu, Azevedo, Luciano, Bein, Thomas, Brochard, Laurent, Beutel, Gernot, Combes, Alain, Costa, Eduardo, Hodgson, Carol, Lindskov, Christian, Lubnow, Matthias, Lueck, Catherina, Michaels, Andrew, Paiva, Jose-Artur, Park, Marcelo, Pesenti, Antonio, Pham, Tài, Quintel, Michael, Marco Ranieri, V., and Ried, Michael
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ADULT respiratory distress syndrome , *EXTRACORPOREAL membrane oxygenation , *DATA analysis , *META-analysis , *BODY mass index , *PATIENTS , *THERAPEUTICS - Abstract
Purpose: Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for patients with acute respiratory distress syndrome (ARDS). The aim of this study was to evaluate associations between ventilatory settings during ECMO for refractory hypoxemia and outcome in ARDS patients.Methods: In this individual patient data meta-analysis of observational studies in adult ARDS patients receiving ECMO for refractory hypoxemia, a time-dependent frailty model was used to determine which ventilator settings in the first 3 days of ECMO had an independent association with in-hospital mortality.Results: Nine studies including 545 patients were included. Initiation of ECMO was accompanied by significant decreases in tidal volume size, positive end-expiratory pressure (PEEP), plateau pressure, and driving pressure (plateau pressure - PEEP) levels, and respiratory rate and minute ventilation, and resulted in higher PaO2/FiO2, higher arterial pH and lower PaCO2 levels. Higher age, male gender and lower body mass index were independently associated with mortality. Driving pressure was the only ventilatory parameter during ECMO that showed an independent association with in-hospital mortality [adjusted HR, 1.06 (95 % CI, 1.03-1.10)].Conclusion: In this series of ARDS patients receiving ECMO for refractory hypoxemia, driving pressure during ECMO was the only ventilator setting that showed an independent association with in-hospital mortality. [ABSTRACT FROM AUTHOR]- Published
- 2016
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119. ECMO for immunosuppressed patients with acute respiratory distress syndrome: drawing a line in the sand.
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Schmidt, Matthieu, Combes, Alain, and Shekar, Kiran
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ADULT respiratory distress syndrome , *IMMUNOCOMPROMISED patients , *EXTRACORPOREAL membrane oxygenation , *INTENSIVE care units - Abstract
The article offers information on the use of extracorporeal membrane oxygenation (ECMO) for immunosuppressed patients with acute respiratory distress syndrome. It discusses that challenges in providing care to the intensive care unit patients. It mentions that challenges in increasingly encountering immunosuppressed patients with acute respiratory distress syndrome.
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- 2019
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120. SUPERNOVA: will its energy trigger the formation of a new therapeutic star?
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Bein, Thomas, De Jong, Audrey, and Perner, Anders
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EXTRACORPOREAL membrane oxygenation , *ADULT respiratory distress syndrome , *SUPERNOVAE - Abstract
The authors comment on the feasibility trial of ECCO2-R veno venous devices allowing extracorporeal blood flows as protective ventilation for acute respiratory distress syndrome. They claim that it is debatable whether a substantial number of participants in the study with coagulation problems, clotting or bleeding, allows a statement whether ECCO2 R is feasible. They believe that further studies are required to reach a targeted balance between anticoagulation and low extracorporeal blood flow.
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- 2019
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121. Prone positioning and extracorporeal membrane oxygenation for severe acute respiratory distress syndrome: time for a randomized trial?
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Guervilly, Christophe, Prud'homme, Eloi, Pauly, Vanessa, Bourenne, Jérémie, Hraiech, Sami, Daviet, Florence, Adda, Mélanie, Coiffard, Benjamin, Forel, Jean Marie, Roch, Antoine, Persico, Nicolas, and Papazian, Laurent
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- *
ADULT respiratory distress syndrome , *EXTRACORPOREAL membrane oxygenation , *TIME trials - Abstract
The authors discuss a retrospective observational study to compare outcomes of severe acute respiratory distress syndrome (ARDS) patients under veno-venous extracorporeal membrane oxygenation (vvECMO) according to the use of prone positioning (PP). Findings showed that patients with severe ARDS who underwent PP ECMO were more likely to be weaned from ECMO. They claim that findings from the study warrant justification for further clinical trials on the value of PP in ECMO.
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- 2019
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122. Determination of brain death under extracorporeal life support.
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Bein, Thomas, Müller, Thomas, and Citerio, Giuseppe
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BRAIN death , *PROOF & certification of death , *MEDICAL ethics , *POSITIVE end-expiratory pressure , *EXTRACORPOREAL membrane oxygenation - Abstract
The article offers information of the diagnosis of brain death under extracorporeal life support for extracorporeal membrane oxygenation (ECMO) patients. Topics discussed include clinical examination of complete termination of brain function for diagnosis of brain death; careful protocol for brain death diagnosis which involve clinical examination, apnea test, and confirmatory technical tests; and need of careful evaluation and professional treatment organ donation of brain-dead ECMO patients.
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- 2019
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123. Focus on extracorporeal life support.
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Schellongowski, Peter, Combes, Alain, and Møller, Morten Hylander
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EXTRACORPOREAL membrane oxygenation , *ADULT respiratory distress syndrome treatment , *CLINICAL trials - Abstract
An introduction is presented in which the editors discuss various articles within the issue on topics including veno-venous extracorporeal membrane oxygenation (VV-ECMO) in severe acute respiratory distress syndrome (ARDS) patients, extracorporeal life support (ECLS), and extracorporeal membrane oxygenation in severe ARDS (EOLIA) trial.
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- 2018
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124. Albumin fluid resuscitation in patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO) therapy is associated with improved survival.
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Wengenmayer, Tobias, Schroth, Florentine, Biever, Paul M., Duerschmied, Daniel, Benk, Christoph, Trummer, Georg, Kaier, Klaus, Bode, Christoph, and Staudacher, Dawid L.
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SERUM albumin , *EXTRACORPOREAL membrane oxygenation , *INTENSIVE care units , *CARDIOGENIC shock , *FLUID therapy , *SURVIVAL analysis (Biometry) , *ALBUMINS , *RETROSPECTIVE studies - Published
- 2018
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125. Have we averted deaths using venoarterial ECMO?
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Schmidt, Matthieu, Wunsch, Hannah, and Brodie, Daniel
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EXTRACORPOREAL membrane oxygenation , *CRITICAL care medicine , *CARDIAC arrest , *MYOCARDIAL infarction , *ARTIFICIAL implants - Abstract
The article offers information on topics related to venoarterial extracorporeal membrane oxygenation (VA-ECMO) in critical care. Topics mentioned include the effectiveness of VA-ECMO in the prevention of death to cardiac arrest patient, the management of acute myocardial infarction, and the importance of the ECMO implantation.
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- 2018
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126. Do trials that report a neutral or negative treatment effect improve the care of critically ill patients? No.
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Vincent, Jean-Louis, Marini, John J., and Pesenti, Antonio
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RANDOMIZED controlled trials , *CRITICALLY ill patient care , *TREATMENT effectiveness , *ADVERSE health care events , *ADRENOCORTICAL hormones , *EXTRACORPOREAL membrane oxygenation - Abstract
The authors talk about the lack of positive impact of randomized controlled trials (RCTs) that report neutral or negative treatment effect on care of critically ill patients. Topics discussed include the adverse effects of treatment and the lack of their relationship with treatment benefits; the trials focusing on the use of corticosteroids in septic shock; and the need to conduct RCTs for extracorporeal membrane oxygenation (ECMO).
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- 2018
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127. Invasive candidiasis in critical care: challenges and future directions
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Tihana Bicanic, Ignacio Martin-Loeches, and C Logan
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medicine.medical_specialty ,Candida glabrata ,biology ,business.industry ,medicine.medical_treatment ,Acute kidney injury ,030208 emergency & critical care medicine ,Critical Care and Intensive Care Medicine ,biology.organism_classification ,medicine.disease ,Discontinuation ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,Candida auris ,Anesthesiology ,Extracorporeal membrane oxygenation ,Medicine ,Infection control ,Renal replacement therapy ,business ,Intensive care medicine - Abstract
Invasive candidiasis is the most common critical care-associated fungal infection with a crude mortality of ~ 40–55%. Important factors contributing to risk of invasive candidiasis in ICU include use of broad-spectrum antimicrobials, immunosuppressive drugs, and total parenteral nutrition alongside iatrogenic interventions which breach natural barriers to infection [vascular catheters, renal replacement therapy, extracorporeal membrane oxygenation (ECMO), surgery]. This review discusses three key challenges in this field. The first is the shift in Candida epidemiology across the globe to more resistant non-albicans species, in particular, the emergence of multi-resistant Candida glabrata and Candida auris, which pose significant treatment and infection control challenges in critical care. The second challenge lies in the timely and appropriate initiation and discontinuation of antifungal therapy. Early antifungal strategies (prophylaxis, empirical and pre-emptive) using tools such as the Candida colonisation index, clinical prediction rules and fungal non-culture-based tests have been developed: we review the evidence on implementation of these tools in critical care to aid clinical decision-making around the prescribing and cessation of antifungal therapy. The third challenge is selection of the most appropriate antifungal to use in critical care patients. While guidelines exist to aid choice, this heterogenous and complex patient group require a more tailored approach, particularly in cases of acute kidney injury, liver impairment and for patients supported by extracorporeal membrane oxygenation. We highlight key research priorities to overcome these challenges in the future.
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- 2020
128. Platelets and extra-corporeal membrane oxygenation in adult patients
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Platelets ,ANTICOAGULANT ,Extracorporeal membrane oxygenation ,IMPACT ,MORTALITY ,Bleeding ,RESPIRATORY-FAILURE ,ACTIVATION ,THROMBOSIS ,TRANSFUSION ,SUPPORT ,HEPARIN-INDUCED THROMBOCYTOPENIA ,Platelet activation ,ECMO ,Platelet dysfunction - Abstract
Despite increasing improvement in extracorporeal membrane oxygenation (ECMO) technology and knowledge, thrombocytopenia and impaired platelet function are usual findings in ECMO patients and the underlying mechanisms are only partially elucidated. The purpose of this meta-analysis and systematic review was to thoroughly summarize and discuss the existing knowledge of platelet profile in adult ECMO population. All studies meeting the inclusion criteria (detailed data about platelet count and function) were selected, after screening literature from July 1975 to August 2019. Twenty-one studies from 1.742 abstracts were selected. The pooled prevalence of thrombocytopenia in ECMO patients was 21% (95% CI 12.9-29.0; 14 studies). Thrombocytopenia prevalence was 25.4% (95% CI 10.6-61.4; 4 studies) in veno-venous ECMO, whereas it was 23.2% (95% CI 11.8-34.5; 6 studies) in veno-arterial ECMO. Heparin-induced thrombocytopenia prevalence was 3.7% (95% CI 1.8-5.5; 12 studies). Meta-regression revealed no significant association between ECMO duration and thrombocytopenia. Platelet function impairment was described in 7 studies. Impaired aggregation was shown in 5 studies, whereas loss of platelet receptors was found in one trial, and platelet activation was described in 2 studies. Platelet transfusions were needed in up to 50% of the patients. Red blood cell transfusions were administered from 46 to 100% of the ECMO patients. Bleeding events varied from 16.6 to 50.7%, although the cause and type of haemorrhage was not consistently reported. Thrombocytopenia and platelet dysfunction are common in ECMO patients, regardless the type of ECMO mode. The underlying mechanisms are multifactorial, and understanding and management are still limited. Further research to design appropriate strategies and protocols for its monitoring, management, or prevention should be matter of thorough investigations.
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- 2020
129. Platelets and extra-corporeal membrane oxygenation in adult patients: a systematic review and meta-analysis
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Pasquale Mastroroberto, Roberto Lorusso, Giuseppe Filiberto Serraino, Matteo Matteucci, Hugo ten Cate, Dario Fina, and Federica Jiritano
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ANTICOAGULANT ,Platelets ,Adult ,Blood Platelets ,medicine.medical_specialty ,medicine.drug_class ,IMPACT ,medicine.medical_treatment ,Population ,RESPIRATORY-FAILURE ,Hemorrhage ,Critical Care and Intensive Care Medicine ,ACTIVATION ,03 medical and health sciences ,0302 clinical medicine ,Extracorporeal Membrane Oxygenation ,TRANSFUSION ,Internal medicine ,Heparin-induced thrombocytopenia ,SUPPORT ,Extracorporeal membrane oxygenation ,medicine ,Humans ,Platelet activation ,education ,education.field_of_study ,business.industry ,Platelet Count ,MORTALITY ,Bleeding ,Platelet dysfunction ,Thrombocytopenia ,Anticoagulant ,030208 emergency & critical care medicine ,medicine.disease ,Thrombosis ,THROMBOSIS ,surgical procedures, operative ,030228 respiratory system ,Respiratory failure ,Meta-analysis ,HEPARIN-INDUCED THROMBOCYTOPENIA ,Systematic Review ,ECMO ,business - Abstract
Despite increasing improvement in extracorporeal membrane oxygenation (ECMO) technology and knowledge, thrombocytopenia and impaired platelet function are usual findings in ECMO patients and the underlying mechanisms are only partially elucidated. The purpose of this meta-analysis and systematic review was to thoroughly summarize and discuss the existing knowledge of platelet profile in adult ECMO population. All studies meeting the inclusion criteria (detailed data about platelet count and function) were selected, after screening literature from July 1975 to August 2019. Twenty-one studies from 1.742 abstracts were selected. The pooled prevalence of thrombocytopenia in ECMO patients was 21% (95% CI 12.9–29.0; 14 studies). Thrombocytopenia prevalence was 25.4% (95% CI 10.6–61.4; 4 studies) in veno-venous ECMO, whereas it was 23.2% (95% CI 11.8–34.5; 6 studies) in veno-arterial ECMO. Heparin-induced thrombocytopenia prevalence was 3.7% (95% CI 1.8–5.5; 12 studies). Meta-regression revealed no significant association between ECMO duration and thrombocytopenia. Platelet function impairment was described in 7 studies. Impaired aggregation was shown in 5 studies, whereas loss of platelet receptors was found in one trial, and platelet activation was described in 2 studies. Platelet transfusions were needed in up to 50% of the patients. Red blood cell transfusions were administered from 46 to 100% of the ECMO patients. Bleeding events varied from 16.6 to 50.7%, although the cause and type of haemorrhage was not consistently reported. Thrombocytopenia and platelet dysfunction are common in ECMO patients, regardless the type of ECMO mode. The underlying mechanisms are multifactorial, and understanding and management are still limited. Further research to design appropriate strategies and protocols for its monitoring, management, or prevention should be matter of thorough investigations. Electronic supplementary material The online version of this article (10.1007/s00134-020-06031-4) contains supplementary material, which is available to authorized users.
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- 2020
130. Extracorporeal membrane oxygenation for refractory cardiac arrest: a retrospective multicenter study
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Lorenzo Calabrò, Mirko Belliato, Maximilian V. Malfertheiner, Federico Pappalardo, Fabio Silvio Taccone, Enrico Contri, Dirk Lunz, Lars Mikael Broman, Anna Maria Scandroglio, Daniel Patricio, Alois Philipp, and Jacques Creteur
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Male ,Resuscitation ,Subarachnoid hemorrhage ,medicine.medical_treatment ,Critical Care and Intensive Care Medicine ,law.invention ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,Heart arrhythmia ,law ,Extracorporeal membrane oxygenation ,Humans ,Medicine ,Extracorporeal cardiopulmonary resuscitation ,Organ donation ,Aged ,Retrospective Studies ,business.industry ,030208 emergency & critical care medicine ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Intensive care unit ,Cardiopulmonary Resuscitation ,Treatment Outcome ,030228 respiratory system ,Anesthesia ,business ,Out-of-Hospital Cardiac Arrest - Abstract
The aim of this study was to assess the neurologic outcome following extracorporeal cardiopulmonary resuscitation (ECPR) in five European centers. Retrospective database analysis of prospective observational cohorts of patients undergoing ECPR (January 2012–December 2016) was performed. The primary outcome was 3-month favorable neurologic outcome (FO), defined as the cerebral performance categories of 1–2. Survival to ICU discharge and the number of patients undergoing organ donation were secondary outcomes. A subgroup of patients with stringent selection criteria (i.e., age ≤ 65 years, witnessed bystander CPR, no major co-morbidity and ECMO implemented within 1 h from arrest) was also analyzed. A total of 423 patients treated with ECPR were included (median age 57 [48–65] years; male gender 78%); ECPR was initiated for OHCA in 258 (61%) patients. Time from arrest to ECMO implementation was 65 [48–84] min. Eighty patients (19%) had favorable neurological outcome. ICU survival was 24% (n = 102); 23 (5%) non-survivors underwent organ donation procedures. Favorable neurological outcome rate was lower (9% vs. 34%, p
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- 2020
131. ECLS-associated infections in adults: what we know and what we don’t yet know
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Matthieu Schmidt, Giacomo Grasselli, Daniel Brodie, Thomas Mueller, and Darryl Abrams
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endocrine system ,medicine.medical_specialty ,Complications ,Context (language use) ,Review ,Infections ,Critical Care and Intensive Care Medicine ,medicine.disease_cause ,Severity of Illness Index ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,Risk Factors ,Anesthesiology ,Epidemiology ,ELSO registry ,medicine ,Humans ,Registries ,ECLS ,Adverse effect ,Intensive care medicine ,Cardiopulmonary disease ,Cross Infection ,business.industry ,030208 emergency & critical care medicine ,Immune dysregulation ,030228 respiratory system ,Life support ,Etiology ,ECMO ,Nosocomial ,business - Abstract
Extracorporeal life support (ECLS) is increasingly used in the management of patients with severe cardiopulmonary disease. Infections are frequently the etiologies underlying the respiratory, and occasionally cardiac, failure that necessitates ECLS. Just as importantly, infections are among the most commonly reported adverse events during ECLS. Infections in this setting may be the sequelae of prolonged critical illness or of underlying immune dysregulation; they may be hospital-acquired infections, and they may or may not be attributable to the presence of ECLS itself, the latter being an aspect that can be difficult to determine. Current registry data and evidence from the literature offer some insights, but also leave open many questions regarding the nature and significance of infections reported both before and during ECLS, including the question of any causal link between ECLS and the development of infections. An ongoing lack of consistency in the identification, diagnosis, management, and prevention of infections during ECLS is limiting our ability to interpret literature data and thus highlighting the need for more rigorous investigation and standardization of definitions. This review aims to characterize the current understanding of infections associated with the use of ECLS, taking into account data from the updated Extracorporeal Life Support Organization Registry, which provides important context for understanding the epidemiology and outcomes of these patients. Electronic supplementary material The online version of this article (10.1007/s00134-019-05847-z) contains supplementary material, which is available to authorized users.
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- 2019
132. Increased mortality in patients with COVID-19 receiving extracorporeal respiratory support during the second wave of the pandemic
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Jordi, Riera, Roberto, Roncon-Albuquerque, María Paz, Fuset, Sara, Alcántara, Pablo, Blanco-Schweizer, and Emilio, Rodríguez-Ruiz
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medicine.medical_specialty ,Respiratory Distress Syndrome ,Letter ,Coronavirus disease 2019 (COVID-19) ,business.industry ,SARS-CoV-2 ,Pain medicine ,MEDLINE ,COVID-19 ,Critical Care and Intensive Care Medicine ,Extracorporeal ,Respiratory support ,Extracorporeal Membrane Oxygenation ,Anesthesiology ,Emergency medicine ,Pandemic ,medicine ,Humans ,In patient ,business ,Pandemics - Published
- 2021
133. Standardized liberation trials in patients with COVID-19 ARDS treated with venovenous extracorporeal membrane oxygenation: when ready, let them breathe!
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Lorenzo Del Sorbo, Eddy Fan, Pradip Tiwari, Ricardo Teijeiro-Paradis, and Amanda Spriel
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ARDS ,medicine.medical_specialty ,Respiratory Distress Syndrome ,Letter ,Coronavirus disease 2019 (COVID-19) ,business.industry ,SARS-CoV-2 ,medicine.medical_treatment ,Pain medicine ,MEDLINE ,COVID-19 ,Critical Care and Intensive Care Medicine ,medicine.disease ,Intensive Care Units ,Extracorporeal Membrane Oxygenation ,Anesthesiology ,Emergency medicine ,Extracorporeal membrane oxygenation ,medicine ,Liberation ,Humans ,In patient ,business - Published
- 2021
134. What’s new in ECMO for COVID-19?
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Daniel Brodie, Graeme MacLaren, Alain Combes, National University Health System [Singapore] (NUHS), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Gestionnaire, Hal Sorbonne Université
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Adult ,medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,[SDV]Life Sciences [q-bio] ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Pain medicine ,MEDLINE ,COVID-19 ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,[SDV] Life Sciences [q-bio] ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,030228 respiratory system ,Anesthesiology ,Emergency medicine ,medicine ,Humans ,COVID-19 in Intensive Care ,business ,ComputingMilieux_MISCELLANEOUS - Abstract
International audience
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- 2020
135. Development and validation of the pediatric risk estimate score for children using extracorporeal respiratory support (Ped-RESCUERS).
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Barbaro, Ryan, Boonstra, Philip, Paden, Matthew, Roberts, Lloyd, Annich, Gail, Bartlett, Robert, Moler, Frank, Davis, Matthew, Barbaro, Ryan P, Boonstra, Philip S, Paden, Matthew L, Roberts, Lloyd A, Annich, Gail M, Bartlett, Robert H, Moler, Frank W, and Davis, Matthew M
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PEDIATRIC respiratory diseases , *EXTRACORPOREAL membrane oxygenation , *MORTALITY , *LOGISTICS , *BAYESIAN analysis , *DISEASE risk factors , *COMPARATIVE studies , *RESEARCH methodology , *MEDICAL cooperation , *PROBABILITY theory , *RESEARCH , *RESPIRATORY insufficiency , *RISK assessment , *EVALUATION research , *TREATMENT effectiveness , *ACQUISITION of data , *HOSPITAL mortality ,RESPIRATORY insufficiency treatment - Abstract
Purpose: To develop and validate the Pediatric Risk Estimation Score for Children Using Extracorporeal Respiratory Support (Ped-RESCUERS). Ped-RESCUERS is designed to estimate the in-hospital mortality risk for children prior to receiving respiratory extracorporeal membrane oxygenation (ECMO) support.Methods: This study used data from an international registry of patients aged 29 days to less than 18 years who received ECMO support from 2009 to 2014. We divided the registry into development and validation datasets by calendar date. Candidate variables were selected for model inclusion if the variable independently changed the mortality risk by at least 2 % in a Bayesian logistic regression model with in-hospital mortality as the outcome. We characterized the model's ability to discriminate mortality with the area under curve (AUC) of the receiver operating characteristic.Results: From 2009 to 2014, 2458 non-neonatal children received ECMO for respiratory support, with a mortality rate of 39.8 %. The development dataset contained 1611 children receiving ECMO support from 2009 to 2012. The model included the following variables: pre-ECMO pH, pre-ECMO arterial partial pressure of carbon dioxide, hours of intubation prior to ECMO support, hours of admission at ECMO center prior to ECMO support, ventilator type, mean airway pressure, pre-ECMO use of milrinone, and a diagnosis of pertussis, asthma, bronchiolitis, or malignancy. The validation dataset included 438 children receiving ECMO support from 2013 to 2014. The Ped-RESCUERS model from the development dataset had an AUC of 0.690, and the validation dataset had an AUC of 0.634.Conclusions: Ped-RESCUERS provides a novel measure of pre-ECMO mortality risk. Future studies should seek external validation and improved discrimination of this mortality prediction tool. [ABSTRACT FROM AUTHOR]- Published
- 2016
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136. Extracorporeal membrane oxygenation: evolving epidemiology and mortality.
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Karagiannidis, Christian, Brodie, Daniel, Strassmann, Stephan, Stoelben, Erich, Philipp, Alois, Bein, Thomas, Müller, Thomas, Windisch, Wolfram, and Müller, Thomas
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EXTRACORPOREAL membrane oxygenation , *EPIDEMIOLOGY , *MORTALITY , *HEART failure , *HEART failure treatment , *RESPIRATORY insufficiency , *DISEASE incidence , *HOSPITAL mortality ,GERMANY. Federal Statistical Office ,RESPIRATORY insufficiency treatment - Abstract
Purpose: The evolution of the epidemiology and mortality of extracorporeal membrane oxygenation (ECMO) remains unclear. The present study investigates the evolving epidemiology and mortality of various ECMO techniques in Germany over time, used for both severe respiratory and cardiac failure.Methods: Data on all patients receiving venovenous (vv-ECMO) and venoarterial (va-ECMO) ECMO as well as pumpless extracorporeal lung assist/interventional lung assist (PECLA/ILA) outside the operating room in Germany from 1 January 2007 through 31 December 2014 were obtained from the Federal Statistical Office of Germany and analyzed.Results: The incidence of vv-ECMO and va-ECMO in the population increased threefold from 1.0:100,000 inhabitants/year in 2007 to a maximum of 3.0:100,000 in 2012, and from 0.1:100,000 in 2007 to 0.7:100,000 in 2012 and to a maximum of 3.5:100,000 in 2014, respectively. The incidence of arteriovenous PECLA/ILA also increased from 0.4:100,000 to a maximum of 0.6:100,000 in 2011, but decreased thereafter to 0.3:100,000 in 2014. The relative proportion of older patients receiving ECMO is steadily increasing. In-hospital mortality decreased over time and reached 58 and 66 % for vv-ECMO and va-ECMO in 2014, respectively. In addition, mortality steadily increased with age and was especially high in the first 48 h of ECMO use.Conclusions: In a high-income country like Germany, the use of ECMO has been rapidly increasing since 2007 for both respiratory and cardiac support, with a recent plateau in vv-ECMO use. In-hospital mortality decreased with increasing ECMO utilization, but remains high, especially in older patients and in the first 48 h of use. [ABSTRACT FROM AUTHOR]- Published
- 2016
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137. A glossary of ARDS for beginners.
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Guérin, Claude, Moss, Marc, Talmor, Daniel, and Guérin, Claude
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ADULT respiratory distress syndrome , *EXTRACORPOREAL membrane oxygenation , *POSITIVE end-expiratory pressure , *NEUROMUSCULAR blocking agents , *LUNG diseases , *ADULT respiratory distress syndrome treatment , *CRITICAL care medicine , *PULMONARY function tests , *TERMS & phrases , *DIAGNOSIS - Abstract
The article offers a glossary of terms related to adult respiratory distress syndrome (ARDS). These include diffuse alveolar damage, transpulmonary pressure and extracorporeal membrane oxygenation (ECMO). An overview of positive end-expiratory pressure (PEEP), neuromuscular blocking agent (NMBA) and lung strain is also presented.
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- 2016
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138. Experts' opinion on management of hemodynamics in ARDS patients: focus on the effects of mechanical ventilation.
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Vieillard-Baron, A., Matthay, M., Teboul, J., Bein, T., Schultz, M., Magder, S., Marini, J., Teboul, J L, and Marini, J J
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ADULT respiratory distress syndrome , *HEMODYNAMIC monitoring , *ECHOCARDIOGRAPHY , *ARTIFICIAL respiration , *LUNG injuries , *EXTRACORPOREAL membrane oxygenation , *ADULT respiratory distress syndrome treatment , *HEMODYNAMICS , *PATIENT monitoring - Abstract
Rationale: Acute respiratory distress syndrome (ARDS) is frequently associated with hemodynamic instability which appears as the main factor associated with mortality. Shock is driven by pulmonary hypertension, deleterious effects of mechanical ventilation (MV) on right ventricular (RV) function, and associated-sepsis. Hemodynamic effects of ventilation are due to changes in pleural pressure (Ppl) and changes in transpulmonary pressure (TP). TP affects RV afterload, whereas changes in Ppl affect venous return. Tidal forces and positive end-expiratory pressure (PEEP) increase pulmonary vascular resistance (PVR) in direct proportion to their effects on mean airway pressure (mPaw). The acutely injured lung has a reduced capacity to accommodate flowing blood and increases of blood flow accentuate fluid filtration. The dynamics of vascular pressure may contribute to ventilator-induced injury (VILI). In order to optimize perfusion, improve gas exchange, and minimize VILI risk, monitoring hemodynamics is important.Results: During passive ventilation pulse pressure variations are a predictor of fluid responsiveness when conditions to ensure its validity are observed, but may also reflect afterload effects of MV. Central venous pressure can be helpful to monitor the response of RV function to treatment. Echocardiography is suitable to visualize the RV and to detect acute cor pulmonale (ACP), which occurs in 20-25 % of cases. Inserting a pulmonary artery catheter may be useful to measure/calculate pulmonary artery pressure, pulmonary and systemic vascular resistance, and cardiac output. These last two indexes may be misleading, however, in cases of West zones 2 or 1 and tricuspid regurgitation associated with RV dilatation. Transpulmonary thermodilution may be useful to evaluate extravascular lung water and the pulmonary vascular permeability index. To ensure adequate intravascular volume is the first goal of hemodynamic support in patients with shock. The benefit and risk balance of fluid expansion has to be carefully evaluated since it may improve systemic perfusion but also may decrease ventilator-free days, increase pulmonary edema, and promote RV failure. ACP can be prevented or treated by applying RV protective MV (low driving pressure, limited hypercapnia, PEEP adapted to lung recruitability) and by prone positioning. In cases of shock that do not respond to intravascular fluid administration, norepinephrine infusion and vasodilators inhalation may improve RV function. Extracorporeal membrane oxygenation (ECMO) has the potential to be the cause of, as well as a remedy for, hemodynamic problems. Continuous thermodilution-based and pulse contour analysis-based cardiac output monitoring are not recommended in patients treated with ECMO, since the results are frequently inaccurate. Extracorporeal CO2 removal, which could have the capability to reduce hypercapnia/acidosis-induced ACP, cannot currently be recommended because of the lack of sufficient data. [ABSTRACT FROM AUTHOR]- Published
- 2016
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139. Thrombocytopenia and extracorporeal membrane oxygenation in adults with acute respiratory failure: a cohort study.
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Abrams, Darryl, Baldwin, Matthew, Champion, Matthew, Agerstrand, Cara, Eisenberger, Andrew, Bacchetta, Matthew, Brodie, Daniel, and Baldwin, Matthew R
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EXTRACORPOREAL membrane oxygenation , *THROMBOCYTOPENIA , *BLOOD platelets , *BLOOD platelet activation , *HEMORRHAGE , *RESPIRATORY insufficiency , *THERAPEUTICS , *APACHE (Disease classification system) , *RESEARCH funding , *PREDICTIVE tests , *RETROSPECTIVE studies , *SEVERITY of illness index , *ACUTE diseases , *PLATELET count ,RESPIRATORY insufficiency treatment - Abstract
Purpose: The association between extracorporeal membrane oxygenation (ECMO) use and the development of thrombocytopenia is widely presumed yet weakly demonstrated. We hypothesized that longer duration of ECMO support would be independently associated with worsened thrombocytopenia.Methods: We performed a single-center retrospective cohort study of 100 adults who received ECMO for acute respiratory failure. We used generalized estimating equations to test the association between days on ECMO and daily percentage of platelets compared to the first post-cannulation platelet count. We constructed a multivariable logistic regression model with backwards stepwise elimination to identify clinical predictors of severe thrombocytopenia (≤50,000/μL) while on ECMO.Results: Days on ECMO was not associated with a decrease in platelet count in the unadjusted analysis (β -0.85, 95 % CI -2.05 to 0.36), nor after considering and controlling for days hospitalized prior to ECMO, APACHE II score, platelet transfusions, and potential thrombocytopenia-inducing medications (β -0.83, 95 % CI -1.9 to 0.25). Twenty-two subjects (22 %) developed severe thrombocytopenia. The APACHE II score and platelet count at the time of cannulation predicted the development of severe thrombocytopenia. The odds of developing severe thrombocytopenia increased 35 % for every 5-point increase in APACHE II score (OR 1.35, 95 % CI 0.94-1.94) and increased 35 % for every 25,000/μL platelets below a mean at cannulation of 188,000/μL (OR 1.35, 95 % CI 1.10-1.64).Conclusions: Duration of ECMO is not associated with the development of thrombocytopenia. The severity of critical illness and platelet count at the time of cannulation predict the development of severe thrombocytopenia while receiving ECMO for respiratory failure. Future studies should validate these findings, especially in cohorts with more venoarterial ECMO patients, and should characterize the association between thrombocytopenia and bleeding events while on ECMO. [ABSTRACT FROM AUTHOR]- Published
- 2016
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140. Venovenous extracorporeal membrane oxygenation for acute respiratory failure : A clinical review from an international group of experts.
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Fan, Eddy, Gattinoni, Luciano, Combes, Alain, Schmidt, Matthieu, Peek, Giles, Brodie, Dan, Muller, Thomas, Morelli, Andrea, Ranieri, V., Pesenti, Antonio, Brochard, Laurent, Hodgson, Carol, Kiersbilck, Cecile, Roch, Antoine, Quintel, Michael, Papazian, Laurent, Ranieri, V Marco, and Van Kiersbilck, Cecile
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EXTRACORPOREAL membrane oxygenation , *ARTIFICIAL respiration , *INTENSIVE care units , *RESPIRATORY distress syndrome , *RESPIRATORY insufficiency , *MEDICAL innovations , *THERAPEUTICS - Abstract
Despite expensive life-sustaining interventions delivered in the ICU, mortality and morbidity in patients with acute respiratory failure (ARF) remain unacceptably high. Extracorporeal membrane oxygenation (ECMO) has emerged as a promising intervention that may provide more efficacious supportive care to these patients. Improvements in technology have made ECMO safer and easier to use, allowing for the potential of more widespread application in patients with ARF. A greater appreciation of the complications associated with the placement of an artificial airway and mechanical ventilation has led clinicians and researchers to seek viable alternatives to providing supportive care in these patients. Thus, this review will summarize the current knowledge regarding the use of venovenous (VV)-ECMO for ARF and describe some of the recent controversies in the field, such as mechanical ventilation, anticoagulation and transfusion therapy, and ethical concerns in patients supported with VV-ECMO. [ABSTRACT FROM AUTHOR]
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- 2016
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141. Brain injury during venovenous extracorporeal membrane oxygenation.
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Luyt, Charles-Edouard, Bréchot, Nicolas, Demondion, Pierre, Jovanovic, Tamara, Hékimian, Guillaume, Lebreton, Guillaume, Nieszkowska, Ania, Schmidt, Matthieu, Trouillet, Jean-Louis, Leprince, Pascal, Chastre, Jean, Combes, Alain, Bréchot, Nicolas, and Hékimian, Guillaume
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BRAIN diseases , *EXTRACORPOREAL membrane oxygenation , *BRAIN injuries , *LUNG injuries , *STROKE , *HYPERCAPNIA , *DISEASE risk factors , *INTENSIVE care units , *SYSTEMATIC reviews , *HOSPITAL mortality - Abstract
Purpose: The frequency of neurological events and their impact on patients receiving venovenous extracorporeal membrane oxygenation (VV-ECMO) are unknown. We therefore study the epidemiology, risk factors, and impact of cerebral complications occurring in VV-ECMO patients.Methods: Observational study conducted in a tertiary referral center (2006-2012) on patients developing a neurological complication (ischemic stroke or intracranial bleeding) while on VV-ECMO versus those who did not, and a systematic review on this topic.Results: Among 135 consecutive patients who had received VV-ECMO, 18 (15 assessable) developed cerebral complications on ECMO: cerebral bleeding in 10 (7.5 %), ischemic stroke in 3 (2 %), or diffuse microbleeds in 2 (2 %), occurring after respective medians (IQR) of 3 (1-11), 21 (10-26), and 36 (8-63) days post-ECMO onset. Intracranial bleeding was independently associated with renal failure at intensive care unit admission and rapid PaCO2 decrease at ECMO initiation, but not with age, comorbidities, or hemostasis disorders. Seven (70 %) patients with intracranial bleeding and one (33 %) with ischemic stroke died versus 40 % of patients without neurological event. A systematic review found comparable intracranial bleeding rates (5 %).Conclusions: Neurological events occurred frequently in patients on VV-ECMO. Intracranial bleeding, the most frequent, occurred early and was associated with higher mortality. Because it was independently associated with rapid hypercapnia decrease, the latter should be avoided at ECMO onset, but its exact role remains to be determined. These findings may have major implications for the care of patients requiring VV-ECMO. [ABSTRACT FROM AUTHOR]- Published
- 2016
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142. Adjuvants to mechanical ventilation for acute respiratory distress syndrome.
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Munshi, Laveena, Rubenfeld, Gordon, and Wunsch, Hannah
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ADULT respiratory distress syndrome treatment , *DRUG efficacy , *DIURETICS , *ADRENOCORTICAL hormones , *NEUROMUSCULAR blocking agents , *ARTIFICIAL respiration , *HORMONE therapy , *THERAPEUTIC use of nitric oxide , *EXTRACORPOREAL membrane oxygenation , *HIGH-frequency ventilation (Therapy) , *INTENSIVE care units , *LYING down position , *THERAPEUTICS - Abstract
The article discusses the implications of using adjuvants in the treatment of acute respiratory distress syndrome (ARDS). Topics include the types o pharmacologic adjuvants including diuretics, corticosteroids, neuromuscular blocking agents and the reports showing data on the administration of pharmacologic adjuvants in patients. Also discussed is a report showing the effectivity of non-pharmacologic agents and the factors affecting the use of adjuvant therapy in treating ARDS.
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- 2016
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143. The ENCOURAGE mortality risk score and analysis of long-term outcomes after VA-ECMO for acute myocardial infarction with cardiogenic shock.
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Muller, Grégoire, Flecher, Erwan, Lebreton, Guillaume, Luyt, Charles-Edouard, Trouillet, Jean-Louis, Bréchot, Nicolas, Schmidt, Matthieu, Mastroianni, Ciro, Chastre, Jean, Leprince, Pascal, Anselmi, Amedeo, and Combes, Alain
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HEALTH outcome assessment , *OXYGENATION (Chemistry) , *MYOCARDIAL infarction treatment , *QUALITY of life , *ANXIETY , *CARDIOGENIC shock , *COMPARATIVE studies , *MENTAL depression , *EXTRACORPOREAL membrane oxygenation , *INTENSIVE care units , *RESEARCH methodology , *MEDICAL cooperation , *POST-traumatic stress disorder , *QUESTIONNAIRES , *RESEARCH , *RISK assessment , *EVALUATION research , *PREDICTIVE tests , *GLASGOW Coma Scale , *THERAPEUTICS ,MORTALITY risk factors ,MYOCARDIAL infarction-related mortality - Abstract
Purpose: This study was designed to identify factors associated with in-intensive care unit (ICU) death and develop a practical mortality risk score for venoarterial-extracorporeal membrane oxygenation (VA-ECMO)-treated acute myocardial infarction (AMI) patients. Long-term survivors' health-related quality of life (HRQOL), anxiety, depression, and post-traumatic stress disorder (PTSD) frequencies were also assessed.Methods: Data from 138 ECMO-treated AMI patients admitted to two French ICUs (2008-2013) were analyzed. ICU survivors contacted >6 months post-ICU discharge were assessed for HRQOL, psychological and PTSD status.Results: Sixty-five patients (47%) survived to ICU discharge. On the basis of multivariable logistic regression analyses, the ENCOURAGE score was constructed with seven pre-ECMO parameters: age >60, female sex, body mass index >25 kg/m(2), Glasgow coma score <6, creatinine >150 μmol/L, lactate (<2, 2-8, or >8 mmol/L), and prothrombin activity <50%. Six months after ECMO, probabilities of survival were 80, 58, 25, 20, and 7% for ENCOURAGE score classes 0-12, 13-18, 19-22, 23-27, and ≥28, respectively. The ENCOURAGE score ROC AUC [0.84 (95% CI 0.77-0.91)] was significantly better than those of the SAVE, SAPS II, and SOFA scores. Survivors' HRQOL evaluated after median follow-up of 32 months revealed satisfactory mental health but persistent physical and emotional-related difficulties, with 34% (95% CI 20-49%) anxiety, 20% (95% CI 8-32%) depression, and 5% (95% CI 0-12%) PTSD symptoms reported.Conclusions: The ENCOURAGE score might be a useful tool to predict mortality of severe cardiogenic shock AMI patients who received VA-ECMO. However, it now needs prospective validation on other populations of AMI patients. [ABSTRACT FROM AUTHOR]- Published
- 2016
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144. Apnea test during brain death assessment in mechanically ventilated and ECMO patients.
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Giani, Marco, Scaravilli, Vittorio, Colombo, Sebastiano, Confalonieri, Andrea, Leo, Rosambra, Maggioni, Elena, Avalli, Leonello, Vargiolu, Alessia, Citerio, Giuseppe, and Colombo, Sebastiano Maria
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APNEA , *BRAIN death , *ARTIFICIAL respiration , *EXTRACORPOREAL membrane oxygenation , *PATIENTS , *BRAIN death laws , *ANALYSIS of variance , *CAUSES of death , *RETROSPECTIVE studies , *POSITIVE end-expiratory pressure , *DIAGNOSIS - Abstract
Purpose: To evaluate the feasibility and efficacy of an apnea test (AT) technique that combines the application of positive end expiratory pressure (PEEP) with subsequent pulmonary recruitment in a large cohort of brain-dead patients.Methods: This study was a retrospective analysis of prospectively collected data on brain-dead patients admitted to our institution (Hospital San Gerardo, Monza, Italy) between January 2010 and December 2014. The rate of aborted apnea tests (ATs), occurrence of complications (i.e., pneumothorax, cardiac arrhythmias, cardiac arrest, and severe hypoxia, defined as PaO2 < 40 mmHg), ventilator settings, hemodynamics, and blood gas analyses were evaluated. Subgroup analysis was performed, with patients classified into veno-arterial extracorporeal membrane oxygenation (ECMO) or non-ECMO groups, and into hypoxic (i.e., baseline PaO2/FiO2 < 200 mmHg) and non-hypoxic (i.e., baseline PaO2/FiO2 > 200 mmHg) groups.Results: In total, 169 consecutive patients including 25 on ECMO were included in the study. No AT abortion nor severe complications were detected. The AT was completed in all patients. Fluid boluses and increases or initiation of vasoactive drugs were required in less than 10 and 3% of the AT procedures, respectively. No clinically meaningful alteration in hemodynamics was recorded. Severe hypoxia occurred during 7 (2.4%) and 4 (8%) of the ATs performed in non-ECMO and ECMO patients, respectively (p = 0.063), and it occurred more frequently in hypoxic patients than in non-hypoxic patients (11.1 vs. 4.8%, respectively; p = 0.002).Conclusions: In a large cohort of consecutive patients, including the largest patient population on ECMO reported to date, our AT technique that combines the application of PEEP with subsequent pulmonary recruitment proved to be feasible and safe. [ABSTRACT FROM AUTHOR]- Published
- 2016
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145. Optimal timing, dose and route of early nutrition therapy in critical illness and shock: the quest for the Holy Grail.
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Reignier, Jean, Van Zanten, Arthur R. H., and Arabi, Yaseen M.
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DIET therapy , *INTENSIVE care patients , *CRITICAL care medicine , *EXTRACORPOREAL membrane oxygenation , *LENGTH of stay in hospitals , *MORTALITY , *RETROSPECTIVE studies - Abstract
The authors comment on a study which examined the safety of early enteral nutrition (EEN) in patients with severe cardiogenic or obstructive shock, requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO). Topics covered include impact of EEN on duration of hospital stay and mortality, limitations related to the retrospective design of the study and nutrition therapy in intensive care unit (ICU) patients.
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- 2018
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146. In this patient in refractory cardiac arrest should I continue CPR for longer than 30 min and, if so, how?
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Nolan, Jerry, Sandroni, Claudio, and Nolan, Jerry P
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CARDIOPULMONARY resuscitation , *RESUSCITATION , *CARDIAC resuscitation , *CARDIAC arrest , *HEART diseases , *BLOOD circulation , *CONVALESCENCE , *EXTRACORPOREAL membrane oxygenation , *LONGITUDINAL method , *MEDICAL protocols , *TIME - Abstract
The article examines whether longer resuscitation times are associated with progressively higher mortality after cardiac arrest (CA). Topics covered include guidelines of the European Resuscitation Council (ERC) regarding cardiopulmonary resuscitation (CPR), impact of the use of extracorporeal CPR (ECPR) on days of survival of CA patients, and the interval between CA and conventional CPR (CCPR).
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- 2017
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147. Modified 4T score for heparin-induced thrombocytopenia diagnosis in VA-ECMO patients
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Daniel Brodie, Romain Pirracchio, Arthur Neuschwander, Antoine Kimmoun, and Amelie Renou
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medicine.medical_specialty ,Heparin ,business.industry ,Pain medicine ,MEDLINE ,Anticoagulants ,Critical Care and Intensive Care Medicine ,medicine.disease ,Thrombocytopenia ,Extracorporeal Membrane Oxygenation ,Heparin-induced thrombocytopenia ,Anesthesia ,Anesthesiology ,medicine ,Humans ,business - Published
- 2020
148. Mortality and costs following extracorporeal membrane oxygenation in critically ill adults: a population-based cohort study
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Sonny Dhanani, Daniel Brodie, Anne-Marie Guerguerian, Peter Tanuseputro, Eddy Fan, Danial Qureshi, Damon C. Scales, Laveena Munshi, Bram Rochwerg, Sam D. Shemie, Kwadwo Kyeremanteng, Robert Talarico, Shannon M. Fernando, and Kednapa Thavorn
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Adult ,Male ,medicine.medical_specialty ,Critical Illness ,medicine.medical_treatment ,Population ,Shock, Cardiogenic ,Critical Care and Intensive Care Medicine ,Cohort Studies ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,Interquartile range ,Anesthesiology ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Mortality ,education ,Aged ,Retrospective Studies ,Ontario ,Respiratory Distress Syndrome ,education.field_of_study ,Inpatient care ,business.industry ,Cardiogenic shock ,030208 emergency & critical care medicine ,Cardiorespiratory fitness ,Middle Aged ,medicine.disease ,Heart Arrest ,Treatment Outcome ,030228 respiratory system ,Emergency medicine ,Female ,business ,Cohort study - Abstract
Extracorporeal membrane oxygenation (ECMO) is used as temporary cardiorespiratory support in critically ill patients. Little is known about population-level short- and long-term outcomes following ECMO, including healthcare use and health system cost across a wide range of sectors. Population-based cohort study in Ontario, Canada (October 1, 2009–March 31, 2017) of adult patients (≥ 18 years) receiving ECMO for cardiorespiratory support. We captured outcomes through linkage to health administrative databases. Primary outcome was mortality during hospitalization, as well as at 7 days, 30 days, 1 year, 2 years, and 5 years following ECMO initiation. We analyzed health system costs (in Canadian dollars) in the 1 year following the date of the index admission. A total of 692 patients were included. Mean (standard deviation [SD]) age was 51.3 (16.0) years. Median (interquartile range [IQR]) time to ECMO initiation from date of admission was 2 (0–9) days. In-hospital mortality was 40.0%. Mortality at 1 year, 2 years, and 5 years was 45.1%, 49.0%, and 57.4%, respectively. Among survivors, 78.4% were discharged home, while 21.2% were discharged to continuing care. Median (IQR) total costs in the 1 year following admission among all patients were Canadian $130,157 (Canadian $58,645–Canadian $240,763), of which Canadian $91,192 (Canadian $38,507–Canadian $184,728) were attributed to inpatient care. Hospital mortality among critically ill adults receiving ECMO for advanced cardiopulmonary support is relatively high, but does not markedly increase in the years following discharge. Survivors are more likely to be discharged home than to continuing care. Median costs are high, but largely reflect inpatient hospital costs, and not costs incurred following discharge.
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- 2019
149. When more could be industry-driven: the case of the extracorporeal treatment of sepsis
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Miet Schetz and Thomas Bein
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medicine.medical_specialty ,business.industry ,Pain medicine ,Health Care Sector ,Equipment Design ,Critical Care and Intensive Care Medicine ,medicine.disease ,Extracorporeal ,Sepsis ,Extracorporeal Membrane Oxygenation ,Anesthesiology ,medicine ,Humans ,Intensive care medicine ,business - Abstract
ispartof: INTENSIVE CARE MEDICINE vol:45 issue:11 pages:1622-1625 ispartof: location:United States status: published
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- 2019
150. Implementation of new ECMO centers during the COVID-19 pandemic: experience and results from the Middle East and India
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Ahmed A. Rabie, Suneel Pooboni, Pranay Oza, Daniel Brodie, Nicholas A Barrett, Yaseen M. Arabi, Mohamed H Azzam, Hani N. Mufti, Arpan Chakraborty, Abdulrahman Alharthy, Marta Velia Antonini, Huda Alfoudri, Abdulrahman A Al-Fares, Akram Abdelbary, Alyaa Elhazmi, Giles J. Peek, Kiran Shekar, Bishoy Zakhary, Alain Combes, and Ibrahim Fawzy Hassan
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Male ,medicine.medical_specialty ,Original ,medicine.medical_treatment ,SWAAC-ELSO ,India ,Critical Care and Intensive Care Medicine ,Hypoxemia ,03 medical and health sciences ,Middle East ,0302 clinical medicine ,Extracorporeal Membrane Oxygenation ,Interquartile range ,Anesthesiology ,Epidemiology ,SARS-Cov2 ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Pandemics ,Retrospective Studies ,Respiratory Distress Syndrome ,Pandemic ,business.industry ,SARS-CoV-2 ,COVID-19 ,030208 emergency & critical care medicine ,Retrospective cohort study ,Odds ratio ,Middle Aged ,surgical procedures, operative ,030228 respiratory system ,Emergency medicine ,Observational study ,medicine.symptom ,ECMO ,business - Abstract
Purpose Extracorporeal membrane oxygenation (ECMO) use for severe coronavirus disease 2019 (COVID-19) patients has increased during the course of the pandemic. As uncertainty existed regarding patient’s outcomes, early guidelines recommended against establishing new ECMO centers. We aimed to explore the epidemiology and outcomes of ECMO for COVID-19 related cardiopulmonary failure in five countries in the Middle East and India and to evaluate the results of ECMO in 5 new centers. Methods This is a retrospective, multicenter international, observational study conducted in 19 ECMO centers in five countries in the Middle East and India from March 1, 2020, to September 30, 2020. We included patients with COVID-19 who received ECMO for refractory hypoxemia and severe respiratory acidosis with or without circulatory failure. Data collection included demographic data, ECMO-related specific data, pre-ECMO patient condition, 24 h post-ECMO initiation data, and outcome. The primary outcome was survival to home discharge. Secondary outcomes included mortality during ECMO, survival to decannulation, and outcomes stratified by center type. Results Three hundred and seven COVID-19 patients received ECMO support during the study period, of whom 78 (25%) were treated in the new ECMO centers. The median age was 45 years (interquartile range IQR 37–52), and 81% were men. New center patients were younger, were less frequently male, had received higher PEEP, more frequently inotropes and prone positioning before ECMO and were less frequently retrieved from a peripheral center on ECMO. Survival to home discharge was 45%. In patients treated in new and established centers, survival was 55 and 41% (p = 0.03), respectively. Multivariable analysis retained only a SOFA score
- Published
- 2021
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