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The number of hospitals with veno-venous extracorporeal membrane oxygenation (VV-ECMO) capabilities is expanding. To support an ECMO program, centers must be equipped to handle associated complications such as pulmonary hemorrhage. We describe a case series of 4 patients with life-threatening pulmonary bleeding and central airway obstruction. A therapeutic approach of anticoagulation cessation coupled with cryoextraction via flexible bronchoscopy led to successful restoration of airway patency without any adverse events. A low threshold to stop anticoagulation with a strong consideration of bronchoscopy with cryotherapy for pulmonary toilet should be done in patients with pulmonary hemorrhage during VV-ECMO. [ABSTRACT FROM AUTHOR]

Objectives: To determine the safety and efficacy of a rapidly deployed intensivist-led venovenous extracorporeal membrane oxygenation cannulation program in a preexisting extracorporeal membrane oxygenation program.Design: A retrospective observational before-and-after study of 40 patients undergoing percutaneous cannulation for venovenous extracorporeal membrane oxygenation in an established cannulation program by cardiothoracic surgeons versus a rapidly deployed medical intensivist cannulation program.Setting: An adult ICU in a tertiary academic medical center in Camden, NJ.Patients: Critically ill adult subjects with severe respiratory failure undergoing percutaneous cannulation for venovenous extracorporeal membrane oxygenation.Interventions: Percutaneous cannulation for venovenous extracorporeal membrane oxygenation performed by cardiothoracic surgeons compared with cannulations performed by medical intensivists.Measurements and Main Results: Venovenous extracorporeal membrane oxygenation cannulation site attempts were retrospectively reviewed. Subject demographics, specialty of physician performing cannulation, type of support, cannulation configuration, cannula size, imaging guidance, success rate, and complications were recorded and summarized. Twenty-two cannulations were performed by three cardiothoracic surgeons in 11 subjects between September 2019 and February 2020. The cannulation program rapidly transitioned to an intensivist-led and performed program in March 2020. Fifty-seven cannulations were performed by eight intensivists in 29 subjects between March 2020 and December 2020. Mean body mass index for subjects did not differ between groups (33.86 vs 35.89; p = 0.775). There was no difference in days on mechanical ventilation prior to cannulation, configuration, cannula size, or discharge condition. There was no difference in success rate of cannulation on first attempt per cannulation site (95.5 vs 96.7; p = 0.483) or major complication rate per cannulation site (4.5 vs 3.5; p = 1).Conclusions: There is no difference between success and complication rates of percutaneous venovenous extracorporeal membrane oxygenation canulation when performed by cardiothoracic surgeons versus medical intensivist in an already established extracorporeal membrane oxygenation program. A rapidly deployed cannulation program by intensivists for venovenous extracorporeal membrane oxygenation can be performed with high success and low complication rates. [ABSTRACT FROM AUTHOR]

Acute respiratory distress syndrome, monitoring, patient self-inflicted lung injury, high-flow oxygen, respiratory failure Is Time-of-Flight Ready for Take Off to Measure Patient Self-Inflicted Lung Injury? Keywords: acute respiratory distress syndrome; high-flow oxygen; monitoring; patient self-inflicted lung injury; respiratory failure EN acute respiratory distress syndrome high-flow oxygen monitoring patient self-inflicted lung injury respiratory failure 168 170 3 12/21/21 20220101 NES 220101 High-flow nasal cannula (HFNC) has emerged as an essential addition to the armamentarium of care for critically ill patients with acute hypoxemic respiratory failure. [Extracted from the article]

JAMA Netw Open 2020; 3:e2018039 KEY WORDS: acute respiratory distress syndrome; coronavirus disease 2019; mechanical ventilation; prone positioning S evere hypoxemia and acute respiratory distress syndrome (ARDS) have been a hallmark of the coronavirus disease 2019 (COVID-19) pandemic. Lung protective ventilation, positive endexpiratory pressure optimization, and prone position ventilation (PPV) remain paramount in reducing ventilator-associated lung injury and improving outcomes for these patients (2, 3). The central line-associated bloodstream infection (CLABSI) rate of 4.9% is higher than prepandemic ARDS comparisons, and the 8.2% occurrence rate of brachial plexus palsies is a relevant negative outcome (7). Tzotzos SJ, Fischer B, Fischer H, et al: Incidence of ARDS and outcomes in hospitalized patients with COVID-19: A global literature survey. [Extracted from the article]

It is common for patients on venovenous extracorporeal membrane oxygenation (VV ECMO) to require continuous renal replacement therapy (CRRT). This can be done using separate vascular access for the CRRT circuit, by placing the CRRT hemofilter within the ECMO circuit, or through a separate CRRT circuit connected to the ECMO circuit. When a CRRT circuit is connected to the ECMO circuit, the inflow and outflow CRRT limbs can both be placed pre-ECMO pump or the CRRT circuit can span the ECMO pump, with the CRRT inflow post-ECMO pump and the outflow pre-ECMO pump. Both configurations require the CRRT alarms to be inactivated due to high positive pressure experienced post-pump and low negative pressure pre-pump. We describe a novel technique that does not require separate venous access and still allows the CRRT alarms to be activated.The CRRT inflow line is connected to the post-oxygenator de-airing port. The CRRT outflow line is connected to the pre-pump side of the ECMO circuit. Pigtails allow for these connections and act as resistors negating the large range of pressures generated by the ECMO centrifugal pump.We implemented this configuration in 11 patients with 100% success rate allowing for alarms to be maintained in all patients. The median number of interruptions per 100 CRRT days was 11.7. The median CRRT filter lifespan was 2.2 days, and the average blood flow was maintained at 311 mL/min.This configuration allows for efficient use of CRRT in ECMO patients while maintaining the safety alarms on the CRRT machine. [ABSTRACT FROM AUTHOR]