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Extracorporeal membrane oxygenation (ECMO) increases circulating volume of distribution, leading to capillary leakage and temporarily altering renal function. Therefore, this may affect pharmacokinetics. In this review, factors affecting pharmacokinetics and pharmacodynamics in veno-arterial and venovenous ECMO, the causes of drug sequestration that may occur in the ECMO circuit, the effects of physicochemical parameters of drugs in the ECMO circuit, and ECMOvariable dose optimization have been reviewed from the studies in the current literature. Data reported on the limitations, indications and complications of ECMO are also mentioned. The limited use of ECMO in the coronavirus disease-2019 pandemic, its use in reported cases, and which symptoms it is usually used to support the treatment of are described. [ABSTRACT FROM AUTHOR]

Objectives: Serious acute vascular complications may occur during ECMO support. In our study, acute vascular complications that developed in patients followed up with ECMO support were evaluated. Methods: Patients older than 18 years of age who received ECMO support were included in this study. Acute vascular complications, risk factors, and results were analyzed by evaluating the data retrospectively. Results: Nineteen patients were included in the study. It was observed that V-A ECMO support was performed in 17 patients and V-V ECMO support was performed in two patients. Acute vascular complications developed in 7 patients (36.8%). A significant correlation was found between the ECMO cannulation type and the development of vascular complications (p=0.032). It was determined that the using of distal perfusion cannula or femoral artery graft to prevent the development of vascular complications did not reduce the development of vascular complications (including digital ischemia). Conclusion: We think that peripheral ECMO cannulation is associated with vascular complications and prospective studies are needed to prevent these complications. [ABSTRACT FROM AUTHOR]

The incidence of postoperative pulmonary complications varies between 1-23 % and these complications can cause serious mortality. Measurement of extravascular lung water (EVLW) is beneficial not only for the prevention of complications but also in weaning, fluid management and monitorization of response to pharmacological interventions. EVLW consists of interstitial, intracellular, alveolar and lymphatic fluid in lungs except for pulmonary vasculature. Its normal range is 3-7 m/kg in healthy adults, values greater than 10 ml/kg point to pulmonary edema. Although the gold standard for measurement of EVLW is the gravimetric method, due to the fact it can only be applied postmortem, measurement methods by using ultrasonography and transpulmonary thermodilution have been developed. EVLW measurement can be affected by renal replacement therapy, extracorporeal membrane oxygenation (ECMO), pleural effusions and high PEEP. New research focusing on the effect of EVLW measurement on postoperative hemodynamic management is necessary in the future. [ABSTRACT FROM AUTHOR]

The Coronavirus Disease 2019 (COVID-19) caused by the new Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) human coronavirus in Wuhan province of China triggered a worldwide respiratory outbreak. To date, antimalarial hydroxychloroquine and some antivirals such as remdesivir, lopinavir/ritonavir, favipiravir was found to be a treatment option for SARS-CoV-2. In addition to supportive therapy such as oxygen supply and extra corporeal membrane oxygenation in critically ill patients, various treatments such as cytokine inhibitors, stem cell therapy, and immune-convalescent plasma (CP) are being explored. Administration of antibodies against a particular agent to a susceptible person for protection or treatment against an infectious disease associated with this agent is called passive antibody therapy, namely, CP therapy. In the worldwilde, so many recovering patient can be candidates of COVID-19 CP donors after detailed clinical and laboratory evaluations. SARS-CoV-2-specific IgG antibodies passively transmitted by transfused plasma can neutralize viral particles and activate the complement system. Thus, viral elimination may be possible. However, it is also important to know that plasma transfusions may be associated with transfusion reactions such as allergic reactions, transfusion-associated acute lung injury and circulating overload. It is essential to establish protocols for the collection, preparation and implementation of the CP in response to the current pandemic. However, the results of the studies on this issue are controversial. In this review, it is aimed to summarize the recommendations in the current literature for the treatment of CP as a therapeutic option for COVID-19. [ABSTRACT FROM AUTHOR]

Objective: TThe application of mechanical support devices such as extracorporeal membrane oxygenatior (ECMO) has increased with the increase in complex cardiac surgery operations in congenital heart diseases. Despite significant advances in ECMO techniques and methods, the prognosis is still poor. The aim of this study is to show the relationship between organ dysfunction and mortality in patients with veno-arterial (VA) ECMO after pediatric cardiac surgery. Method: Sixty-three patients in the pediatric cardiac ICU who had VA-ECMO and followed up up to 48 hours in our clinic, were retrospectively included in the study and two groups were formed as follows: Group 1: Patients exited within 30 days (n: 47), Group 2: Survived patients (n: 16). Along with the demographic data of the patients, ECMO placement time, creatinine, BUN (blood urea nitrogen), ALT (alanine aminotransferase), AST (aspartate aminotransferase), bilirubin, albumin and platelet counts were recorded. Results: While 36 patients (57.1%) left ECMO in our study group, 16 of these patients (16/63,25.4%) were discharged. A total of 47 patients (47/63, 74.6%) died. Although the number of patients who underwent univentricular repair (26/47,55.31%) in Group 1 was higher (n=5:31.25%) than Group 2, this difference was not significant (p>0.05). Postoperative ECMO was implanted in 27 patients (57.44%) in Group 1 and 4 patients (31.25%) in Group 2, and this difference was statistically significant (p<0.02). While levels of creatinine, BUN, ALT, AST were higher in Group 1 patients who had higher mortality rates, albumin and platelet values were lower than Group 2 (p<0.05). Conclusion: It has been determined that organ dysfunction parameters were found to be effective in showing mortality, mortality rates were higher among patients in whom ECMO was placed postoperatively. [ABSTRACT FROM AUTHOR]

Ischemia and compartment syndrome may be seen, especially in the distal limb, after femora-femoral cannulation for extracorporeal membrane oxygenation (ECMO). Several techniques have been used to decrease the rate of complications. Arterial hypoxemia may be prevented by reperfusion with distal limb. Prophylactic superficial femoral artery cannulation results in ease in operation and prevents perfusion. In the present case, we present prophylactic superficial femoral artery cannulation for limb reperfusion. [ABSTRACT FROM AUTHOR]

Fulminant myocarditis is severe and aggressive, but it is self-limited and usually has a favorable prognosis if the patients can survive the acute phase. When drug treatment is not effective, extracorporeal membrane oxygenation technology should be applied to support cardiopulmonary function. Extracorporeal membrane oxygenation can simultaneously support function of the left ventricle, right ventricle, and lungs, and provide stable blood circulation for patients with heart and respiratory failure, which allows sufficient time for the cardiopulmonary system to recover. Fulminant myocarditis affects cardiac systolic function, as well as the function of autorhythmic cells and the conduction system. If severe bradycardia or atrioventricular block appears, a pacemaker needs to be installed. We report a child with fulminant myocarditis who was treated with extracorporeal membrane oxygenation combined with an artificial pacemaker. [ABSTRACT FROM AUTHOR]

Acute respiratory distress syndrome (ARDS) is characterized by pulmonary edema caused by sudden increase in alveolocapillary membrane permeability, hypoxemia, and bilateral lung infiltration. Despite improvement in ICU treatment modalities, the mortality rate among ARDS patients is still considerably high. In the treatment of ARDS, in addition to the treatment of underlying cause, low-tidal volume, lungprotective mechanical ventilation is recommended. However, in patients who cannot attain target oxygen level or develop high plateau pressure despite low-tidal volume ventilation and who cannot tolerate high carbon dioxide and low pH levels, extracorporeal membrane oxygenation (ECMO) may be considered as a good treatment option. In this article, cases of ARDS patients treated with ECMO in our clinic during 2013-14 have been retrospectively documented and discussed in line with the literature. [ABSTRACT FROM AUTHOR]

Patients with severe acute respiratory distress syndrome (ARDS) is an acute diffuse, inflammatory lung injury, leading to increased pulmonary vascular permeability with hypoxemia and bilateral radiographic opacities, associated with decreased lung compliance. Extracorporeal membrane oxygenation (ECMO) has been used to support primary or secondary diseases causing respiratory or cardiac failures in newborns, children and adults. Patients with severe ARDS are candidates for ECMO therapy. ECMO is a support modality, not a treatment; it is only beneficial in patients whose primary disease is reversible. ECMO complications-which can lead to mortality, morbidity, long-term disability and reduced quality of life-include surgical and organ bleeding, renal and multiorgan failure and central nervous system problems. The aim of this article was to provide a general overview of ECMO use and outcomes patients with severe acute respiratory distress syndrom. [ABSTRACT FROM AUTHOR]

Lung injury resulting from inhalation of chemical products continues to be associated with high morbidity and mortality. Concentrated nitric acids are also extremely corrosive fuming chemical liquids. Fumes of nitric acid (HNO3) and various oxides of nitrogen such as nitric oxide (NO) and nitrogen dioxide (NO2) may cause fatal illnesses such as severe pulmonary edema and acute respiratory distress syndrome (ARDS) when inhaled. Intensive respiratory management including mechanical ventilation with positive end expiratory pressure (PEEP), inverse ratio ventilation, replacement of surfactant and extracorporeal membrane oxygenation (ECMO), steroids and n-acetylcysteine (NAC) may improve survival. In this case report we present the diagnosis and successful treatment of a 57 years old male patient who developed ARDS following pulmonary edema due to nitric acid fumes inhalation. [ABSTRACT FROM AUTHOR]

Extracorporeal life support (ECLS) is instituted for the management of life threatening pulmonary or cardiac failure (or both), when no other form of treatment has been or is likely to be successful. It has being used in developed countries for many years. ECLS has come into practice for a while in Turkey, in order to ECLS recommendations. However, most of them are postcardiotomy cases. However, this therapeutic option has more indications including its reason that brought it into practice. All equipment of the system has being changed with the developing technology. The aim of this paper is to point out this modality, to introduce equipment, and to give information about organization and management to bring this therapeutic option in Turkey in order. [ABSTRACT FROM AUTHOR]