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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]

Metformin can cause gastrointestinal system symptoms, hyperlactatemia, and lactic acidosis even at therapeutic doses, and toxicity can result in serious complications and high mortality with massive infections. The prognosis for undifferentiated lactic acidosis is poor, with an expected case fatality rate of 30-50%. We present the case of a patient who was admitted to the emergency department with a large intentional metformin overdose. The patient was initially asymptomatic, but deteriorated rapidly during the observation period, developed cardiac arrest, and required extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy. Considering this case, we aim to emphasize that metformin overdoses may worsen in the late stages and that the follow-up period should be performed in a monitored setting that can provide, if needed, advanced cardiac support therapies such as ECMO. [ABSTRACT FROM AUTHOR]

Objective: This study examined the clinical consequences of pregnancy coexisting with severe acute respiratory syndrome coronavirus 2 in the intensive care unit (ICU). Materials and Methods: The study was designed as a retrospective observational study. After the ethical approval of the local ethics committee, the study was conducted for a period when the number of young coronavirus disease-2019 (COVID-19) cases increased in our country. The patients enrolled in the study were pregnant/puerperal patients followed up in our third-level ICU. Results: The mean age of 35 pregnant women included in the study was 29.57±4.36 years. Twenty-one of the births (80.8%) were preterm births. Twelve (34.3%) patients received invasive mechanical ventilation (IMV), and 5 (41.7%) of these patients were deceased. Twenty-six (74.3%) underwent a cesarean section (C/S). There were 5 (14.3%) patients who needed extracorporeal membrane oxygenation and 3 (8.5%) patients who needed continuous renal replacement therapy. The 28-day neonatal mortality rate for 26 births was 3.8%. The maternal mortality rate in the ICU was 14.3%. Conclusion: The preterm birth rate was high in our pregnant patients followed up in the ICU with a diagnosis of COVID-19. Because of clinical and radiological progression in pregnant women, it is difficult to indicate any gestational week in which maternal outcomes are better to undergo C/S. IMV mortality is not higher than in non-pregnant patients, so endotracheal intubation should not be avoided in appropriate patients, whether pregnancy continues or not. The absence of fully vaccinated patients in the study group revealed the protective effect of vaccination during pregnancy. [ABSTRACT FROM AUTHOR]

Objective: Extracorporeal membrane oxygenation (ECMO) is used as a life support system in patients with either cardiac or respiratory failure. The aim of our study was to evaluate our experience with ECMO used for cardiac support in patients with postcardiotomy syndrome (cardiogenic shock) at our center. Methods: Fifty patients treated with ECMO with cardiac failure either in the intensive care unit or operative room due to failure to wean from cardiopulmonary by-pass were retrospectively inspected. Demographic data, ECMO protocols, and clinical follow-up data were collected and reviewed. Results: All patients received venoarterial (VA) ECMO because of cardiogenic shock. The mean duration of ECMO was 3.7±3.4 days. The survival rate for ECMO and the survival rate to discharge were 72%. The overall cardiogenic shock mortality rate for ECMO was 28%. Conclusion: ECMO use in patients with cardiogenic shock (postcardiotomy syndrome) is associated with high mortality. According to our data, VA ECMO may be a beneficial mechanical assist device in short‐term for patients with cardiogenic shock with an acceptable weaning rate. The success rate of ECMO may depend on the time of initiation and duration of use. [ABSTRACT FROM AUTHOR]

The vascular cannulation step is of great importance for the effective and safe implementation of extracorporeal membrane oxygenation (ECMO) support. We experienced various problems associated with ECMO vascular cannulation (malposition, thrombosis, recannulation, collapse) in 3 patients who developed coronavirus disease-2019 acute respiratory distress syndrome and received veno-venous ECMO support, and here we share our experience in their management. Appropriate vascular cannula size, vascular cannula structure, selection of the vascular cannulation site, and precise vascular cannulation can make ECMO support more effective and reliable. [ABSTRACT FROM AUTHOR]

Many cardiac, pulmonary, and psychiatric complications occur due to long-term bed rest, infection, and critical illness neuropathy/myopathy in extra-corporeal membrane oxygenation (ECMO) applied coronavirus disease-2019 (COVID-19) inpatients in intensive care units. Physiotherapy plays an important role in restoring physical functions in the subacute phase following ECMO decannulation. After being discharged, and with combined rehabilitation, these patients experience a faster recovery and their quality of life increases. In this article, the effects of the combined physiotherapy program, which was applied to two patients with COVID-19 who received ECMO treatment and were discharged from the intensive care unit, is discussed. Early application of the combined rehabilitation program after discharge resulted in a positive outcome. [ABSTRACT FROM AUTHOR]

Objective: Extracorporeal membrane oxygenation (ECMO) may be used in patients with severe respiratory and/or cardiac pathologies. Transferring a patient on ECMO support to advanced hospital may become life-saving for whom. We evaluated the effects of very long distance transportation with ECMO. Methods: This study includes 10 patients who were transferred from a distant hospital to an advanced care hospital while on veno-venous (VV) or veno-arterial ECMO between 2017 and 2019. A transfer distance of at least 1000 km was the required inclusion criterion for the study. The primary outcome was all cause mortality in the hospital and in 1-year. The secondary outcomes were the duration of ECMO run and mechanical ventilation, durations of intensive care unit and hospital stay. Results: The mean distance of transport was 1878.2±440.7. One adverse event occurred because inappropriate electrical connection of the plane so backup ECMO device was switched on. Overall hospital mortality of the patients was 40% and 1-year survival was 50%. Conclusion: Interfacility transfer on ECMO support between too far centers is safe and may be a life-saving procedure for the patient. The survival rates of VV ECMO seems to be better. [ABSTRACT FROM AUTHOR]

Patients who do not respond to conventional mechanical ventilation (MV) support for respiratory failure due to the Coronavirus disease-19 may require the support of extracorporeal membrane oxygenation (ECMO). Intrahospital transportation of critically ill patients under MV and ECMO support carries potential risks that could be life-threatening. A structured process performed by a professional team plays a vital role in improving patient safety during transportation of the patient. In this presentation, we aim to share our experiences during the intrahospital transportation of a patient on ECMO support with appropriate equipment and a team of experienced personel. [ABSTRACT FROM AUTHOR]

Hypercoagulopathy associated with the novel coronavirus disease (COVID-19) is the leading cause of acute respiratory distress syndrome (ARDS), multiple organ failure, and mortality. Extracorporeal membrane oxygenation (ECMO) has been used to manage patients with COVID 19-associated severe respiratory or cardiac failure. In this report, we aim to summarise our experience with deadly thrombotic complications during venovenous ECMO (vvECMO) treatment in 6 patients with COVID-19-associated ARDS between March 19, 2020 and April 20, 2020. Based on our experience with 6 COVID-19-associated ARDS patients on ECMO, we intend to raise awareness regarding thrombotic complications leading to mortality. [ABSTRACT FROM AUTHOR]

Aim: Extracorporeal membrane oxygenation (ECMO) is an important option for the management of severe acute respiratory distress syndrome (ARDS) in Coronavirus disease-2019 (COVID-19) cases. We aimed to present our experiences of ECMO in patients with respiratory failure secondary to COVID-19. Methods: Data of 22 consecutive COVID-19 patients with severe respiratory failure whom were supported with ECMO were collected from computer-based hospital software retrospectively. Patients were treated in a single medical center between April 23, 2020 and February 14, 2021. Patients were analyzed from the points of laboratory and inflammatory markers, ventilation and ECMO features. Results: The ages of patients were between 30 and 69 years (mean age: 56.3±10.63). All patients were under maximum ventilator support, with the prone position. All patients had elevated levels of inflammatory indicators as D-dimer and ferritin. The mean level of ferritin was 1,564±1,611 ng/mL. D-dimer value was maximum 10.000 mg/mL (mean: 5,215±3,104), CRP increased to 177 mg/L (mean: 159±71). Percent of lymphocytes decreased as low as 2% (mean: 4.16±2.10). The mean duration of veno-arterial (VA) ECMO was 1.6±0.94 days whereas, for veno-venous (VV) ECMO, it was 10.05±5 days. VA ECMO was decided due to cardiovascular collapse. Four patients with VA ECMO survived a maximum of 3 days. Four of (22.22%) of 18 VV ECMO supported patient's blood gas values were at normal ranges, 3 of them needed tracheostomy, and all of could be discharged from the hospital. Conclusion: Although, ECMO support for severe respiratory failure patients with COVID-19 is more challenging than regular ECMO applications, especially VV ECMO usage should be reminded as a remedy. [ABSTRACT FROM AUTHOR]

Acute fulminant myocarditis (AFM) is a clinical condition that can lead to sudden onset of rapidly progressing cardiogenic shock with significant arrhythmia and possible cardiac arrest. Mechanical circulation support has been reported to provide effective cardiac support in patients with AFM. In this article, we aimed to present the case of a 14-year-old girl with AFM who experienced a cardiogenic shock and resistant ventricular tachycardia unresponsive to medical treatment; however, she could be successfully treated with veno-arterial extracorporeal membrane oxygenation and discharged without neurological sequelae from the hospital. [ABSTRACT FROM AUTHOR]

Aims: Limited data about disease management strategies are available for pediatric patients with coronavirus disease-2019, particularly in Turkey. This study aimed to share the data on patients aged under 18 years in our country to be beneficial for understanding the disease course in children. Methods: A retrospective review of the medical records of pediatric patients aged under 18 years who were confirmed as coronavirus disease-2019 between March 11, and June 23, 2020, and were admitted to our hospitals was conducted. Results: A total of 220 pediatric patients with coronavirus disease-2019 were evaluated, of which 48.2% were boys, with a median age of 10 years, and 9.5% had underlying diseases. Patients were classified according to severity, with the percentages of asymptomatic, mild, moderate, and critical/severe cases determined to be 25.5%, 45%, 26.8%, and 2.7%, respectively. Extracorporeal membrane oxygenation was required in two patients (0.9%) and mechanical ventilation in three (1.4%). Targeted therapies were used in six patients (2.7%), with hydroxychloroquine being the most commonly used agent either alone (one patient) or in combination with favipiravir (five patients). Two patients (0.9%) died, and nine (4.1%) were still hospitalized during the study period. Conclusion: Although the disease course of coronavirus disease-2019 seems to be mild in children, critical illness is significant, and the treatment strategy primarily should consist of supportive care according to our preliminary observations. [ABSTRACT FROM AUTHOR]

The maternal and fetal mortality rate in unstable pulmonary embolisms accompanied by obstructive cardiac shock is approximately 30%. An intervention aimed at the pulmonary clot is essential under these conditions. There are various ways of removing this clot from the pulmonary arteries, including thrombolytic administration, percutaneous catheter-based thrombectomy, and direct surgical clot removal. These procedures all have advantages and disadvantages. Increasing use is being made of extracorporeal membrane oxygenation (ECMO) as a means of reducing these risks to a minimum. There are studies recommending ECMO together with thrombolysis or surgical thrombectomy. However, which study is superior to another is unclear. The purpose of the present study was, therefore, to assess the benefits and risks of ECMO use in pregnant patients with pulmonary embolism and to endeavor to produce a new algorithm. [ABSTRACT FROM AUTHOR]

Extracorporeal membrane oxygenation (ECMO) may be the last option in patients with severe acute respiratory distress syndrome (ARDS) in whom conventional methods have failed. The best results are obtained in patients with severe ARDS after trauma. Injured lungs can recover completely with ECMO therapy. A 44-year-old male patient was brought to the emergency department after sustaining severe thoracic gunshot injury. The patient was rushed into emergency surgery; however, pneumonectomy could not be performed due to morphological variation and widespread contusion in the lungs. The patient had flail chest with extensive damage of the ribs. Titanium plates could not be placed, as there was a major loss in the bone tissue. After cutting the fractured rib ends, the open chest wall was repaired with dual mesh and covered with serratus and latissimus dorsi muscles. However, the flail chest could not be corrected. During the follow-up in the intensive care unit, the patient developed ARDS and conventional therapies were unsuccessful. Thus, ECMO was used to allow lung healing. ECMO treatment was continued for seven days and was completed without any complications. The patient was transferred to the regular ward after 29 days. ECMO can be used as a life-saving treatment that allows lung healing in case conventional treatment methods have failed. [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]

Introduction: Experiences in the COVID-19 pandemic have also shown us that extracorporeal membrane oxygenation (ECMO) is very effective in facilitating the response to treatment in severe acute respiratory distress syndrome (ARDS) patients who do not respond to conventional methods. Materials and Methods: The case we are going to present was 46 years old, influensa positive female with known diabetes mellitus, who was intubated with severe ARDS, which developed as a result of pneumonia caused by viral, bacterial and fungal pathogens. Despite positive pressure ventilation, prone position, neuromuscular blockade to eliminate ventilator asynchrony and appropriate medical treatment, the patient’s hypoxemia could not be corrected. In arterial blood gas evaluation, pO2 : 68.5 mmHg, pCO2 : 28.5 mmHg, SpO2 : 97.7%, pO2 /FiO2 ratio was 97. She has severe ARDS (Figure 1). Results: Venovenous ECMO was started to the patient for the treatment of severe ARDS. the arterial blood gas taken at this time, pO2 : 147 mmHg, pCO2 : 30 mmHg, pO2 /FiO2 >300, was observed. On the 8th day of the procedure, ECMO was successfully decannulated. No complications were encountered during the ECMO procedure. On the 33rd day of hospitalization, the patient was discharged home without the need for oxygen support. Conclusion: With this case, we have seen once again that ECMO, with a professional multidisciplinaryapproach and start in correct time, is of great importance in improving the prognosis in youngpatients with severe ARDS without serious co-morbidities. [ABSTRACT FROM AUTHOR]

Introduction: The need for mechanical ventilation and mortality rates are high as a result of acute respiratory distress syndrome (ARDS) developing after COVID-19. The role of Extracorporeal Membrane Oxygenation (ECMO) supportive therapy in the COVID-19 pandemic is still unclear. In our study, we aimed to share the effectiveness of the ECMO supportive treatment, the difficulties we encountered, and our clinical experiences in 26 patients with ARDS caused by COVID-19 pneumonia in the intensive care unit of a third-level training and research hospital during the pandemic period. Materials and Methods: Patients who received ECMO support between 11.03.2020 and 01.03.2021 in the University of Health Sciences Turkey, Prof. Dr. Cemil Taşcıoğlu City Hospital were evaluated retrospectively. During the study period, ECMO supportive treatment was applied to 26 patients due to ARDS. Results: A total of 26 patients underwent V-V ECMO and 2 patients could be decannulated. Sixteen (61.5%) of the patients were male, 10 (38.5%) were female, with a mean age of 51.3 (29-71). Mean time from hospitalization to intubation was 10.1±5.9 (1-27) days, mean duration of stay on mechanical ventilator before ECMO was 9.7±7.2 (1-28) days, mean duration of stay on ECMO support was 12. It was found to be 3 (1-23) days (Table 1). Of the 26 patients who received ECMO support, 24 died. One of the surviving patients left ECMO support after 13 days and the other 16 days later. After ECMO, MV support continued for 21 days and 16 days, respectively. Surviving patients were discharged with full recovery. ECMO was terminated due to bleeding in two patients and cannula removal in two patients. Conclusion: ECMO supportive therapy is associated with high mortality in ARDS patients developing after COVID-19. However, in COVID 19 disease, ECMO is a life-saving support method when applied in the early period. The usefulness of ECMO as a rescue therapy in critically ill patients with ARDS due to COVID-19 has so far been limited and more studies are needed for its application in these patients. [ABSTRACT FROM AUTHOR]

Introduction: The use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) in trauma patients is controversial, and there is little experience with its use for chest traumas in the literature. In this report, we describe a case with severe chest trauma in which VV-ECMO was introduced and saved the patient’s life. Case: A 55-year-old male experienced blunt trauma due to a traffic accident. He had chronic obstructive lung disease history. He presented with bilateral hemothorax, right pneumothorax, multiple bilateral rib and clavicula fractures, bilateral lung contusions, and dissection in descending aorta. The patient was intubated, and a right thoracic drain was inserted. The respiratory condition of the patient worsened because of increased subcutaneous emphysema, and left pleural drain was inserted. Severe respiratory failure due to lung contusions persisted. He was operated by cardiovascular surgery, and aortic dissection was repaired. The VV-ECMO was performed on the same day because of the patient’s massive hemothorax and worsening respiratory condition. Furthermore, the patient was weaned off from VV-ECMO on the 5th day, and he was transferred to the ward without any complication on the 21st day. Discussion: ECMO can be useful for chest traumas. Because a common complication of ECMO is bleeding, the use of ECMO support for patients with trauma was limited in the past. Therefore, decisions must be made on a case-by-case basis. [ABSTRACT FROM AUTHOR]

Introduction: Extracorporeal membrane oxygenation (ECMO) has been rapidly developed and is widely used for respiratory and cardiac support in adults. Inadequate support of a patient during ECMO due to impaired drainage is a common problem. This case report represents the importance of considering mechanics of ECMO support. Case: Forty-two-year-old male with a past medical history of diabetes mellitus presented to the emergency department with unconciousnes and worsening of breath after suicide with Janumet 50/1000 (metformin and sitagliptin, n=60). On admission to ICU, his Glasgow Coma Scale was 9, respiratory rate was 23 breaths/min, heart rate was 120 bpm and mean blood pressure (mBP) was 35 mmHg despite high dose of vazopressors and inotropes. He was intubated and femoral-femoral veno-arterial (VA) ECMO was initiated at a blood flow of 4.5 L/min and gas flow at 3.0 L/min of 100% oxygen. In the following hours chattering of the lines was occured and blood flow of ECMO decreased to 1-1.5 L/min. Firstly, we reduced the pump speed. Then fluid challenge was done to resolve ongoing problem but it was useless. The cannulae was 25 French so it was large enough for drainage. The Chest X-ray showed that inappropriate position of drainage canula that was in the lower level which it should had been (Figure 1). Then we sent the catheter up to the right atrium entrance under steril condition and checked position by transthoracic echocardiography. The ECMO blood flow returned to normal and chattering of the lines disappeared. Discussion: Management of technical issues during ECMO is complex but essential to improving outcomes. The chattering of ECMO line is very common and the causes include kinks in the circuit, hypovolemia, inadequate cannula size, or cannula malposition. In this case, femoral drainage cannulae position was checked by Chest-xray and then inserted sufficiently deep to access the right atrium to provide effective drainage pressures. [ABSTRACT FROM AUTHOR]

Objective: The new coronavirus disease, in which hundreds of thousands of people are infected in the world, appears in tables ranging from asymptomatic course to severe acute respiratory distress syndrome. Extracorporeal membrane oxygenation (ECMO) is one of the salvage treatments applied in intubated patients due to high mortality. We aimed to describe our experience in a COVID-19 infected pregnant woman with ECMO theraphy in our clinic. Case: A 37-year-old patient who was 34 weeks pregnant presented with a fever of 39 °C for 3 days, and a cough. Because of the appearance of bilateral ground glass on CT, viral pneumonia. She was admitted into our intensive care unit, and high dose of vitamin C, and tocilizumab (a humanized monoclonal antibody against the interleukin-6 receptor) were added to the treatment. The patient had increased respiratory difficulty (SpO2: %83) and was taken under the support of MV. Venovenous ECMO treatment was planned on the third day of intubation The results of a laboratory examination were leukocyte: 14.03 K/uL; neutrophiltolymphocyte ratio: 19.35; C-reactive protein: 244.8 mg/L; ferritin: 140.7 µg/L; procalcitonin: 14.7 ng/mL; D-dimer: 13.300 ng/mL and fibrinogen: 790 mg/Dl. The first polymerase chain reaction test was evaluated as SARSCoV-2 positive favipiravir 200 mg PO 2x3, piperacilin-tazobactam 3x4,5 gr IV and enoxaparin 6000 IU SC 2x1 were initiated. On the seventh day of ECMO, the patient developed sudden hypotension, metabolic acidosis, and P/F rate quickly dropped below 100. The patient died despite all the necessary interventions. Conclusion: ECMO indications are respiratory insufficiency, P/F ratio below 100, MV time of less than 7 days, age below 65 years. We could not achieve a successful result, we believe that new experiences. [ABSTRACT FROM AUTHOR]

Objective: Oxygenator is a critical component of extracorporeal membrane oxygenation (ECMO). Blood damage indices of high-flow/low-pressure oxygenators are important for their performance evaluation and are typically performed with animal blood which results in large experimental variation. This study aims to develop a practical cardiovascular device testing set-up focusing on blood damage of neonatal ECMO oxygenators and apply this set-up to novel hemorheology protocols targeting subhemolythic damage and biocompatibility. Materials and Methods: A small in-house test oxygenator is built to the tests of fluorinated polyimide hollow fibers. Blood-organ set-up built with ECMO system by changing oxygenator of the system instead of the real oxygenator of the system. The test oxygenator was monitored and blood samples were taken at some points (from 15 up to 360 minutes). Following protocols are conducted: SEM, Erythrocyte Deformability, Structure of fibers are characterized under scanning electron microscopy (SEM) before and after the experiments. Results: SEM imaging of fibers showed that the porous structure remains intact. No significant difference is obtained on the blood gas composition, demonstrating that the prototype works like a normal oxygenator as expected. Blood tests show that blood cells re-join the circulation in a healthy way, it was observed that the elongation response of the blood cells was the same no matter how much pressure was applied. Conclusion: The proposed blood-organ culture setup is a potentially useful system for testing cardiovascular devices with human blood. As such the novel blood damage protocols translated from fundamental hemorheology research would impact cardiovascular device developments. The preliminary blood damage and oxygenation performance of the prototype oxygenator are encouraging. [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]