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Background: A paucity of evidence exists regarding the risks and benefits of Extracorporeal Membrane Oxygenation (ECMO) in adult kidney transplantation. Methods: This was a systematic review conducted from Jan 1, 2000 to April 24, 2020 of adult kidney transplant recipients (pre‐ or post‐ transplant) and donors who underwent veno‐arterial or veno‐venous ECMO cannulation. Death and graft function were the primary outcomes, with complications as secondary outcomes. Results: Twenty‐three articles were identified that fit inclusion criteria. 461 donors were placed on ECMO, with an overall recipient 12‐month mortality rate of 1.3% and a complication rate of 61.5%, the majority of which was delayed graft function. Fourteen recipients were placed on ECMO intraoperatively or postoperatively, with infection as the most common indication for ECMO. The 90‐day mortality rate for recipients on ECMO was 42.9%, with multisystem organ failure and infection as the ubiquitous causes of death. 35.7% of patients experienced rejection within 6 months of decannulation, yet all were successfully treated. Conclusions: ECMO use in adult kidney transplantation is a useful adjunct. Recipient morbidity and mortality from donors placed on ECMO mirrors that of recipients from standard criteria donors. The morbidity and mortality of recipients placed on ECMO are also similar to other patient populations requiring ECMO. [ABSTRACT FROM AUTHOR]

Background: A paucity of evidence exists regarding risks and benefits of extracorporeal membrane oxygenation (ECMO) in adult liver transplantation. Methods: This was a systematic review conducted from January 1, 2000 to April 24, 2020 of adult liver transplant recipients (pre‐ or post‐transplant) and donors who underwent Veno‐arterial or Veno‐venous ECMO cannulation. Death was the primary outcome, with graft function and complications as secondary outcomes. Results: Forty‐one articles were identified that fit criteria. A total of 183 donors were placed on ECMO, with recipient complication profiles and mortality that mirrored rates from standard criteria donors. Sixty‐one recipients were placed on ECMO intraoperatively or postoperatively. Most patients experienced at least one complication with infections as the most common cause and minimal complications specifically related to ECMO use. Multisystem organ failure (MSOF) and infections were more common among liver recipients who died compared to those who survived. Overall mortality at 90 days was 45.9%. Causes of death were most commonly MSOF and infections. Conclusions: ECMO use in adult liver transplantation is a useful adjunct. Recipient morbidity and mortality from donors placed on ECMO parallel that of recipients from standard criteria donors, and morbidity and mortality of recipients placed on ECMO are similar to other ECMO populations. [ABSTRACT FROM AUTHOR]

Background: Advances in ECMO have made it a useful adjunct in critically ill pediatric patients; however, a dearth of evidence exists regarding risks and benefits in pediatric abdominal transplantation. The purpose of this study was to perform a qualitative systematic review of outcomes in pediatric patients undergoing ECMO support pre– or post–abdominal organ transplantation. Methods: This was a systematic review conducted from Jan 1, 1989, to April 24, 2020, via PubMed, Embase, Scopus, Web of Science, the Cochrane Library, and ClinicalTrials.gov of all pediatric solid abdominal organ transplant recipients (pre‐ and post‐transplant) and donors who underwent V‐A or V‐V ECMO cannulation. Death was the primary outcome, with graft function and complications as secondary outcomes. Results: Fourteen articles were identified that fit criteria, with 88% being case reports. Three patients were donors placed on ECMO, with no mortality among the 8 recipients of organs from these donors. Nineteen recipients were placed on ECMO. All were liver transplants. Most patients experienced at least one complication (84%), with bleeding as the most common cause (44%). Mortality was 26%. Causes of death included multiorgan system failure (n = 3), heart failure (n = 1), Systemic inflammatory response syndrome (n = 1), abdominal compartment syndrome (n = 3), bleeding (n = 1), septic shock from aspergillus (n = 1), and hepatic artery thrombosis (n = 2). Conclusions: The data are poor on ECMO usage in pediatric abdominal transplantation. While complications were high, mortality did not appear to be related to ECMO usage and was relatively low given the severity of patient illness. [ABSTRACT FROM AUTHOR]

Introduction: Preinjury alcohol use and older age have independently been associated with poor outcomes. This study examined whether higher levels of blood alcohol concentration (BAC) correlated with an increased likelihood of poor outcomes in older trauma patients.Methods: This was a retrospective cohort study of injured patients ≥65 years with BAC testing presenting to a Level 1 trauma center between 2015 and 2018. Patients were stratified by BAC at 4 thresholds of intoxication: BAC ≧10 mg/dL, BAC ≧80 mg/dL, BAC ≧150 mg/dL, and BAC ≧200 mg/dL. Propensity score matching using inverse probability of treatment weighting was used to estimate outcomes. Logistic and Poisson regression models were performed for each threshold of the BAC level with the matched cohort to assess clinical outcomes.Results: Of all older patients (n = 3112), 32.5% (n = 1012) had BAC testing. In the matched cohort of 883 patients (76.7 ± 8.2 years; 48.1% female), 111 (12.5%) had BAC ≧10 mg/dL, 83 (74.8%) had BAC ≧80 mg/dL, 60 (54.1%) had BAC ≧150 mg/dL, and 37 (33.3%) had BAC ≧200 mg/dL. Falls (60.5%) and motor vehicle crashes (28.9%) were the most common mechanisms of injury. Median (IQR) of Injury Severity Score (ISS) was 5 (1-10). The risk of severe injury (ISS ≧15) was similar between alcohol-positive and alcohol-negative patients (9.9% vs 15.0%, P = .151). BAC ≧10 g/dL was not associated with length of stay, intensive care unit admission, or in-hospital complication, nor was any of the other 3 analyzed BAC thresholds.Conclusion: Overall, any detectable BAC along and increasing thresholds of BAC was not associated with poor in-hospital outcomes of older patients after trauma. Alcohol screening was low in this population, and intoxication may bias injury assessment, leading to mistriage of older trauma patients. [ABSTRACT FROM AUTHOR]