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4. Percutaneous cannulation is associated with lower rate of severe neurological complication in femoro-femoral ECPR: results from the Extracorporeal Life Support Organization Registry

Author

Liangshan Wang, Chenglong Li, Xin Hao, Peter Rycus, Joseph E. Tonna, Peta Alexander, Eddy Fan, Hong Wang, Feng Yang, and Xiaotong Hou

Subjects
Extracorporeal cardiopulmonary resuscitation, Cardiac arrest, Percutaneous cannulation, Surgical cannulation, Severe neurological complication, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Percutaneous cannulation is now accepted as the first-line strategy for extracorporeal cardiopulmonary resuscitation (ECPR) in adults. However, previous studies comparing percutaneous cannulation to surgical cannulation have been limited by small sample size and single-center settings. This study aimed to compare in-hospital outcomes in cardiac arrest (CA) patients who received femoro-femoral ECPR with percutaneous vs surgical cannulation. Methods Adults with refractory CA treated with percutaneous (percutaneous group) or surgical (surgical group) femoro-femoral ECPR between January 2008 and December 2019 were extracted from the international Extracorporeal Life Support Organization registry. The primary outcome was severe neurological complication. Multivariable logistic regression analyses were performed to assess the association between percutaneous cannulation and in-hospital outcomes. Results Among 3575 patients meeting study inclusion, 2749 (77%) underwent percutaneous cannulation. The proportion of patients undergoing percutaneous cannulation increased from 18% to 89% over the study period (p

Published
2023
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6. Development and Validation of Extracorporeal Membrane Oxygenation Mortality-Risk Models for Congenital Diaphragmatic Hernia

Author

Guner, Yigit S, Nguyen, Danh V, Zhang, Lishi, Chen, Yanjun, Harting, Matthew T, Rycus, Peter, Barbaro, Ryan, Di Nardo, Matteo, Brogan, Thomas V, Cleary, John P, and Yu, Peter T

Subjects
Engineering, Biomedical Engineering, Pediatric, Digestive Diseases, Heart Disease, Infant Mortality, Cardiovascular, Good Health and Well Being, Extracorporeal Membrane Oxygenation, Female, Hernias, Diaphragmatic, Congenital, Humans, Infant, Newborn, Logistic Models, Male, Registries, Retrospective Studies, ECMO, CDH, mortality risk, risk score, Biomedical engineering
Abstract

The purpose of our study was to develop and validate extracorporeal membrane oxygenation (ECMO)-specific mortality risk models for congenital diaphragmatic hernia (CDH). We utilized the data from the Extracorporeal Life Support Organization Registry (2000-2015). Prediction models were developed using multivariable logistic regression. We identified 4,374 neonates with CDH with an overall mortality of 52%. Predictive discrimination (C statistic) for pre-ECMO mortality model was C = 0.65 (95% confidence interval, 0.62-0.68). Within the highest risk group, based on the pre-ECMO risk score, mortality was 87% and 75% in the training and validation data sets, respectively. The pre-ECMO risk score included pre-ECMO ventilator settings, pH, prior diaphragmatic hernia repair, critical congenital heart disease, perinatal infection, and demographics. For the on-ECMO model, mortality prediction improved substantially: C = 0.73 (95% confidence interval, 0.71-0.76) with the addition of on-ECMO-associated complications. Within the highest risk group, defined by the on-ECMO risk score, mortality was 90% and 86% in the training and validation data sets, respectively. Mortality among neonates with CDH needing ECMO can be reliably predicted with validated clinical variables identified in this study. ECMO-specific mortality prediction tools can allow risk stratification to be used in research and quality improvement efforts, as well as with caution for individual case management.

Published
2018

7. Pediatric Extracorporeal Life Support Organization Registry International Report 2016

Author

Barbaro, Ryan P, Paden, Matthew L, Guner, Yigit S, Raman, Lakshmi, Ryerson, Lindsay M, Alexander, Peta, Nasr, Viviane G, Bembea, Melania M, Rycus, Peter T, and Thiagarajan, Ravi R

Subjects
Pediatric Research Initiative, Pediatric, Adolescent, Cardiopulmonary Resuscitation, Child, Child, Preschool, Extracorporeal Membrane Oxygenation, Humans, Infant, Infant, Newborn, Registries, extracorporeal membrane oxygenation, extracorporeal life support, outcomes, complications, pediatric, neonate, Extracorporeal Life Support Organization, ELSO member centers, Biomedical Engineering
Abstract

The purpose of this report is to describe the international growth, outcomes, complications, and technology used in pediatric extracorporeal life support (ECLS) from 2009 to 2015 as reported by participating centers in the Extracorporeal Life Support Organization (ELSO). To date, there are 59,969 children who have received ECLS in the ELSO Registry; among those, 21,907 received ECLS since 2009 with an overall survival to hospital discharge rate of 61%. In 2009, 2,409 ECLS cases were performed at 157 centers. By 2015, that number grew to 2,992 cases in 227 centers, reflecting a 24% increase in patients and 55% growth in centers. ECLS delivered to neonates (0-28 days) for respiratory support was the largest subcategory of ECLS among children

Published
2017

8. Definitions of adverse events associated with extracorporeal membrane oxygenation in children: results of an international Delphi process from the ECMO-CENTRAL ARC

Author

Alexander, Peta M A, Di Nardo, Matteo, Combes, Alain, Vogel, Adam M, Antonini, Marta Velia, Barrett, Nicholas, Benedetti, Giulia M, Bettencourt, Amanda, Brodie, Daniel, Gómez-Gutiérrez, René, Gorga, Stephen M, Hodgson, Carol, Kapoor, Poonam Malhotra, Le, Jennifer, MacLaren, Graeme, O’Neil, Erika R, Ostermann, Marlies, Paden, Matthew L, Patel, Neil, Rojas-Peña, Alvaro, Said, Ahmed S, Sperotto, Francesca, Willems, Ariane, Vercaemst, Leen, Yoganathan, Ajit P, Lorts, Angela, del Nido, Pedro J, Barbaro, Ryan P, Abecasis, Francisco, Al Foudri, Huda, Anders, Marc M., Angus, Derek C., Annich, Gail M., Arachchillage, Deepa J., Akcan-Arikan, Ayse, Armstrong, Aimee K., Balcells, Joan, Barrett, Meredith, Bartlett, Robert H., Belda-Hofheinz, Sylvia, Bembea, Melania M., Best, Derek J., Bonadonna, Desiree, Boonstra, Philip S., Brogan, Thomas V, Brown, Katherine L, Butragueño-Laiseca, Laura, Butt, Warwick W., Camporota, Luigi, Cardenas, Barbara, Cascarano, Maria T., Caspi, Joseph, Chen, Eric, Chiletti, Roberto, Colombo, Giovanna G., Conte, Marisa L., Crowe, Liz, Cvetkovic, Mirjana, Dalton, Heidi J., Daverio, Marco, Davidson, Mark G., Davis, Carl, DiGeronimo, Robert J., Egbunine, Ariel, Ellis, W. Cory, Fan, Eddy, Foster, Claire C, Fraser, John F., Friedman, Matthew L., Furlong-Dillard, Jamie, Fynn-Thompson, Francis, Garcia, Alejandro V., Geppert, Jeffery, Gillette, Nicole, Grazioli, Lorenzo, Greene, Christina L, Guerguerian, Anne-Marie, Guilliams, Kristin P., Haji Fortis, Jumana Y., Hao, Jianming, Heinsar, Silver, Hejduk, Mark W., Himebauch, Adam S., Horvat, Christopher M., Hoskote, Aparna, Hou, Xiaotong, Hyslop, Robert W., Ibrahim, Nicole, Ito, Takuya, Karagiannidis, Christian, Karam, Oliver, Kaushik, Shubhi, Kilbaugh, Todd J., Kim-Campbell, Nahmah, Kirsch, Roxanne E, Kormos, Robert L., Kornberger, Angela, Krucoff, Mitchell W., Lakshminrusimha, Satyan, LaRovere, Kerri L, Leger, Pierre-Louis, Levy, Philip T., Lorusso, Roberto, Lyster, Haifa, Malone, Matthew P., McMullan, D. Michael, Mečířová, Soña, Mehran, Roxana, Merz, Scott I., Mochizuki, Shuichi, Moler, Frank W., Molla, Kalkidan, Monagle, Paul, Morgan, Gareth J., Morgan, Catherine, Morice, Marie-Claude, Muszynski, Jennifer A., Najaf, Tasnim A., Nellis, Marianne E., Newburger, Jane W., O'Rourke, P. Pearl, Ostadal, Petr, Ozment, Caroline P., Pagani, Francis D., Peek, Giles J., Polito, Angelo, Priest, John R., Raman, Lakshmi, Rintoul, Natalie E., Roy, Nathalie, Rubin, Juli, Rumford, Martha, Rycus, Peter, Ryerson, Lindsay M., Sakamoto, Wakako, Segura-Matute, Susana, Shekar, Kiran, Spinella, Philip C., Spitzer, Ernest, Starr, Joanne P., Stead, Christine, Steffen, Katherine, Steiner, Marie E., Tan, Lucy, Tasker, Robert C., Taylor, J. Michael, Thiagarajan, Ravi R., Tonna, Joseph E., Ubertini, Gina M., van Leeuwen, Grace, Vang, Eric, Ventetuolo, Corey E., Venugopal, Prem S., Weinberg, Allison, Westrope, Claire, Wu, Changfu, Wylie, Gillian, Zeymer, Uwe, Zivick, Elizabeth E., and Zochios, Vasileios

Abstract

Extracorporeal membrane oxygenation (ECMO) is a high-risk and low-volume life support with increasing clinical study. However, heterogenous outcome definitions impede data assimilation into evidence to guide practice. The Academic Research Consortium (ARC), an international collaborative forum committed to facilitating the creation of stakeholder-driven consensus nomenclature and outcomes for clinical trials of medical devices, supported the ECMO Core Elements Needed for Trials Regulation And quality of Life (ECMO-CENTRAL) ARC. The ECMO-CENTRAL ARC was assembled to develop definitions of paediatric ECMO adverse events for use in clinical trials and regulatory device evaluation. An initial candidate list of ECMO adverse events derived from the mechanical circulatory support ARC was supplemented with a review of ECMO-relevant adverse event definitions collated from literature published between Jan 1, 1988, and Feb 20, 2023. Distinct teams of international topic experts drafted separate adverse event definitions that were harmonised to existing literature when appropriate. Draft definitions were revised for paediatric ECMO relevance with input from patients, families, and an international expert panel of trialists, clinicians, statisticians, biomedical engineers, device developers, and regulatory agencies. ECMO-CENTRAL ARC was revised and disseminated across research societies and professional organisations. Up to three rounds of internet-based anonymous surveys were planned as a modified Delphi process. The expert panel defined 13 adverse event definitions: neurological, bleeding, device malfunction, acute kidney injury, haemolysis, infection, vascular access-associated injury, non-CNS thrombosis, hepatic dysfunction, right heart failure, left ventricular overload, lactic acidaemia, and hypoxaemia. Definitional structure varied. Among 165 expert panel members, 114 were eligible to vote and 111 voted. Consensus was achieved for all proposed definitions. Agreement ranged from 82% to 95%. ECMO-CENTRAL ARC paired rigorous development with methodical stakeholder involvement and dissemination to define paediatric ECMO adverse events. These definitions will facilitate new research and the assimilation of data across clinical trials and ECMO device evaluation in children.

Published
2024
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9. The Association of Modifiable Postresuscitation Management and Annual Case Volume With Survival After Extracorporeal Cardiopulmonary Resuscitation

Author

Joseph E. Tonna, MD, MS, Craig H. Selzman, MD, Jason A. Bartos, MD, PhD, Angela P. Presson, PhD, Zhining Ou, MS, Yeonjung Jo, BS, Lance Becker, MD, Scott T. Youngquist, MD, MS, Ravi R. Thiagarajan, MBBS, MPH, M. Austin Johnson, MD, PhD, Peter Rycus, MPH, and Heather T. Keenan, MDCM, PhD

Subjects
Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

IMPORTANCE:. It is not know if hospital-level extracorporeal cardiopulmonary resuscitation (ECPR) case volume, or postcannulation clinical management associate with survival outcomes. OBJECTIVES:. To describe variation in postresuscitation management practices, and annual hospital-level case volume, for patients who receive ECPR and to determine associations between these management practices and hospital survival. DESIGN:. Observational cohort study using case-mix adjusted survival analysis. SETTING AND PARTICIPANTS:. Adult patients greater than or equal to 18 years old who received ECPR from the Extracorporeal Life Support Organization Registry from 2008 to 2019. MAIN OUTCOMES AND MEASURES:. Generalized estimating equation logistic regression was used to determine factors associated with hospital survival, accounting for clustering by center. Factors analyzed included specific clinical management interventions after starting extracorporeal membrane oxygenation (ECMO) including coronary angiography, mechanical unloading of the left ventricle on ECMO (with additional placement of a peripheral ventricular assist device, intra-aortic balloon pump, or surgical vent), placement of an arterial perfusion catheter distal to the arterial return cannula (to mitigate leg ischemia); potentially modifiable on-ECMO hemodynamics (arterial pulsatility, mean arterial pressure, ECMO flow); plus hospital-level annual case volume for adult ECPR. RESULTS:. Case-mix adjusted patient-level management practices varied widely across individual hospitals. We analyzed 7,488 adults (29% survival); median age 55 (interquartile range, 44–64), 68% of whom were male. Adjusted hospital survival on ECMO was associated with mechanical unloading of the left ventricle (odds ratio [OR], 1.3; 95% CI, 1.08–1.55; p = 0.005), performance of coronary angiography (OR, 1.34; 95% CI, 1.11– 1.61; p = 0.002), and placement of an arterial perfusion catheter distal to the return cannula (OR, 1.39; 95% CI, 1.05–1.84; p = 0.022). Survival varied by 44% across hospitals after case-mix adjustment and was higher at centers that perform more than 12 ECPR cases/yr (OR, 1.23; 95% CI, 1.04–1.45; p = 0.015) versus medium- and low-volume centers. CONCLUSIONS AND RELEVANCE:. Modifiable ECMO management strategies and annual case volume vary across hospitals, appear to be associated with survival and should be the focus of future research to test if these hypothesis-generating associations are causal in nature.

Published
2022
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10. Venoarterial Extracorporeal Life Support Use in Acute Pulmonary Embolism Shows Favorable Outcomes.

Author

Scott, Erik J., Young, Steven, Ratcliffe, Sarah J., Wang, Xin-Qun, Mehaffey, J. Hunter, Sharma, Aditya, Rycus, Peter, Tonna, Joseph, Yarboro, Leora, Bryner, Ben, Collins, Michael, and Teman, Nicholas R.

Abstract

Differences in outcomes by indication for venoarterial extracorporeal life support (VA-ECLS) are poorly described. We hypothesized that patients on VA-ECLS for acute pulmonary embolism (PE) have fewer complications and better survival than patients on VA-ECLS for other indications. All patients ≥18 years on VA-ECLS from the Extracorporeal Life Support Organization global registry (2010-2019) were evaluated (n = 29,842). After excluding patients aged >79 years (n = 729) and those with incomplete indication data (n = 2530), patients were stratified by VA-ECLS indication for PE vs all other indications. The association between being discharged alive and each type of complication with VA-ECLS indication was assessed. Of 26,583 patients included in the analysis, 978 (3.7%) were on VA-ECLS for a primary diagnosis of acute PE. Acute PE patients were younger (53.1 vs 56.7 years, P <.001) and were more likely to be women (52.1% vs 32.3%, P <.001). Patients who underwent VA-ECLS for acute PE were 78% more likely to be discharged alive vs patients supported with VA-ECLS for other reasons (52.8% vs 40.4%; P <.001). Acute PE patients had fewer cardiovascular and renal complications (26.6% vs 38.0% and 31.1% vs 39.4%, respectively; adjusted P <.001). Acute PE patients had higher odds of having clots and mechanical complications (8.7% vs 7.9% and 16.7% vs 14.6%, respectively; adjusted P <.001). Patients undergoing VA-ECLS for acute PE have higher odds of survival to hospital discharge compared with those supported for other indications. Additionally, VA-ECLS in this population is associated with fewer cardiovascular and renal complications but higher mechanical complications. [Display omitted] [ABSTRACT FROM AUTHOR]

Published
2024
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11. Extracorporeal Membrane Oxygenation Support for Influenza A: Retrospective Review of the Extracorporeal Life Support Organization Registry Comparing H1N1 With Other Subtypes

Author

Erika R. O’Neil, MD, Huiming Lin, MS, Meng Li, PhD, Lara Shekerdemian, MD, Joseph E. Tonna, MD, MS, Ryan P. Barbaro, MD, Jayvee R. Abella, PhD, Peter Rycus, MPH, Graeme MacLaren, MBBS, MSc, Marc M. Anders, MD, and Peta M. A. Alexander, MBBS

Subjects
Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

OBJECTIVES:. Although there is a substantial published experience of extracorporeal membrane oxygenation during the H1N1 pandemic, less is known about the use of extracorporeal membrane oxygenation in patients with other subtypes of the influenza A virus. We hypothesized that the severity of illness and survival of patients supported with extracorporeal membrane oxygenation would differ for those with H1N1 influenza A compared with other subtypes of influenza A. DESIGN, SETTING, PATIENTS:. Retrospective study of extracorporeal membrane oxygenation–supported adults (> 18 yr) with influenza A viral infection reported to the Extracorporeal Life Support Organization Registry between 2009 and 2019. We describe the frequency and compare characteristics and factors associated with in-hospital survival using a least absolute shrinkage and selection operator regression analysis. MAIN OUTCOMES AND MEASURES:. Of 2,461 patients supported with extracorporeal membrane oxygenation for influenza A, 445 had H1N1, and 2,004 had other subtypes of influenza A. H1N1 was the predominant subtype between 2009 and 2011. H1N1 patients were younger, with more severe illness at extracorporeal membrane oxygenation cannulation and higher reported extracorporeal membrane oxygenation complications than those with other influenza A subtypes. Patient characteristics including younger age and higher weight and patient management characteristics including longer ventilation duration before extracorporeal membrane oxygenation were associated with worse survival. Extracorporeal membrane oxygenation complications were associated with reduced survival. There was no difference in survival to hospital discharge according to influenza subtype after adjusting for other characteristics. CONCLUSIONS:. Patients supported with extracorporeal membrane oxygenation for H1N1 were younger, with more severe illness than those supported for other influenza A subtypes. Survival to hospital discharge was associated with patient characteristics, management characteristics, and extracorporeal membrane oxygenation complications but was not impacted by the specific influenza A subtype.

Published
2021
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12. Outcomes of Pediatric Patients With Sepsis Related to Staphylococcus aureus and Methicillin-Resistant Staphylococcus aureus Infections Requiring Extracorporeal Life Support: An ELSO Database Study

Author

Cortney Foster, Dayanand Bagdure, Jason Custer, Adrian Holloway, Peter Rycus, Jenni Day, and Adnan Bhutta

Subjects
ECMO, MSSA, MRSA, outcomes, sepsis, pediatric, Pediatrics, RJ1-570
Abstract

Background: Extracorporeal membrane oxygenation (ECMO) is increasingly utilized for pediatric sepsis unresponsive to steroids and inotropic support. Outcomes of children with sepsis are influenced by the type of pathogen causing their illness.Objective: To determine if the outcomes of children with Staphylococcus aureus sepsis receiving ECMO differed according to microbial sensitivity (Methicillin-resistant Staphylococcus aureus [MRSA] vs. Methicillin-sensitive Staphylococcus aureus [MSSA]).Methods: Retrospective case-matched cohort study of children (0–

Published
2021
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14. Extracorporeal Membrane Oxygenation After Liver Transplant in Children: A Review of the ELSO Registry

Author

Di Nardo, Matteo, Cousin, Vladimir L., Alunni-Fegatelli, Danilo, Grazioli, Serge, Rycus, Peter, Thiagarajan, Ravi R., Joye, Raphael, and Polito, Angelo

Abstract

There are minimal data describing use of extracorporeal membrane oxygenation (ECMO) in pediatric patient after a liver transplantation (LT). This study aimed at describing ECMO run in this specific situation using the data from Extracorporeal Life Support Organization (ELSO) Registry between January 1, 2010, to December 31, 2022. We described patients’ characteristics at ECMO initiation, outcome and mortality risk factors. We identified 27 patients with a median age of 2.7 years (interquartile range (IQR) = 1.5–9.9). Main indication for ECMO support was respiratory (14/27 [52%]) followed by extracorporeal cardiopulmonary resuscitation (ECPR) (7/27 [26%]) and cardiac (6/27 [22%]). Overall in-hospital mortality was 63% (17/27). Mortality rate according to ECMO indications was 50% for both respiratory and cardiac failure and reached 100% for ECPR patients. Overall, nonsurvivors experienced significantly more complications under ECMO support (p= 0.007). Main on-ECMO complications were hemorrhagic (11/27 [41%]) and thrombotic (7/27 [26%]). No clinical or biologic factors was predictive of patients’ outcome. Our results suggest that ECMO support is a viable option for cardiac and respiratory indications after pediatric LT. Occurrence of complications while on ECMO are associated with unfavorable outcomes. The extremely high mortality rate in ECPR patients merits further research.

Published
2024
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15. Risk Factors for Severe Primary Graft Dysfunction in Infants Following Heart Transplant

Author

Tajinder P. Singh, Elizabeth L. Profita, Peter Rycus, Ravi Thiagarajan, and Kimberlee Gauvreau

Subjects
children, heart transplant, outcomes, pediatric, primary graft dysfunction, primary graft failure, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background Previous studies suggest that infant heart transplant (HT) recipients are at higher risk of developing severe primary graft dysfunction (PGD) than older children. We sought to identify risk factors for developing severe PGD in infant HT recipients. Methods and Results We identified all HT recipients aged

Published
2021
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16. Cardiac Tamponade Complicating Extracorporeal Membrane Oxygenation: An Extracorporeal Life Support Organization Registry Analysis.

Author

Basílio, Carla, Anders, Marc, Rycus, Peter, Paiva, José Artur, and Roncon-Albuquerque, Roberto

Abstract

Cardiac tamponade is a potentially life-threatening complication during extracorporeal membrane oxygenation (ECMO). In this study, the authors assessed the incidence, patient characteristics, and risk factors for mortality of cardiac tamponade during ECMO. The authors queried the Extracorporeal Life Support Organization (ELSO) Registry from 1997 to 2021 for all adults with cardiac tamponade as a reported complication during ECMO. Cardiac tamponade was reported in 2,176 (64% men; 53.8 ± 0.33 years) of 84,430 adults (2.6%). Venoarterial ECMO was the main configuration (78%), followed by venovenous ECMO (VV ECMO) (18%), for cardiac (67%), pulmonary (21%) support, and extracorporeal cardiopulmonary resuscitation (ECPR) (12%). Percutaneous cannulation was performed in 51%, with the femoral vein and femoral artery as the most common sites for drainage and return cannulae, with dual-lumen cannulae in 39% of VV ECMO. Hospital survival was lower (35% v 49%; p < 0.01) when compared with that of all adults from the ELSO Registry. In multivariate analysis, age, aortic dissection and/or rupture, COVID-19, ECPR, pre-ECMO renal-replacement therapy, and prone position are associated with hospital mortality, whereas ECMO for pulmonary support is associated with hospital survival. Similarly, renal, cardiovascular, metabolic, neurologic, and pulmonary complications occurred more frequently in nonsurvivors. Cardiac tamponade is a rare complication during ECMO that, despite being potentially reversible, is associated with high hospital mortality. Venoarterial ECMO is the most common configuration. ECMO for pulmonary support was associated with higher survival, and ECPR was associated with higher mortality. In these patients, other ECMO-related complications were frequently reported and associated with hospital mortality. [ABSTRACT FROM AUTHOR]

Published
2024
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17. Extracorporeal membrane oxygenation for life-threatening asthma refractory to mechanical ventilation: analysis of the Extracorporeal Life Support Organization registry

Author

Hye Ju Yeo, Dohyung Kim, Doosoo Jeon, Yun Seong Kim, Peter Rycus, and Woo Hyun Cho

Subjects
Extracorporeal Life Support Organization, Extracorporeal membrane oxygenation, Outcomes, Near-fatal asthma, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background The use of extracorporeal membrane oxygenation (ECMO) in cases of near-fatal asthma (NFA) has increased, but the benefits and potential complications of this therapy have yet to be fully investigated. Methods Cases were extracted from the Extracorporeal Life Support Organization Registry between March 1992 and March 2016. All patients with a diagnosis of asthma (according to the International Classification of Diseases 9th edition), who also received ECMO, were extracted. Exclusion criteria included patients who underwent multiple courses of ECMO; those who received ECMO for cardiopulmonary resuscitation or cardiac dysfunction; and those with another primary diagnosis, such as sepsis. We analyzed survival to hospital discharge, complications, and clinical factors associated with in-hospital mortality, in patients with severe life-threatening NFA requiring ECMO support. Results In total 272 patients were included. The mean time spent on ECMO was 176.4 hours. Ventilator settings, including rate, fraction of inspired oxygen (FiO2), peak inspiratory pressure (PIP), and mean airway pressure, significantly improved after ECMO initiation (rate (breaths/min), 19.0 vs. 11.3, p

Published
2017
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19. Extracorporeal membrane oxygenation for refractory cardiac arrest

Author

Steven A Conrad and Peter T Rycus

Subjects
Extracorporeal cardiopulmonary resuscitation, extracorporeal membrane oxygenation, refractory cardiac arrest, Anesthesiology, RD78.3-87.3, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Extracorporeal cardiopulmonary resuscitation (ECPR) is the use of rapid deployment venoarterial (VA) extracorporeal membrane oxygenation to support systemic circulation and vital organ perfusion in patients in refractory cardiac arrest not responding to conventional cardiopulmonary resuscitation (CPR). Although prospective controlled studies are lacking, observational studies suggest improved outcomes compared with conventional CPR when ECPR is instituted within 30-60 min following cardiac arrest. Adult and pediatric patients with witnessed in-hospital and out-of-hospital cardiac arrest and good quality CPR, failure of at least 15 min of conventional resuscitation, and a potentially reversible cause for arrest are candidates. Percutaneous cannulation where feasible is rapid and can be performed by nonsurgeons (emergency physicians, intensivists, cardiologists, and interventional radiologists). Modern extracorporeal systems are easy to prime and manage and are technically easy to manage with proper training and experience. ECPR can be deployed in the emergency department for out-of-hospital arrest or in various inpatient units for in-hospital arrest. ECPR should be considered for patients with refractory cardiac arrest in hospitals with an existing extracorporeal life support program, able to provide rapid deployment of support, and with resources to provide postresuscitation evaluation and management.

Published
2017
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20. Extracorporeal Life Support Organization Registry International Report 2022: 100,000 Survivors

Author

Tonna, Joseph E., Boonstra, Philip S., MacLaren, Graeme, Paden, Matthew, Brodie, Daniel, Anders, Marc, Hoskote, Aparna, Ramanathan, Kollengode, Hyslop, Rob, Fanning, Jeffrey J., Rycus, Peter, Stead, Christine, Barrett, Nicholas A., Mueller, Thomas, Gómez, Rene D., Malhotra Kapoor, Poonam, Fraser, John F., Bartlett, Robert H., Alexander, Peta M.A., Barbaro, Ryan P., Abbasi, Adeel, Said Abdalmohsen, Ahmad, Abdelbary, Akram M., Abecasis, Francisco, Abel, Peter, Abu-Omar, Yasir, Adams, Douglas R, Manuel Africano, Juan, Aganga, Devon, Agati, Salvatore, Agerstrand, Cara, Aguillon, Mario V., Akers, Crystal S., Akhtarekhavari, Julia, Alazzam, Mohammad Izzat Salah, Albert, Martin, Alberti, Angela, Al-Fares, Abdulrahman A., Alfoudri, Huda, Allaert, Silvie, Allbert, Keesha N., Allen, Christopher T., Lescano Alva, Miguel Ángel, Alwardt, Cory M., Amigoni, Angela, Anandamurthy, Balaram, Anastasiadis, Kyriakos, Anders, Nicholas R., Anderson, Scott A., Anderson, Patricia L., Andrijević, Ana, Annoni, Alice, Anselmi, Michael, Anstey, James R., Antonini, Marta V., Antonitsis, Polychronis, Stein Araujo, Tays, Arcalas, Rhodney, Areinamo, Igor, Martin Arias, Anibal, Armijo-Garcia, Veronica, Aronsky, Vladimir, Arora, Lovkesh, Arora, Madhur, Leigh Aspenleiter, Marit, Atik, Fernando A., AugustGeorg Auzinger, Erin Colleen, Azzam, Ismail, Bacchetta, Matthew, Bak, Erica I., Balcells, Joan, Sánchez Ballesteros, Jesús, Banjac, Igor S., Barbaria, Jacqueline M., Barrigoto, Cleide L., Bass, Stephanie D., Batranović, Uroš, Bauer, Matthew H., Fernando Bautista, Diego, Beck, Robert M., Giraldo Bejarano, Estefania, Belohlavek, Jan, Bembea, Melania M., Benes, Jan, Benharash, Peyman, Benish, Lynne A., Bennett, Suzanne, Bento, Luís F.N., Bermudez, Christian A., Bertini, Pietro, Best, Derek, Bharat, Ankit, Bhutta, Omar J., Bizzell, Samantha J., Blakeman, Stephanie A., Blanco-Schweizer, Pablo, Blanton, Jessica K., Blood, Peggy S., Bohlmann, Allison S., Kyle Bohman, John, Bombino, Michela, Kathleen Bonadonna, Desiree, Bond, Ashley, Borgmann, Kristina M., Bourgoin, Pierre, Boville, Brian M., Boza, Raquel, Brady, Heather L., Brady, Alison, Braunlich, Jessica M., Bridges, Brian C., Brinkley, Karen K., Brookshire, Robert S., Brozzi Nicole Brueggemann, Nicolas A., Buckley, Dwight P., Buckley, Klayton, Budhani, Irfan B., Bukamal, Nazar, Burgos, Lucrecia M, Burša, Filip, Busby, Landon K., Buscher, Hergen, Butler, Menoly, Butt, Warwick W., Byrnes, Jonathan W., Calaritis, Christos, Caldwell, Lisa R., Calligaro, Gregory L., Campbell, Patrick T., Camporota, Luigi, Fernando Caneo, Luiz, Jovo Carapic, Vladimir, Carrasco-Carrasco, Cristina, Ivan Carrizo, Nestor, Carrow, Heidi, Carton, Edmund G., Casabella, Christian, Gomez Casal, Vanesa, Casey, Francis L., Castillo, Andres, Castleberry, Anthony W., Alexandros Cavayas, Yiorgos, Cerqua, Karey, Ming Chan, Kai Man ChanWai, Brian Chapman, Jason, Brahma Chari, Hari, Cheifetz, Omair ChaudharyIra M., Chen, Robin H.S, Chen, Weiting, Cheung, Eva W., Cheung, Anson, Chico, Juan I., Chiletti, Roberto, Jin Cho, Hwa, Cholette, Jill M., Christensen, Steffen, Chui, Betty S., Circelli, Alessandro, Clement, Katherine C., Cleuziou, Julie, Clouse, Brian, Cole, Gwendolen, Coles, Garrett M., Collins, Monika F., Collins, Monika F., Connelly, James, Conrad, Steven A., Cook, Marlene, Copeland, Hannah, Copus, Scott C., Cox, Charles S., Craig, Lynne K., Crain, Natasha, Cremonese, Ricardo V., Criswell, Emily A., Cross, Lisa M., Crowley, Moira A., Crowley, Jerome C., Cruz, Leonora, Cypel, Marcelo, Czarnik, Tomasz, Czuczwa, Miroslaw E., Sica da Rocha, Taís, Daddow, Samuel, Dali, Dante C., Dalton, Heidi J., Daly, Kathleen J.R., Damuth, Emily, Daniel, Dennis A., Daniel IV, John M., Daniel, Josiane M., Danis, Max D., Danko, Melissa E., Rodrigues Dantas, Joao Alberto, Daoust, Isabelle, Dauwe, Dieter F., Davidson, Mark, Davis, Joel C., Davis, Mitchell, D’Cunha, Jonathan, de Arruda Bravim, Bruno, de BoodeKim T. De La Cruz, Willem P., Gray DeAngelis, Kathryn, Debeuckelaere, Gerdy, Deitemyer, Matthew A., DellaVolpe, Jeffrey, Deneau, Jamie L., DeNino, Walter F., Denmark, Christopher G., Denney, Derek, DeValeria, Patrick A., Dewulf, Petra, Di Nardo, Matteo, DiBardino, Daniel J., DiMartino, Joseph, Dimopoulos, Stavros, Domico, Michele B., Dominy, Meaghan E., Donker, Dirk W., Dresbach, Till, Droogh, Joep M., Dunlap, Tiffany W., Dupon, Allsion, Durham, Lucian A., Durward, Andrew, Dvorak, Anna, Dyett, John F., Dziedzina, Carol L., Eaken, Carmen L., Eaton, Jonathan S., Eberle, Christopher J., Edwards, Linda, Efseviou, Christakis, Eigner, Juliann M., Ahmed Elhamrawi, Hazem, Elhazmi, Alyaa M., Elizondo, Tammy, Ellersick, Beverly L., Emling, Jonathan A., Ernst, Andreas, Pablo Escalante, Juan, Espinoza, Otoniel, Evey, Lee W., Fan, Eddy, Fang, Gary, Faulkner, Gail M., Fauman, Karen R, Ferguson, Niall, Ferreira, Benigno, Fiane, Arnt E., Andrade Fierro, Dario, Martha Filippi, María, Findeisen, Michael C., Finlay, Katie, Finlayson, Gordon, Fischer, Gwenyth A., Fischer, Courtney D., Fischer, William J., Fisher, Caleb M., Fitriasari, Reni, Fitzgerald, Jillian, Fix, Melissa K., Fleming, Sarah B., Flynn, Brigid C., Forst, Beth A., Fortuna, Philip P., Foti, Giuseppe, Fox, Matthew P., Franco, Thais O., David Freeland, C., Fried, Justin A., Friedman, Matthew L., Furlanetto, Beatriz, Fux, Thomas, Gaião, Sérgio, Gale, Michael J., Garcia, Joann Kathleen G., Garcia-Montilla, Romel, Gardner, Eric R., Garg, Meena, Garrison, Lawrence L., Gavrilovic, Srdjan M., Gawda, Ryszard, Geer, Laura W., Gelandt, Elton A., Gelvin, Michael G., Genovese, Bradley M., George, Jeffrey A., George, Timothy J, George, Sangley, Ghimire, Anup, Giani, Marco, Gill, Baljit S., Glikes, Erin, Golecki, Michael, Gongora, Enrique, Govener, Sara, Graf, Amanda, Grasselli, Giacomo, Gray, Brian W., Greenlee, Joseph A., Gregoric, Igor D., Gregory, Melinda, Grins, Edgars, Volker Groesdonk, Heinrich, Group, Kimberly F., Guarracino, Fabio, Joy Guidi-Solloway, Alexandra, Gunn, Tyler M., Guru, Pramod K, Haddle, John C., Haft, Jonathan W., Haisz, Emma, Hall, Julie L., Hall, Cameron, Hamaguchi, Jun, Hammond, Terese C., Han, Peggy K., Hardison, Daphne C., Harischandra, Dickwelle T., Hart, Shaun M., Harting, Matthew T., Hartley, Louise, Harvey, Chris J., Hasan, Zubair, Fawzy Hassan, Ibrahim, Hastings, Jennifer R., Hatcher, Renee’, Hatton, Kevin W., Haught, Christopher K., Awori Hayanga, Jeremiah, Peter Haydon, Timothy, Healy, Aaron H., Heard, Micheal L., Heather, Beth M., Hendrix, Rik H.J., Hennig, Felix, Hermens, Greet HermansJeannine A.J., Hernandez, Deborah A., Hernandez-Montfort, Jaime, Herrera, Guillermo, Hickman, Keri, Hittel, Ashley, Hobbs, Crystal, Hoffman, Jordan R.H., Hollinger, Laura E., Homishak, Michael, Horigoshi, Nelson K., Hoshino, Kota, Huang, Shu-Chien, Huenges, Katharina, Hussey, Alexander D., Hyslop, Robert W., Ihle, Rayan E., Ingemansson, Ola, Ivulich, Daniel, Jackson, Amanda L., Garcia Jacques, Rogelio, Jain, Harsh, Jakobs, Sharon M., Jan, Robert, Janowiak, Lisa M., Jara, Claire B., Jarden, Angela M., Jarzembowski, Jamie L., Jaudon, Andrew, Kishore Jayanthi, Venkata Krishna, Jennings, Joseph A., Jeong, Inseok, Meza Jiménez, Rafael, Jimenez-Rodriguez, Gian M., Joachim, Sabrina, Joelsons, Daniel, Johnson, Caroline A., Johnson, Andrea L., Jones, Jeffry H., Joseph, Mark, Joseph, Sunimol, Joshi, Raja, Joyce, Christopher J., Seung Jung, Jae, Carone Junior, José, Kallas, Harry J., KamerkarPilje Kang, Asavari, Kar, Biswajit, Karapanagiotidis, Georgios T., Kattan, Javier, Kaufman, David A., Kawauchi, Akira, Keene, Sarah D., Keller, Norma M., Keller, Roberta, Kelley, Emily W., Kelley, Kellie, Kelly-Geyer, Janet F., Kenderessy, Peter, Kenny, Laura E., Keshavjee, Shaf, Kessel, D., Kessler, Heather, Keuler, Suzanne, Khicha, Sanjay, Wan Kim, Do, Kim, Richard Y., Maxwell Kime, Aaron, Kincade, Robert C., Kipfmueller, Florian, Kirk, Douglas A., Klein, Liviu, Knapp, Randall S., Knapp, Randall S., Kneyber, Martin C.J., Knowles, Andrea L., Koch, Jillian M., Koepke, Stephanie, Kogelmann, Klaus M., Elzo Kraemer, Carlos, Krauklis, Amanda, Krumroy, Samantha L., Kumar, Madhan, Kumar, Arun, Kumpf, Matthias E, Kyle, Kimberly, Laffin, Anna, Kees Lagrand, Wim, Lahiji, Parshawn A., Keung Lai, Peter Chi, Ka Lai, Cally Ho, Danielle Laird, Amanda, Landsberg, Michelle LaMarreDavid M., Lanmueller, Pia, Oude Lansink-Hartgring, Annemieke, Beth Larson, Sharon, Laufenberg, De’Ann M., Lavana, Jayshree, Layne, Tracie L., John Lazar, Michael, Ledoux, Matthew R., Lee, Raymond C., Leek, Thomas M., Lequier, Laurance, Lesbekov, Timur, Leslie, Robert, Anne Leung, Kit Hung, Lillie, Jon, Phang Lim, Yeong, Lim, Sang-Hyun, Lin, Ling, Lindsey, Thomas, Ho Ling, Steven Kin, Lingle, Kaitlyn J., Lipes, Jed, Liu, Songqiao, Llevadias, Judit, Lomas, Erin A., Longenecker, Robert D., Lorusso, Roberto, Ann Low, Tracy, Steven Lubinsky, Anthony, Lucas, Matthias LubnowMark T., Lucchini, Alberto, Luze, Lisa E., Lynch, William R., Manoj, M.C., Maas, Jacinta J., MacNamara, Vanessa, Madden, Jesse L., Maimone, Justin, Malhotra, Rajiv, Malone, Matthew P., Mangukia, Chirantan, Manzur-Sandoval, Daniel, Maráczi, Veronika, Marinaro, Jonathan L., Marinucci, Christina R., Marshall, Tammy, Martin, Mark, Marwali, Eva M., Maslach-Hubbard, Anna, Matijašević, Jovan, Mattke, Adrian, Mattucci, Joseph, Maul, Timothy M., Maybauer, Marc O., Mayette, Michael, Mayville, Joni R., McAllister, Catherine, McBride, Martha W., Scott McCaul, David, McClelland, Samantha L.S., Gregory McCloskey, Colin, McGregor, Randy, McKamie, Wesley A., McKee, Andrew D., McMahon, Chelsea M., McMullin, Kaye, McNicol, Jane, McNulty, John P., McRae, Thomas, Meade, Maureen E., Meersseman, Philippe, Mekeirele, Michael, Ito Mendes, Elisa, Menon, Anuradha P., Meyer, Jason P., Meyers, Jourdan E., Meyns, Bart, Mignone, John L., Miller, Brittany D., Miller, Malcolm G.A., Miller, Deborah, Mintak, Renee, Minter, Sarah M., Reis Miranda, Dinis, Mirza, Farrukh, Mishkin, Joseph D., Modelewski, Paul, Mohan, Rajeev C., Hui Mok, Yee, Money, Dustin, Monteagudo, Julie, Moores, Russell R., Moran, Patrick, Morelock, Shawn, Moreno, Marsha R., Blanco Morillo, Juan, Morrison, Tracy, Morton, John M., Morton, Brenda, Moscatelli, Andrea, Mosier, Jarrod M., Muellenbach, Ralf M., Mueller, Andreas, Mueller, Dale, Musca, Steven C., Nagpal, Dave, Najaf, Tasnim, Narasimhan, Mangala, Nater, Melissa, Natividad, Zynthia, Nedeljkov, Djordje, Nelson, Bryan D., Newman, Sally F., Newton, Debra E., Neyman, Jonathan L., George Ng, Wing Yiu, Nicholson, Meghan C., Nicolaas, Christine, Nix, Charlie, Nkwantabisa, Raymond, Nolan, Shirley, Norese, Mariano, Norton, Bridget M., Norton, Bridget M., O’Brien, Serena G., O’Callaghan, Maura, Oishi, Peter, O’Leary, Tony D., Olia, Salim E., O’Meara, Carlisle, Oppel, Emily E., Arias Ortiz, Julian, Oza, Pranay L., Ozment, Caroline P., Pacific, Marjorie, Pálizas, Fernando, Palmer, David, Paoletti, Luca, Pardo, Diego H., Paredes, Pablo, Patel, Thomas PasgaardMrunal G., Patel, Sandeep M., Patel, Vijay S., Patel, Brijesh V., PatelDrisya Paul, Sameer, Pawale, Amit A., Pearson, Nicole M., Renee Pearson, Crystal, Peek, Giles J., Pellecchia, Crescens M., Pellegrino, Vincent, Peperstraete, Harlinde, Perkins, Rebecca L., Perkins, Brandon, Peterec, Steven, Peterman, Claire, Phillips, Cooper W., Piekutowski, Richard R., Pilan, María L., Luisa Pilan, Maria, Mark Pincus, Jason, Pino, Melissa, Plambeck, Robert W., Plisco, Michael S., Plumley, Donald A., Plunkett, Mark D., Poffo, Robinson, Poh, Pei-Fen, Polito, Angelo, Pollema, Travis L, Pozzi, Matteo, Pozzi, Matteo, Pranikoff, Thomas, Prekker, Matthew E., Prossen, Erik F., Puligandla, Pramod S., Puslecki, Mateusz, Raheel Qureshi, Muhammad, Emilia Rabanal, Lily, Abdulhamid Rabie, Ahmed, Rackley, Craig R., Radovancevic, Rajko, Raes, Matthias, Allen Raff, Lauren Desiree, Rahban, Youssef, Raimer, Patricia L., Rajbanshi, Bijoy G., Ramanan, Raj, Rambaud, Jerome, Ramírez-Arce, Jorge A., Simões Ramos, Ana Carolina, Rao, Suresh G., Rector, Raymond, Redfors, Bengt, Regmi, Ashim, Alejandro Rey, Jose, Miguel Ribeiro, Joao, Richards, Chelsea E, Joan Richardson, C., Riddle, Christy C., Riera, Jordi, Ripardo, Marina, Rivas, Fernando M., Roan, Ronald M., Robertson, Elizabeth, Robinson, Megan, Röder, Daniel, Rodrigus, Inez E.R., Paul Roeleveld, Peter, Romano, Jennifer C., Rona, Roberto, Ann Rosenberg, Carol, Rosenow, Felix, Rowe, Robert J., Rower, Katy E., Rudolph, Kristina L., Fernando Rueda, Luis, Ruf, Bettina, Russell, Hyde M., Russell, Nichole, Ryan, Kathleen, Saberi, Asif A., Said, Ahmed S., Sailor, Caitlin, Sakal, Angela, Lujan Salas, Gisela, Salazar, Leonardo, Saleem, Kashif, Samoukovic, Gordan, Sanchez, Pablo G., Marie Santiago, Lian, Sargin, Murat, Miguel Sassine, Assad, Satou, Nancy L., Saunders, Paul C., Schachinger, Scott, Schaible, Thomas, Schellongowski, Peter, Schlager, Gerald W., Schmid, Christof, Schmitt, Joachim, Schnell, LeeAndra, Schnur, Janos, Schroeder, Lukas, Schubach, Scott, Schuetz, Michael T., Schwartz, Gary S., Schwarz, Patricia, Scriven, Nicole M., Seabrook, Ruth B., Seefeldt, Cassandra, Seelhammer, Troy G., Segura-Matute, Susana, Sen, Ayan, Adrian Seoane, Leonardo, Shaffer, Jamie, Shafi, Bilal M., Shambley, Shannon, Shankar, Shyam, Shapland, Amanda, Sharng, Yih, Shavelle, David, Sheldrake, Jayne, Mohan Shetty, Rajesh, Shiber, Joseph R., Shimzu, Naoki, Lou Short, Billie, Sichting, Kay A., Sidehamer, Keith E., Siebenaler, Teka, Silvestry, Scott C., Sinclair, Jennifer T, Sinclair, Andrew, Singh, Aalok R., Singh, Gurmeet, Skinner, Sean C., Smart, Alexandra, Smith, Reanna M., Smith, Adam, Smith, Karen, Sommer-Candelario, Sherri, Song, Seunghwan, Sorensen, Gro, Sousa, Eduardo, Sower, Christopher T., Spadea, Nicholas V, Spangle, April, Speicher, David G., Spieth, Peter M., Srivastava, Ankur, Srivastava, Neeraj, Stahl, Mark, Stallkamp, Eric D., Stanley, Vanessa J., Starr, Joanne P., Staudinger, Thomas, Stevens, Berkeley E., Stevens, Kimberly, Stocker, Christian, Strickland, Richard, Suarez, Erik E., Kumar Subramanian, Rakesh, Sudakevych, Serhii, Summerall, Charlene, Sundararajan, Santosh, Susupaus, Attapoom, Suzuki, Hiroyuki, Sweberg, Todd, Sydzyik, Troy, Anh Ta, Tuan, Tagliari, Luciana, Tanaka, Hiroyuki, Tanski, Christopher T., Tasset, Mark, Taylor, Donna M., Teman, Nicholas R., Ramesh Thangaraj, Paul, Thiagarajan, Ravi R., Thiruchelvam, Timothy, Thomas, James A., Thomas, Owain D., Thompson, Shaun L., Thomson, David A., Thukaram, Roopa, Todd, Mark L., Toeg, Hadi, Torres, Silvio F., Trautner, Simon, Trombino, Terry, Tuazon, Divina M., Tuel, Julie, Tukacs, Monika, Turner, April N., Tyree, Melissa M., Uchiyama, Makoto, Vaijyanath, Prashant, van den Brule, Judith M.D., van Dyck, Marlice A., van Gijlswijk, Mascha, Van Meurs, Krisa P., VanDyck, Tyler J., Vardi, Amir, Vega, Alejandra, Ventetuolo, Corey E., Vera, Magdalena, Vercaemst, Leen, Vets, Philippe, Viamonte, Heather, Vidlund, Mårten, Vitali, Sally H., Vlaa, Alexander P.J., Vuylsteke, Alain, Loon Wan, Kah, Watkins, Reuben, Watson, Pia, Weast, Travis A., Weaver, Karen E., Welkovics, Norbert, Wellner, Heidi L., Wells, Jason C., Welter, Karen, Westpheling, Amber G., Whalen, Lesta D.S., Whebell, Stephen, Wiersema, Ubbo, Wiisanen, Matthew E., Eugene Wilcox, Bradley, Wille, Keith, Jan Will, Ellyne, Wilson, Brock J., Win, April M., Winearls, James R., Wise, Linda J., Witter, Tobias, Ruby Wong, Hoi Mei, Worku, Berhane, Wright, Tina M, Wu, James K., Yalon, Larissa A., Yantosh, Garrett, Yaranov, Dmitry M., Yee, Pat, Yi, Cassia, Yost, Christian C., Young, John, Younger, Katrina, Zaborowski, Steven, Zachmann, Brenda, Zainab, Asma, Zanai, Rosanna, Zhao, Ju, Zhou, Chengbin, and Zinger, Marcia

Abstract

The Extracorporeal Life Support Organization (ELSO) maintains the world’s largest extracorporeal membrane oxygenation (ECMO) registry by volume, center participation, and international scope. This 2022 ELSO Registry Report describes the program characteristics of ECMO centers, processes of ECMO care, and reported outcomes. Neonates (0–28 days), children (29 days–17 years), and adults (≥18 years) supported with ECMO from 2009 through 2022 and reported to the ELSO Registry were included. This report describes adjunctive therapies, support modes, treatments, complications, and survival outcomes. Data are presented descriptively as counts and percent or median and interquartile range (IQR) by year, group, or level. Missing values were excluded before calculating descriptive statistics. Complications are reported per 1,000 ECMO hours. From 2009 to 2022, 154,568 ECMO runs were entered into the ELSO Registry. Seven hundred and eighty centers submitted data during this time (557 in 2022). Since 2009, the median annual number of adult ECMO runs per center per year increased from 4 to 15, whereas for pediatric and neonatal runs, the rate decreased from 12 to 7. Over 50% of patients were transferred to the reporting ECMO center; 20% of these patients were transported with ECMO. The use of prone positioning before respiratory ECMO increased from 15% (2019) to 44% (2021) for adults during the coronavirus disease-2019 (COVID-19) pandemic. Survival to hospital discharge was greatest at 68.5% for neonatal respiratory support and lowest at 29.5% for ECPR delivered to adults. By 2022, the Registry had enrolled its 200,000th ECMO patient and 100,000th patient discharged alive. Since its inception, the ELSO Registry has helped centers measure and compare outcomes across its member centers and strategies of care. Continued growth and development of the Registry will aim to bolster its utility to patients and centers.

Published
2024
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21. Foundations of a life support equipment exchange platform

Author

Sleasman, Justin R., Hijawi, Ula, Alsalemi, Abdullah, Rabie, Mohamed, Noorizadeh, Mohammad, Stead, Aidan, Cooley, Christopher, Donnelly, Conor, Haft, Jonathan W., Abrams, Darryl, Stead, Christine, Ryan, Kathleen R., Rycus, Peter, Fox, Alexander D., Ogino, Mark T., Alexander, Peta M.A., Sleasman, Justin R., Hijawi, Ula, Alsalemi, Abdullah, Rabie, Mohamed, Noorizadeh, Mohammad, Stead, Aidan, Cooley, Christopher, Donnelly, Conor, Haft, Jonathan W., Abrams, Darryl, Stead, Christine, Ryan, Kathleen R., Rycus, Peter, Fox, Alexander D., Ogino, Mark T., and Alexander, Peta M.A.

Abstract

Background: The Extracorporeal Life Support Organization Supplies Platform (https://Supplies.ELSO.org) was created out of Extracorporeal Membrane Oxygenation (ECMO) disposable product shortage prior to and during the Coronavirus Disease 2019 (COVID-19) pandemic. This novel Platform supports Centers in obtaining disposables from other Centers when alternative avenues are exhausted. Methods: Driven by the opportunity for increased patient care by using the product availability of the 962 ELSO centers worldwide was the motivation to form an efficient online supply sharing Platform. The pandemic created by COVID-19 became a catalyst to further recognize the magnitude of the supply disruption on a global scale, impacting allocations and guidelines for institutions, practice, and patient care. Conclusions: Records kept on the Platform website are helpful to the industry by providing insights into where difficulties exist in the supply chain for needed equipment. Yet, the common thread is awareness, of how critical situations can stretch resources and challenge our resolve for the best patient care. ELSO is proud to support member centers in these situations, by providing a means of attaining needed ECMO life support products to cover supply shortages.

Published
2023
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22. Issues in Differential Response

Author

Hughes, Ronald C., Rycus, Judith S., Saunders-Adams, Stacey M., Hughes, Laura K., and Hughes, Kelli N.

Abstract

Differential response (DR), also referred to as alternative response (AR), family assessment response (FAR), or multiple track response, was developed to incorporate family-centered, strengths-based practices into child protective services (CPS), primarily by diverting lower risk families into an assessment track rather than requiring the traditional CPS investigation. Since the program's inception, researchers have conducted several large evaluation studies of DR programs, and a large body of research and program literature has been published touting the success and benefits of DR. In response to significant concerns about the clarity and consistency of DR program models and the validity and generalizability of its associated research, the authors undertook a comprehensive, three-pronged evaluation to provide guidance in shaping the ongoing development of DR programs. This report summarizes the methodology, findings, conclusions, and recommendations from the review.

Published
2013
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23. Discussion of Issues in Differential Response

Author

Hughes, Ronald C. and Rycus, Judith S.

Abstract

In this article, the authors responded to nine commentaries by 17 contributors to their article, "Issues in Differential Response." The authors found that a majority of the respondents agreed with the major conclusions of "Issues in Differential Response." However, there were varying degrees of disagreement regarding the significance of some of the article's conclusions. The authors point out and discuss the considerable divergence in the respondents' definitions of differential response (DR), their assessment of DR reform's empirical support, and their assessment of its potential for progressive development as an evidence-informed model for child welfare practice. The authors conclude that research claims and public belief regarding DR reform's safety and effectiveness exceed its scientific support, and they make suggestions for improving model building and outcome research for DR reform.

Published
2013
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24. Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry

Author

Barbaro, R, Maclaren, G, Boonstra, P, Iwashyna, T, Slutsky, A, Fan, E, Bartlett, R, Tonna, J, Hyslop, R, Fanning, J, Rycus, P, Hyer, S, Anders, M, Agerstrand, C, Hryniewicz, K, Diaz, R, Lorusso, R, Combes, A, Brodie, D, Alexander, P, Barrett, N, Belohlavek, J, Fisher, D, Fraser, J, Hssain, A, Jung, J, Mcmullan, M, Mehta, Y, Ogino, M, Paden, M, Shekar, K, Stead, C, Abu-Omar, Y, Agnoletti, V, Akbar, A, Alfoudri, H, Alviar, C, Aronsky, V, August, E, Auzinger, G, Aveja, H, Bakken, R, Balcells, J, Bangalore, S, Barnes, B, Bautista, A, Bellows, L, Beltran, F, Benharash, P, Benni, M, Berg, J, Bertini, P, Blanco-Schweizer, P, Brunsvold, M, Budd, J, Camp, D, Caridi-Scheible, M, Carton, E, Casanova-Ghosh, E, Castleberry, A, Chipongian, C, Choi, C, Circelli, A, Cohen, E, Collins, M, Copus, S, Coy, J, Crist, B, Cruz, L, Czuczwar, M, Daneshmand, M, Davis II, D, De la Cruz, K, Devers, C, Duculan, T, Durham, L, Elapavaluru, S, Elzo Kraemer, C, Filho, E, Fitzgerald, J, Foti, G, Fox, M, Fritschen, D, Fullerton, D, Gelandt, E, Gerle, S, Giani, M, Goh, S, Govener, S, Grone, J, Guber, M, Gudzenko, V, Gutteridge, D, Guy, J, Haft, J, Hall, C, Hassan, I, Herran, R, Hirose, H, Ibrahim, A, Igielski, D, Ivascu, F, Izquierdo Blasco, J, Jackson, J, Jain, H, Jaiswal, B, Johnson, A, Jurynec, J, Kellter, N, Kohl, A, Kon, Z, Kredel, M, Kriska, K, Kunavarapu, C, Lansink-Hartgring, O, Larocque, J, Larson, S, Layne, T, Ledot, S, Lena, N, Lillie, J, Lotz, G, Lucas, M, Ludwigson, L, Maas, J, Maertens, J, Mast, D, Mccardle, S, Mcdonald, B, Mclarty, A, Mcmahon, C, Meybohm, P, Meyns, B, Miller, C, Moraes Neto, F, Morris, K, Muellenbach, R, Nicholson, M, O'Brien, S, O'Keefe, K, Ogston, T, Oldenburg, G, Oliveira, F, Oppel, E, Pardo, D, Parker, S, Pedersen, F, Pellecchia, C, Pelligrini, J, Pham, T, Phillips, A, Pirani, T, Piwowarczyk, P, Plambeck, R, Pruett, W, Quandt, B, Ramanathan, K, Rey, A, Reyher, C, Riera del Brio, J, Roberts, R, Roe, D, Roeleveld, P, Rudy, J, Rueda, L, Russo, E, Sanchez Ballesteros, J, Satou, N, Saueressig, M, Saunders, P, Schlotterbeck, M, Schwarz, P, Scriven, N, Serra, A, Shamsah, M, Sim, L, Smart, A, Smith, A, Smith, D, Smith, M, Sodha, N, Sonntagbauer, M, Sorenson, M, Stallkamp, E, Stewart, A, Swartz, K, Takeda, K, Thompson, S, Toy, B, Tuazon, D, Uchiyama, M, Udeozo, O, van Poppel, S, Ventetuolo, C, Vercaemst, L, Vinh Chau, N, Wang, I, Williamson, C, Wilson, B, Winkels, H, Barbaro R. P., MacLaren G., Boonstra P. S., Iwashyna T. J., Slutsky A. S., Fan E., Bartlett R. H., Tonna J. E., Hyslop R., Fanning J. J., Rycus P. T., Hyer S. J., Anders M. M., Agerstrand C. L., Hryniewicz K., Diaz R., Lorusso R., Combes A., Brodie D., Alexander P., Barrett N., Belohlavek J., Fisher D., Fraser J., Hssain A. A., Jung J. S., McMullan M., Mehta Y., Ogino M. T., Paden M. L., Shekar K., Stead C., Abu-Omar Y., Agnoletti V., Akbar A., Alfoudri H., Alviar C., Aronsky V., August E., Auzinger G., Aveja H., Bakken R., Balcells J., Bangalore S., Barnes B. W., Bautista A., Bellows L. L., Beltran F., Benharash P., Benni M., Berg J., Bertini P., Blanco-Schweizer P., Brunsvold M., Budd J., Camp D., Caridi-Scheible M., Carton E., Casanova-Ghosh E., Castleberry A., Chipongian C. T., Choi C. W., Circelli A., Cohen E., Collins M., Copus S., Coy J., Crist B., Cruz L., Czuczwar M., Daneshmand M., Davis II D., De la Cruz K., Devers C., Duculan T., Durham L., Elapavaluru S., Elzo Kraemer C. V., Filho E. C., Fitzgerald J., Foti G., Fox M., Fritschen D., Fullerton D., Gelandt E., Gerle S., Giani M., Goh S. G., Govener S., Grone J., Guber M., Gudzenko V., Gutteridge D., Guy J., Haft J., Hall C., Hassan I. F., Herran R., Hirose H., Ibrahim A. S., Igielski D., Ivascu F. A., Izquierdo Blasco J., Jackson J., Jain H., Jaiswal B., Johnson A. C., Jurynec J. A., Kellter N. M., Kohl A., Kon Z., Kredel M., Kriska K., Kunavarapu C., Lansink-Hartgring O., LaRocque J., Larson S. B., Layne T., Ledot S., Lena N., Lillie J., Lotz G., Lucas M., Ludwigson L., Maas J. J., Maertens J., Mast D., McCardle S., McDonald B., McLarty A., McMahon C., Meybohm P., Meyns B., Miller C., Moraes Neto F., Morris K., Muellenbach R., Nicholson M., O'Brien S., O'Keefe K., Ogston T., Oldenburg G., Oliveira F. M., Oppel E., Pardo D., Parker S. J., Pedersen F. M., Pellecchia C., Pelligrini J. A. S., Pham T. T. N., Phillips A. R., Pirani T., Piwowarczyk P., Plambeck R., Pruett W., Quandt B., Ramanathan K., Rey A., Reyher C., Riera del Brio J., Roberts R., Roe D., Roeleveld P. P., Rudy J., Rueda L. F., Russo E., Sanchez Ballesteros J., Satou N., Saueressig M. G., Saunders P. C., Schlotterbeck M., Schwarz P., Scriven N., Serra A., Shamsah M., Sim L., Smart A., Smith A., Smith D., Smith M., Sodha N., Sonntagbauer M., Sorenson M., Stallkamp E. B., Stewart A., Swartz K., Takeda K., Thompson S., Toy B., Tuazon D., Uchiyama M., Udeozo O. I., van Poppel S., Ventetuolo C., Vercaemst L., Vinh Chau N. V., Wang I. -W., Williamson C., Wilson B., Winkels H., Barbaro, R, Maclaren, G, Boonstra, P, Iwashyna, T, Slutsky, A, Fan, E, Bartlett, R, Tonna, J, Hyslop, R, Fanning, J, Rycus, P, Hyer, S, Anders, M, Agerstrand, C, Hryniewicz, K, Diaz, R, Lorusso, R, Combes, A, Brodie, D, Alexander, P, Barrett, N, Belohlavek, J, Fisher, D, Fraser, J, Hssain, A, Jung, J, Mcmullan, M, Mehta, Y, Ogino, M, Paden, M, Shekar, K, Stead, C, Abu-Omar, Y, Agnoletti, V, Akbar, A, Alfoudri, H, Alviar, C, Aronsky, V, August, E, Auzinger, G, Aveja, H, Bakken, R, Balcells, J, Bangalore, S, Barnes, B, Bautista, A, Bellows, L, Beltran, F, Benharash, P, Benni, M, Berg, J, Bertini, P, Blanco-Schweizer, P, Brunsvold, M, Budd, J, Camp, D, Caridi-Scheible, M, Carton, E, Casanova-Ghosh, E, Castleberry, A, Chipongian, C, Choi, C, Circelli, A, Cohen, E, Collins, M, Copus, S, Coy, J, Crist, B, Cruz, L, Czuczwar, M, Daneshmand, M, Davis II, D, De la Cruz, K, Devers, C, Duculan, T, Durham, L, Elapavaluru, S, Elzo Kraemer, C, Filho, E, Fitzgerald, J, Foti, G, Fox, M, Fritschen, D, Fullerton, D, Gelandt, E, Gerle, S, Giani, M, Goh, S, Govener, S, Grone, J, Guber, M, Gudzenko, V, Gutteridge, D, Guy, J, Haft, J, Hall, C, Hassan, I, Herran, R, Hirose, H, Ibrahim, A, Igielski, D, Ivascu, F, Izquierdo Blasco, J, Jackson, J, Jain, H, Jaiswal, B, Johnson, A, Jurynec, J, Kellter, N, Kohl, A, Kon, Z, Kredel, M, Kriska, K, Kunavarapu, C, Lansink-Hartgring, O, Larocque, J, Larson, S, Layne, T, Ledot, S, Lena, N, Lillie, J, Lotz, G, Lucas, M, Ludwigson, L, Maas, J, Maertens, J, Mast, D, Mccardle, S, Mcdonald, B, Mclarty, A, Mcmahon, C, Meybohm, P, Meyns, B, Miller, C, Moraes Neto, F, Morris, K, Muellenbach, R, Nicholson, M, O'Brien, S, O'Keefe, K, Ogston, T, Oldenburg, G, Oliveira, F, Oppel, E, Pardo, D, Parker, S, Pedersen, F, Pellecchia, C, Pelligrini, J, Pham, T, Phillips, A, Pirani, T, Piwowarczyk, P, Plambeck, R, Pruett, W, Quandt, B, Ramanathan, K, Rey, A, Reyher, C, Riera del Brio, J, Roberts, R, Roe, D, Roeleveld, P, Rudy, J, Rueda, L, Russo, E, Sanchez Ballesteros, J, Satou, N, Saueressig, M, Saunders, P, Schlotterbeck, M, Schwarz, P, Scriven, N, Serra, A, Shamsah, M, Sim, L, Smart, A, Smith, A, Smith, D, Smith, M, Sodha, N, Sonntagbauer, M, Sorenson, M, Stallkamp, E, Stewart, A, Swartz, K, Takeda, K, Thompson, S, Toy, B, Tuazon, D, Uchiyama, M, Udeozo, O, van Poppel, S, Ventetuolo, C, Vercaemst, L, Vinh Chau, N, Wang, I, Williamson, C, Wilson, B, Winkels, H, Barbaro R. P., MacLaren G., Boonstra P. S., Iwashyna T. J., Slutsky A. S., Fan E., Bartlett R. H., Tonna J. E., Hyslop R., Fanning J. J., Rycus P. T., Hyer S. J., Anders M. M., Agerstrand C. L., Hryniewicz K., Diaz R., Lorusso R., Combes A., Brodie D., Alexander P., Barrett N., Belohlavek J., Fisher D., Fraser J., Hssain A. A., Jung J. S., McMullan M., Mehta Y., Ogino M. T., Paden M. L., Shekar K., Stead C., Abu-Omar Y., Agnoletti V., Akbar A., Alfoudri H., Alviar C., Aronsky V., August E., Auzinger G., Aveja H., Bakken R., Balcells J., Bangalore S., Barnes B. W., Bautista A., Bellows L. L., Beltran F., Benharash P., Benni M., Berg J., Bertini P., Blanco-Schweizer P., Brunsvold M., Budd J., Camp D., Caridi-Scheible M., Carton E., Casanova-Ghosh E., Castleberry A., Chipongian C. T., Choi C. W., Circelli A., Cohen E., Collins M., Copus S., Coy J., Crist B., Cruz L., Czuczwar M., Daneshmand M., Davis II D., De la Cruz K., Devers C., Duculan T., Durham L., Elapavaluru S., Elzo Kraemer C. V., Filho E. C., Fitzgerald J., Foti G., Fox M., Fritschen D., Fullerton D., Gelandt E., Gerle S., Giani M., Goh S. G., Govener S., Grone J., Guber M., Gudzenko V., Gutteridge D., Guy J., Haft J., Hall C., Hassan I. F., Herran R., Hirose H., Ibrahim A. S., Igielski D., Ivascu F. A., Izquierdo Blasco J., Jackson J., Jain H., Jaiswal B., Johnson A. C., Jurynec J. A., Kellter N. M., Kohl A., Kon Z., Kredel M., Kriska K., Kunavarapu C., Lansink-Hartgring O., LaRocque J., Larson S. B., Layne T., Ledot S., Lena N., Lillie J., Lotz G., Lucas M., Ludwigson L., Maas J. J., Maertens J., Mast D., McCardle S., McDonald B., McLarty A., McMahon C., Meybohm P., Meyns B., Miller C., Moraes Neto F., Morris K., Muellenbach R., Nicholson M., O'Brien S., O'Keefe K., Ogston T., Oldenburg G., Oliveira F. M., Oppel E., Pardo D., Parker S. J., Pedersen F. M., Pellecchia C., Pelligrini J. A. S., Pham T. T. N., Phillips A. R., Pirani T., Piwowarczyk P., Plambeck R., Pruett W., Quandt B., Ramanathan K., Rey A., Reyher C., Riera del Brio J., Roberts R., Roe D., Roeleveld P. P., Rudy J., Rueda L. F., Russo E., Sanchez Ballesteros J., Satou N., Saueressig M. G., Saunders P. C., Schlotterbeck M., Schwarz P., Scriven N., Serra A., Shamsah M., Sim L., Smart A., Smith A., Smith D., Smith M., Sodha N., Sonntagbauer M., Sorenson M., Stallkamp E. B., Stewart A., Swartz K., Takeda K., Thompson S., Toy B., Tuazon D., Uchiyama M., Udeozo O. I., van Poppel S., Ventetuolo C., Vercaemst L., Vinh Chau N. V., Wang I. -W., Williamson C., Wilson B., and Winkels H.

Abstract

Background: Multiple major health organisations recommend the use of extracorporeal membrane oxygenation (ECMO) support for COVID-19-related acute hypoxaemic respiratory failure. However, initial reports of ECMO use in patients with COVID-19 described very high mortality and there have been no large, international cohort studies of ECMO for COVID-19 reported to date. Methods: We used data from the Extracorporeal Life Support Organization (ELSO) Registry to characterise the epidemiology, hospital course, and outcomes of patients aged 16 years or older with confirmed COVID-19 who had ECMO support initiated between Jan 16 and May 1, 2020, at 213 hospitals in 36 countries. The primary outcome was in-hospital death in a time-to-event analysis assessed at 90 days after ECMO initiation. We applied a multivariable Cox model to examine whether patient and hospital factors were associated with in-hospital mortality. Findings: Data for 1035 patients with COVID-19 who received ECMO support were included in this study. Of these, 67 (6%) remained hospitalised, 311 (30%) were discharged home or to an acute rehabilitation centre, 101 (10%) were discharged to a long-term acute care centre or unspecified location, 176 (17%) were discharged to another hospital, and 380 (37%) died. The estimated cumulative incidence of in-hospital mortality 90 days after the initiation of ECMO was 37·4% (95% CI 34·4–40·4). Mortality was 39% (380 of 968) in patients with a final disposition of death or hospital discharge. The use of ECMO for circulatory support was independently associated with higher in-hospital mortality (hazard ratio 1·89, 95% CI 1·20–2·97). In the subset of patients with COVID-19 receiving respiratory (venovenous) ECMO and characterised as having acute respiratory distress syndrome, the estimated cumulative incidence of in-hospital mortality 90 days after the initiation of ECMO was 38·0% (95% CI 34·6–41·5). Interpretation: In patients with COVID-19 who received ECMO, both estimated

Published
2020

26. Is Fasciotomy Associated With Increased Mortality in Extracorporeal Cardiopulmonary Resuscitation?

Author

Shu, Henry T., Cho, Sung-Min, Harris, Andrew B., Jami, Meghana, Shou, Benjamin L., Griffee, Matthew J., Zaaqoq, Akram M., Wilcox, Christopher J., Anders, Marc, Rycus, Peter, Whitman, Glenn, Kim, Bo Soo, and Shafiq, Babar

Abstract

Our primary objective was to identify if fasciotomy was associated with increased mortality in patients who developed acute compartment syndrome (ACS) on extracorporeal cardiopulmonary resuscitation (ECPR). Additionally, we sought to identify any additional risk factors for mortality in these patients and report the amputation-free survival following fasciotomy. We retrospectively reviewed adult ECPR patients from the Extracorporeal Life Support Organization registry who were diagnosed with ACS between 2013 and 2021. Of 764 ECPR patients with limb complications, 127 patients (17%) with ACS were identified, of which 78 (63%) had fasciotomies, and 14 (11%) had amputations. Fasciotomy was associated with a 23% rate of amputation-free survival. There were no significant differences in demographics or baseline laboratory values between those with and without fasciotomy. Overall, 88 of 127 (69%) patients with ACS died. With or without fasciotomy, the mortality of ACS patients was similar, 68% vs.71%. Multivariable logistic regression demonstrated that body mass index (BMI; adjusted odds ratio [aOR] = 1.22, 95% confidence interval [CI] = 1.01–1.48) and 24 hour mean blood pressure (BP; aOR = 0.93, 95% CI = 0.88–0.99) were independently associated with mortality. Fasciotomy was not an independent risk factor for mortality (aOR = 0.24, 95% CI = 0.03–1.88). The results of this study may help guide surgical decision-making for patients who develop ACS after ECPR. However, the retrospective nature of this study does not preclude selection bias in patients who have received fasciotomy. Thus, prospective studies are necessary to confirm these findings.

Published
2023
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27. Field Guide to Child Welfare, Volumes I-IV.

Author

Child Welfare League of America, Inc., Washington, DC., Rycus, Judith S., Hughes, Ronald C., Rycus, Judith S., Hughes, Ronald C., and Child Welfare League of America, Inc., Washington, DC.

Abstract

Unique in its explicit use of a developmental perspective of all child welfare activities, this four-volume field guide was designed to support education and training of child welfare professionals throughout their careers. The volumes integrate both theory and practice, and can serve as text for college courses or inservice training, and as a resource for transfer of training from workshop setting to the workplace. Volume I, "Foundations of Child Protective Services," covers: (1) "Child Welfare Values"; (2) "A Family-Centered Approach to Child Protection"; and (3) "Sexual Abuse." Volume II, "Case Planning and Family-Centered Casework," covers: (4) "Case Planning and Family-Centered Casework"; and (5) "Culture and Diversity in Child Welfare Practice." Volume III, "Child Development and Child Welfare," covers: (6) "The Effects of Abuse and Neglect on Child Development"; and (7) "Child Welfare Services for Children with Developmental Disabilities." Volume IV, "Placement and Permanence," covers: (8) "Attachment, Separation, and Placement"; (9) "Working with Families of Children in Placement"; (10) "Working with Foster and Other Caregivers"; and (11) "Adoption" (co-authored by Denise A. Goodman). Contains a 439-item bibliography. (HTH)

Published
1998

28. Developmental Disabilities and Child Welfare.

Author

Child Welfare League of America, Inc., New York, NY., Rycus, Judith S., Hughes, Ronald C., Rycus, Judith S., Hughes, Ronald C., and Child Welfare League of America, Inc., New York, NY.

Abstract

This monograph addresses common misconceptions about developmental disabilities, describes the conditions that child welfare workers are most likely to see, provides examples of effective interventions, and stresses the importance of early intervention to promote healthy development. Specific chapters include: (1) "Understanding Developmental Disabilities," which discusses the definition of a developmental disability, factors that contribute to developmental disabilities, child abuse and neglect and developmental disabilities, and barriers to effective services; (2) "Myths and Misconceptions about Developmental Disabilities"; (3) "Cerebral Palsy," which addresses early indicators of cerebral palsy including abnormal muscle tone, abnormal patterns or delayed motor development, persistent reflexes, and treatment and prognosis; (4) "Epilepsy"; (5) "Mental Retardation"; (6) "Spina Bifida"; (7) "Autism and Other Pervasive Developmental Disorders"; (8) "Attention-Deficit/Hyperactivity Disorder and Learning Disabilities"; (9) "Prenatal Exposure to Alcohol and Other Drugs"; and (10) "Services for Children with Developmental Disabilities and Their Families," which discusses crisis intervention theory, the service needs of families of children with disabilities, the role of child welfare agencies, respite care, specialized foster or kinship care placement, adoption, special education, counseling and emotional support, advocacy, and parent-professional relationships. (Contains 54 references.) (CR)

Published
1998

30. Association Between Early Change in Arterial Carbon Dioxide Tension and Outcomes in Neonates Treated by Extracorporeal Membrane Oxygenation

Author

Joram, Nicolas, Rozé, Jean-Christophe, Tonna, Joseph E., Rycus, Peter, Beqiri, Erta, Pezzato, Stefano, Moscatelli, Andrea, Robba, Chiara, Liet, Jean-Michel, Bourgoin, Pierre, Czosnyka, Marek, Léger, Pierre-Louis, Rambaud, Jérôme, Smielewski, Peter, and Chenouard, Alexis

Abstract

The primary objective was to investigate the association between partial pressure of carbon dioxide (PaCO2) change after extracorporeal membrane oxygenation (ECMO) initiation and neurologic outcome in neonates treated for respiratory failure. A retrospective analysis of the Extracorporeal Life Support Organization (ELSO) database including newborns supported by ECMO for respiratory indication during 2015–2020. The closest Pre-ECMO (Pre-ECMO PaCO2) and at 24 hours after ECMO initiation (H24 PaCO2) PaCO2values allowed to calculate the relative change in PaCO2(Rel Δ PaCO2= [H24 PaCO2– Pre-ECMO PaCO2]/Pre-ECMO PaCO2). The primary outcome was the onset of any acute neurologic event (ANE), defined as cerebral bleeding, ischemic stroke, clinical or electrical seizure, or brain death during ECMO. We included 3,583 newborns (median age 1 day [interquartile range {IQR}, 1–3], median weight 3.2 kg [IQR, 2.8–3.6]) from 198 ELSO centers. The median Rel Δ PaCO2value was −29.9% [IQR, −46.2 to −8.5]. Six hundred nine (17%) of them had ANE (405 cerebral bleedings, 111 ischemic strokes, 225 seizures, and 6 brain deaths). Patients with a decrease of PaCO2> 50% were more likely to develop ANE than others (odds ratio [OR] 1.78, 95% confidence interval [CI], 1.31–2.42, p< 0.001). This was still observed after adjustment for all clinically relevant confounding factors (adjusted OR 1.94, 95% CI, 1.29–2.92, p= 0.001). A significant decrease in PaCO2after ECMO start is associated with ANE among neonates requiring ECMO for respiratory failure. Cautious PaCO2decrease should be considered after start of ECMO therapy.

Published
2023
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34. Heroes v-a: Hemorrhagic complications in veno-arterial extracorporeal life support-development and internal validation of multivariable prediction model in adult patients.

Author

Willers A., Swol J., Van Kuijk S., Buscher H., McQuilten Z., Ten Cate H., Rycus P., McKellar S., Lorusso R., Tonna J., Willers A., Swol J., Van Kuijk S., Buscher H., McQuilten Z., Ten Cate H., Rycus P., McKellar S., Lorusso R., and Tonna J.

Abstract

Introduction: There is an increase in use of extracorporeal life support (ECLS) for cardiac support, with new indications emerging. Bleeding complications are the most frequent complications, associated with high morbidity and mortality. Despite the high frequency, the risk factors for bleeding complications remain poorly investigated. Method(s): To develop a prediction model for bleeding complications, adult patients included in the Extracorporeal Life Support Organization (ELSO) registry undergoing V-A ECLS between 2000 and 2020 were analyzed. The primary outcome was bleeding complications during V-A ECLS. Backward stepwise elimination in multivariable logistic regression analysis was used to develop the prediction model. The performance of the model was tested by ROC curves with AUC for discriminative ability and calibration plots. To detect overfitting of the model, internal validation was performed. Result(s): Single V-A ECLS runs were recorded in 28.767 adult patients, of which 29,0% developed bleeding complications. Sex, BMI, surgical cannulation, respiratory and hemodynamic variables prior to ECLS, the use of additional support devices, pre-ECLS interventions and different type of diagnosis were included in the prediction model. The model showed a fair predictive capability with an AUC of 0.66. Internal validation showed almost no overfitting of the model. An online calculator may simplify the use of the model. Conclusion(s): A multivariable model was developed and internally validated to calculate the risk for bleeding complications for adult patients receiving V-A ECLS. This model showed a favorabel predictive capability compared to the current literature. External validation is needed to confirm clinical use of this model.

Published
2021

35. Extracorporeal Membrane Oxygenation Support for Influenza A: Retrospective Review of the Extracorporeal Life Support Organization Registry Comparing H1N1 With Other Subtypes.

Author

O'Neil, ER, Lin, H, Li, M, Shekerdemian, L, Tonna, JE, Barbaro, RP, Abella, JR, Rycus, P, MacLaren, G, Anders, MM, Alexander, PMA, O'Neil, ER, Lin, H, Li, M, Shekerdemian, L, Tonna, JE, Barbaro, RP, Abella, JR, Rycus, P, MacLaren, G, Anders, MM, and Alexander, PMA

Abstract

OBJECTIVES: Although there is a substantial published experience of extracorporeal membrane oxygenation during the H1N1 pandemic, less is known about the use of extracorporeal membrane oxygenation in patients with other subtypes of the influenza A virus. We hypothesized that the severity of illness and survival of patients supported with extracorporeal membrane oxygenation would differ for those with H1N1 influenza A compared with other subtypes of influenza A. DESIGN SETTING PATIENTS: Retrospective study of extracorporeal membrane oxygenation-supported adults (> 18 yr) with influenza A viral infection reported to the Extracorporeal Life Support Organization Registry between 2009 and 2019. We describe the frequency and compare characteristics and factors associated with in-hospital survival using a least absolute shrinkage and selection operator regression analysis. MAIN OUTCOMES AND MEASURES: Of 2,461 patients supported with extracorporeal membrane oxygenation for influenza A, 445 had H1N1, and 2,004 had other subtypes of influenza A. H1N1 was the predominant subtype between 2009 and 2011. H1N1 patients were younger, with more severe illness at extracorporeal membrane oxygenation cannulation and higher reported extracorporeal membrane oxygenation complications than those with other influenza A subtypes. Patient characteristics including younger age and higher weight and patient management characteristics including longer ventilation duration before extracorporeal membrane oxygenation were associated with worse survival. Extracorporeal membrane oxygenation complications were associated with reduced survival. There was no difference in survival to hospital discharge according to influenza subtype after adjusting for other characteristics. CONCLUSIONS: Patients supported with extracorporeal membrane oxygenation for H1N1 were younger, with more severe illness than those supported for other influenza A subtypes. Survival to hospital discharge was associated with patient

Published
2021

40. Initial ELSO Guidance Document: ECMO for COVID-19 Patients with Severe Cardiopulmonary Failure

Author

Bartlett, RH, Ogino, MT, Brodie, D, McMullan, DM, Lorusso, R, MacLaren, G, Stead, CM, Rycus, P, Fraser, JF, Belohlavek, J, Salazar, L, Mehta, Y, Raman, L, Paden, ML, Bartlett, RH, Ogino, MT, Brodie, D, McMullan, DM, Lorusso, R, MacLaren, G, Stead, CM, Rycus, P, Fraser, JF, Belohlavek, J, Salazar, L, Mehta, Y, Raman, L, and Paden, ML

Abstract

Disclaimer: ECMO has, and will certainly continue, to play a role in the management of COVID-19 patients. It should be emphasized that this initial guidance is based on the current best evidence for ECMO use during this pandemic. Guidance documents addressing additional portions of ECMO care are currently being assembled for rapid publication and distribution to ECMO centers worldwide.

Published
2020

43. Resuscitation Using ECPR During In-Hospital Cardiac Arrest (RESCUE-IHCA) Mortality Prediction Score and External Validation.

Author

Tonna, Joseph E., Selzman, Craig H., Girotra, Saket, Presson, Angela P., Thiagarajan, Ravi R., Becker, Lance B., Zhang, Chong, Rycus, Peter, and Keenan, Heather T.

Abstract

The aim of this study was to develop and validate a score to accurately predict the probability of death for adult extracorporeal cardiopulmonary resuscitation (ECPR). ECPR is being increasingly used to treat refractory in-hospital cardiac arrest (IHCA), but survival varies from 20% to 40%. Adult patients with extracorporeal membrane oxygenation for IHCA (ECPR) were identified from the American Heart Association GWTG-R (Get With the Guidelines–Resuscitation) registry. A multivariate survival prediction model and score were developed to predict hospital death. Findings were externally validated in a separate cohort of patients from the Extracorporeal Life Support Organization registry who underwent ECPR for IHCA. A total of 1,075 patients treated with ECPR were included. Twenty-eight percent survived to discharge in both the derivation and validation cohorts. A total of 6 variables were associated with in-hospital death: age, time of day, initial rhythm, history of renal insufficiency, patient type (cardiac vs noncardiac and medical vs surgical), and duration of the cardiac arrest event, which were combined into the RESCUE-IHCA (Resuscitation Using ECPR During IHCA) score. The model had good discrimination (area under the curve: 0.719; 95% CI: 0.680-0.757) and acceptable calibration (Hosmer and Lemeshow goodness of fit P = 0.079). Discrimination was fair in the external validation cohort (area under the curve: 0.676; 95% CI: 0.606-0.746) with good calibration (P = 0.66), demonstrating the model's ability to predict in-hospital death across a wide range of probabilities. The RESCUE-IHCA score can be used by clinicians in real time to predict in-hospital death among patients with IHCA who are treated with ECPR. [Display omitted] [ABSTRACT FROM AUTHOR]

Published
2022
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44. Extracorporeal Membrane Oxygenation for Pediatric Toxin Exposures: Review of the Extracorporeal Life Support Organization Registry

Author

Koshel, Christine K., Alexander, Peta M.A., Rycus, Peter, and Alibrahim, Omar

Abstract

Evidence for the use of extracorporeal membrane oxygenation (ECMO) in children with refractory respiratory failure or shock following ingestion or toxin exposure, has been confined to single-center experiences, individual case reports, and extrapolated from adult cohorts; no pediatric multicenter cohorts exist. The objective of this retrospective review of the Extracorporeal Life Support Organization registry is to describe pediatric ECMO use following ingestion or toxin exposure, and define factors associated with mortality. Twenty-eight children between the ages of 30 days and 18 years met inclusion criteria between January 1, 2008 and December 31, 2017. The primary outcome measure was mortality before hospital discharge, which occurred in 32% of patients. Factors associated with in-hospital mortality included pre-ECMO use of inhaled nitric oxide (44.4% vs.5.3%, p= 0.026), lower pre-ECMO arterial blood gas pH (6.97 [6.80–7.17] vs.7.20 [7.15–7.32], p= 0.034), and higher pre-ECMO PaCO2(79 [57–85] vs.49 [38–63], p= 0.014). Receipt of inotropic support during ECMO was more common in nonsurvivors (66.7% vs.21.1%, p= 0.035). Extracorporeal membrane oxygenation should be considered in the most severe pediatric toxin exposures as a bridge to recovery, providing time for both toxin elimination and end-organ recovery.

Published
2022
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45. Extracorporeal Membrane Oxygenation Support for Antineutrophil Cytoplasmic Antibody-associated Vasculitides: An ELSO Registry Analysis

Author

O’Neil, Erika R., Quinn, Rachel E., Olson, Taylor L., Rycus, Peter T., Anders, Marc M., Chartan, Corey A., Vogel, Tiphanie P., Silva-Carmona, Manuel, and Coleman, Ryan D.

Abstract

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides with pulmonary involvement include granulomatosis with polyangiitis, microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis, and can present with life-threatening pulmonary hemorrhage in up to 40% of patients. Mortality in those patients who require intubation and mechanical ventilation can reach 77%. Extracorporeal membrane oxygenation (ECMO) can be used to support these patients through definitive diagnosis and treatment, although minimizing the risk of ventilator-induced lung injury. We aimed to determine factors associated with favorable outcomes in patients with (ANCA)-associated vasculitides supported on ECMO. We performed a retrospective observational study using the Extracorporeal Life Support Organization registry of pediatric and adult patients with ANCA-associated vasculitis supported on ECMO from 2010 to 2020. One hundred thirty-five patients were included for analysis. Many patients had renal involvement (39%) in addition to pulmonary involvement (93%). Survival was 73% in AAV patients supported on ECMO. The presence of pulmonary hemorrhage was not associated with worse outcomes in our cohort. Older age, the use of venoarterial ECMO, ECMO-cardiopulmonary resuscitation, or sustaining a cardiac arrest before ECMO was associated with decreased survival. In conclusion, venovenous ECMO should be considered as a supportive bridge to definitive diagnosis and treatment in (ANCA)-associated vasculitides, regardless if pulmonary hemorrhage is present.

Published
2022
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46. Neurological Outcome According to the Site of Cannulation in Septic Children Supported by Venoarterial Extracorporeal Membrane Oxygenation

Author

Chenouard, Alexis, Liet, Jean-Michel, Maminirina, Pierre, Denis, Manon, Tonna, Joseph, Rycus, Peter, Joram, Nicolas, and Bourgoin, Pierre

Abstract

The impact of cervical cannulation on neurologic outcome has not been yet studied among children receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the context of severe sepsis or septic shock. A retrospective cohort study was performed using the extracorporeal life support organization (ELSO) registry. A total of 559 children weighing less than 20 kg with a primary or secondary diagnosis of severe sepsis, septic shock or toxic shock syndrome were included between January 1, 2010, and December 31, 2019. Cervical cannulation was performed in 485 children (87%) and central cannulation in 74 children (13%). The prevalence of acute neurologic event (ANE) was 32%, including clinical and/or electroencephalographic seizures, cerebral infarction, cerebral hemorrhage, and/or brain death. In multivariable analysis, we did not find an association between cervical cannulation and greater/lesser odds of ANE during ECMO (adjusted odds ratio [aOR] = 1.39, 95% confidence interval [CI] 0.72–2.65; P= 0.326). Only pre-ECMO acidosis was independently associated with the development of ANE (pH < 6.99; aOR = 2.71, 95% CI 1.34–5.49; P= 0.006; pH 6.99 to <7.12; aOR = 2.57, 95% CI 1.37–4.82; P= 0.003). Thus, the site of cannulation appears not as a modifiable neurologic risk factor in this young septic population.

Published
2021
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47. Repeat Extracorporeal Membrane Oxygenation Support Is Appropriate in Selected Children With Cardiac Disease: An Extracorporeal Life Support Organization Study

Author

Alsoufi, Bahaaldin, Trivedi, Jaimin, Rycus, Peter, Sinha, Pranava, and Deshpande, Shriprassad

Abstract

Objective: Children requiring multiple consecutive extracorporeal membrane oxygenation (ECMO) runs likely have ongoing cardiac pathology (eg, residual lesions, myocardial dysfunction) and are exposed to increased complications and end-organ failure. Often, repeat back-to-back ECMO is suggested to be futile due to poor reported survival.Methods: Using Extracorporeal Life Support Organization (ELSO) data (2011-2019), we evaluated children (n = 669) who received multiple cardiac ECMO runs (≥2) within 30 days interval. Factors associated with hospital mortality were evaluated using multivariable regression analysis.Results: Median ECMO runs was 2 (range: 2-5) including 294 (44%) patients who received extracorporeal cardiopulmonary resuscitation (ECPR). There were 250 (37%) hospital survivors. Survivors were more likely older, Caucasian, and less likely to have hypoplastic left heart syndrome, require >2 runs, receive longer support duration, require inotropes or have acidosis while on ECMO, or develop renal and neurological complications. On multivariable analysis, factors associated with death included neonates (odds ratio [OR] = 3.6, 95% CI = 1.8-7.5, P= .0002), African Americans (OR = 2.7, 95% CI = 1.4-4.9, P= .0307), longer ECMO duration (OR = 1.1, 95% CI = 1.05-1.11, P< .0001, per 10 hours), central cannulation at initial run (OR = 1.7, 95% CI = 1.1-2.8, P= .0285), renal failure (OR = 3.0, 95% CI = 1.9-4.6, P< .0001), and neurological complications (OR = 3.8, 95% CI = 2.2-6.8, P< .0001).Conclusions: In selected children with cardiac pathology, multiple back-to-back ECMO and/or ECPR runs are associated with 37% hospital survival. Although registry data limit the ability to clearly determine selection criteria for repeat ECMO, our findings suggest that in properly selected patients, repeat ECMO support is not futile. Ongoing assessment of support adequacy, end-organ function, and cardiopulmonary recovery is necessary as longer support and emerging complications are associated with poor survival.

Published
2021
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48. Essentials of Inservice Training for Child Welfare Workers

Author

Rycus, Judith S.

Abstract

Discusses the application of the principles of andragogy, a learning system for educating adults, to the inservice training of child welfare workers, and briefly describes the seven-step model as outlined by Ingalls. (BR)

Published
1978

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