Acute kidney injury is a common complication in patients receiving extracorporeal membrane oxygenation (ECMO). The underlying mechanisms are multifactorial including the primary disease, effects of invasive mechanical ventilation, ECMO circuit-related factors and critical illness in general. Renal replacement therapy (RRT) is often required to control fluid balance and is associated with worse outcomes. No consensus exists for indication, timing, modality, and how to best to combine RRT and ECMO. This chapter provides an update of the epidemiology, outcomes and pathophysiology of acute kidney injury in patients receiving ECMO, highlights technical aspects when combining RRT with ECMO, and identifies future research questions.

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Acute kidney injury in ECMO patients.

ABSTRACT Introduction Extracorporeal membrane oxygenation (ECMO) is primarily used for the supportive treatment of patients suffering from severe cardiopulmonary failure. With the continued development of ECMO technology, the relevant scenarios also extend pre-hospital and inter-hospital. In order to meet the needs of emergency treatment in communities, disaster sites and battlefields, inter-hospital transfer and evacuation; miniaturized and portable ECMO has become a current research hotspot. Area covered The paper first introduces the principle, composition and common modes of ECMO and summarizes the research status of portable ECMO, Novalung and wearable ECMO, analyzes the characteristics and shortcomings of existing equipment. finally, we discussed the focus and development trend of portable ECMO technology. Expert opinion Currently, portable ECMO has many applications in interhospital transport and there are various studies on portable and wearable ECMO devices, but the development of portable ECMO still faces many challenges. In the future, research related to integrated components, rich sensor arrays, Intelligent ECMO system and lightweight technology can make future portable ECMO more suitable for pre-hospital emergency and interhospital transport.

Research progress of portable extracorporeal membrane oxygenation

BACKGROUND
Extracorporeal membrane oxygenation (ECMO) has salvaged many people's life during global pandemics. However, ECMO is associated with a high incidence of hemostatic complications. This study aims to explore the effects of the ECMO system on the coagulation system in the healthy ovine ECMO model.


METHODS
Ten healthy male sheep were included. Five received the veno-arterial ECMO and five received the veno-venous ECMO. Heparin was infused for systemic anticoagulation and was adjusted according to the activated clotting time. Blood routine tests, coagulation factors, anticoagulation proteins, and fibrinolysis markers were tested at the baseline and every 24 hours. After weaning, the pump heads were dissected to explore thrombosis.


RESULTS
Platelets decreased in the first 72 hours and returned to the baseline at the 120th hour. The neutrophils increased in the first 24 hours and returned to the baseline at the 48th hour. Factors II, VII, and X decreased in the first 24 hours and gradually increased, while factors VIII, IX, XI, and XII decreased in the first 24 hours and remained at a low level. The baseline antithrombin was 73.2 ± 14.4% and reduced to 42.6 ± 9.9% at the 168th hour. Pathology showed seven sheep developed thrombus, but no clinically relevant bleeding or thrombosis events occurred.


CONCLUSIONS
The study explored hemostatic alterations during ECMO in healthy animal models, which eliminated the confounding under critically ill conditions. The study may provide insights into ECMO hemostatic disorders and aid the design of optimal therapeutic strategies.

Hemostatic alterations during extracorporeal membrane oxygenation in ovine veno-venous and veno-arterial models.

Extracorporeal membrane oxygenation (ECMO) is a rescue therapy in patients with cardiopulmonary emergencies (1, 2). Although the use of ECMO is gradually increasing, ECMO is still a very costly and invasive treatment. ECMO education programs may expand the availability of this treatment to meet growing needs (3). Fuwai Hospital is a national center for cardiovascular disease in China, and it has provided ECMO support since 2004 (4, 5). In 2019, Fuwai hospital launched a three-month education program for venoarterial (V-A) ECMO that recruited participants from all over the nation. The program was composed of didactic courses, water-drill courses, high-fidelity simulation, and clinical training. By June 2022, 10 sessions had been held. This study aimed to introduce the three-month education program for V-A ECMO and to evaluate the program by assessing the participants’ feedback.

https://doi.org/10.34197/ats-scholar.2022-0106br

A Nationwide Three-Month Education Program for Venoarterial Extracorporeal Membrane Oxygenation

Introduction:Extracorporeal membrane oxygenation (ECMO) is an imperative short-term cardiopulmonary support device now. We aimed to provide a single-center experience of veno-arterial (V-A) ECMO ma...

Outcomes from adult veno-arterial extracorporeal membrane oxygenation in a cardiovascular disease center from 2009 to 2019.

Background: Extracorporeal membrane oxygenation (ECMO) provides cardiopulmonary support for critically ill patients. Portable ECMO devices can be applied in both in-hospital and out-of-hospital emergency conditions. We evaluated the safety and biocompatibility of a novel centrifugal pump and ECMO device of the OASSIST ECMO System (Jiangsu STMed Technologies Co., Suzhou, China) in a 168-h ovine ECMO model. Methods: The portable OASSIST ECMO system consists of the control console, the pump drive, and the disposable centrifugal pump. Ten healthy sheep were used to evaluate the OASSIST ECMO system. Five were supported on veno-venous ECMO and five on veno-arterial ECMO, each for 168 h. The systemic anticoagulation was achieved by continuous heparin infusion to maintain the activated clotting time (ACT) between 220 and 250 s. The rotary speed was set at 3,200-3,500 rpm. The ECMO configurations and ACT were recorded every 6 hours (h). The free hemoglobin (fHb), complete blood count, and coagulation action test were monitored, at the 6th h and every 24 h after the initiation of the ECMO. The dissection of the pump head and oxygenator were conducted to explore thrombosis. Results: Ten sheep successfully completed the study duration without device-related accidents. The pumps ran stably, and the ECMO flow ranged from 1.6 ± 0.1 to 2.0 ± 0.11 L/min in the V-V group, and from 1.8 ± 0.1 to 2.4 ± 0.14 L/min in the V-A group. The anticoagulation was well-performed. The ACT was maintained at 239.78 ± 36.31 s, no major bleeding or thrombosis was observed during the ECMO run or in the autopsy. 3/5 in the V-A group and 4/5 in the V-V group developed small thrombus in the bearing pedestal. No obvious thrombus formed in the oxygenator was observed. The hemolytic blood damage was not significant. The average fHb was 0.17 ± 0.12 g/L. Considering hemodilution, the hemoglobin, white blood cell, and platelets didn't reduce during the ECMO runs. Conclusions: The OASSIST ECMO system shows satisfactory safety and biocompatibility for the 168-h preclinical evaluation in the ovine model. The OASSIST ECMO system is promising to be applied in clinical conditions in the future.

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Jiachen Qi

Papers

Outcomes from adult veno-arterial extracorporeal membrane oxygenation in a cardiovascular disease center from 2009 to 2019.

Safety and Efficacy of a Novel Centrifugal Pump and Driving Devices of the OASSIST ECMO System: A Preclinical Evaluation in the Ovine Model