Structured review of post-cardiotomy extracorporeal membrane oxygenation: Part 2-pediatric patients.
Roberto Lorusso,Giuseppe Maria Raffa,Mariusz Kowalewski,Khalid Alenizy,Niels Sluijpers,Maged Makhoul,Daniel Brodie,Mike McMullan,I-Wen Wang,Paolo Meani,Graeme MacLaren,Heidi J. Dalton,Ryan P. Barbaro,Xaotong Hou,Nicholas C. Cavarocchi,Yih-Sharng Chen,Ravi R. Thiagarajan,Peta M. A. Alexander,Bahaaldin Alsoufi,Christian A. Bermudez,Ashish S. Shah,Jonathan W. Haft,Lilia Oreto,David A. D'Alessandro,Udo Boeken,Glenn J.R. Whitman +25 more
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TLDR
A comprehensive overview of the literature with respect to the prevalence of ECMO use, patient characteristics, ECMO management, and in-hospital and early post-discharge patient outcomes for those treated for post-cardiotomy heart, lung, or heart-lung failure is presented.Abstract:
Veno-arterial extracorporeal membrane oxygenation (ECMO) is established therapy for short-term circulatory support for children with life-treating cardiorespiratory dysfunction. In children with congenital heart disease (CHD), ECMO is commonly used to support patients with post-cardiotomy shock or complications including intractable arrhythmias, cardiac arrest, and acute respiratory failure. Cannulation configurations include central, when the right atrium and aorta are utilized in patients with recent sternotomy, or peripheral, when cannulation of the neck or femoral vessels are used in non-operative patients. ECMO can be used to support any form of cardiac disease, including univentricular palliated circulation. Although veno-arterial ECMO is commonly used to support children with CHD, veno-venous ECMO has been used in selected patients with hypoxemia or ventilatory failure in the presence of good cardiac function. ECMO use and outcomes in the CHD population are mainly informed by single-center studies and reports from collated registry data. Significant knowledge gaps remain, including optimal patient selection, timing of ECMO deployment, duration of support, anti-coagulation, complications, and the impact of these factors on short- and long-term outcomes. This report, therefore, aims to present a comprehensive overview of the available literature informing patient selection, ECMO management, and in-hospital and early post-discharge outcomes in pediatric patients treated with ECMO for post-cardiotomy cardiorespiratory failure.read more
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Platelets and extra-corporeal membrane oxygenation in adult patients: a systematic review and meta-analysis
Federica Jiritano,Federica Jiritano,Giuseppe Filiberto Serraino,Hugo ten Cate,Dario Fina,Dario Fina,Matteo Matteucci,Matteo Matteucci,Pasquale Mastroroberto,Roberto Lorusso +9 more
TL;DR: Thrombocytopenia and platelet dysfunction are common in ECMO patients, regardless the type of ECMO mode, and the underlying mechanisms are multifactorial, and understanding and management is still limited.
Journal ArticleDOI
2020 EACTS/ELSO/STS/AATS expert consensus on post-cardiotomy extracorporeal life support in adult patients
Roberto Lorusso,Glenn J.R. Whitman,Milan Milojevic,Giuseppe Maria Raffa,David M. McMullan,Udo Boeken,Jonathan W. Haft,Christian A. Bermudez,Ashish S. Shah,David A. D'Alessandro +9 more
TL;DR: The authors have attempted to create a concise, comprehensive and relevant analysis of all aspects related to PC-ECLS, with a particular emphasis on indications, technique, management, and avoidance of complications.
Journal ArticleDOI
2020 EACTS/ELSO/STS/AATS expert consensus on post-cardiotomy extracorporeal life support in adult patients
Roberto Lorusso,Glenn J.R. Whitman,Milan Milojevic,Milan Milojevic,Giuseppe Maria Raffa,David M. McMullan,Udo Boeken,Jonathan W. Haft,Christian A. Bermudez,Ashish S. Shah,David A. D'Alessandro +10 more
TL;DR: A concise, comprehensive and relevant analysis of all aspects related to PC-ECLS, with a particular emphasis on indications, technique, management and avoidance of complications, appraisal of new approaches and ethics, education and training is created.
Journal ArticleDOI
2020 EACTS/ELSO/STS/AATS Expert Consensus on Post-Cardiotomy Extracorporeal Life Support in Adult Patients
Roberto Lorusso,Glenn J.R. Whitman,Milan Milojevic,Milan Milojevic,Giuseppe Maria Raffa,David M. McMullan,Udo Boeken,Jonathan W. Haft,Christian A. Bermudez,Ashish S. Shah,David A. D'Alessandro +10 more
TL;DR: A concise, comprehensive and relevant analysis of all aspects related to PC-ECLS, with a particular emphasis on indications, technique, management and avoidance of complications, appraisal of new approaches and ethics, education and training is created.
Journal ArticleDOI
Left Ventricle Unloading with Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. Systematic Review and Meta-Analysis
Mariusz Kowalewski,Pietro Giorgio Malvindi,Kamil Zieliński,Gennaro Martucci,Artur Słomka,Piotr Suwalski,Roberto Lorusso,Paolo Meani,Antonio Arcadipane,Michele Pilato,Giuseppe Maria Raffa +10 more
TL;DR: In heterogeneous populations of critically ill adults in CS and supported with VA-ECMO, the adjunct of LV unloading is associated with lower early mortality and higher rate of weaning and the highest mortality risk benefit was observed in case of acute myocardial infarction.
References
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Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial.
Giles J. Peek,Miranda Mugford,Ravindranath Tiruvoipati,Andrew Wilson,Elizabeth Allen,Mariamma M. Thalanany,Clare Hibbert,Ann Truesdale,Felicity Clemens,Nicola J. Cooper,Richard K. Firmin,Diana Elbourne +11 more
TL;DR: Transfer of adult patients with severe but potentially reversible respiratory failure, whose Murray score exceeds 3.0 or who have a pH of less than 7.20 on optimum conventional management, to a centre with an ECMO-based management protocol is recommended to significantly improve survival without severe disability.
Journal ArticleDOI
Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta-analysis of 1,866 adult patients.
Richard Cheng,Rory Hachamovitch,Michelle M. Kittleson,Jignesh Patel,Francisco A. Arabia,Jaime Moriguchi,Fardad Esmailian,Babak Azarbal +7 more
TL;DR: Although ECMO can improve survival of patients with advanced heart disease, there is significant associated morbidity with performance of this intervention.
Journal ArticleDOI
Predicting Survival after Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Failure. The Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) Score
Matthieu Schmidt,Michael Bailey,Jayne Sheldrake,Carol L. Hodgson,Cecile Aubron,Peter Rycus,Carlos Scheinkestel,D. Jamie Cooper,Daniel Brodie,Vincent Pellegrino,Alain Combes,David Pilcher +11 more
TL;DR: The Respiratory ECMO Survival Prediction (RESP) score is a relevant and validated tool to predict survival for patients receiving ECMO for respiratory failure and helps clinicians to target patients most likely to benefit from ECMO.
Journal ArticleDOI
Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock
Ardawan Rastan,Andreas Dege,Matthias Mohr,Nicolas Doll,Volkmar Falk,Thomas Walther,Friedrich W. Mohr +6 more
TL;DR: Extracorporeal membrane oxygenation support is an acceptable option for patients with postcardiotomy cardiogenic shock who otherwise would die and is justified by good long-term outcome of hospital survivors.
Journal ArticleDOI
Concomitant implantation of Impella® on top of veno-arterial extracorporeal membrane oxygenation may improve survival of patients with cardiogenic shock.
Federico Pappalardo,Christian Schulte,Marina Pieri,Benedikt Schrage,Rachele Contri,Gerold Soeffker,Teresa Greco,Rosalba Lembo,Kai Müllerleile,Antonio Colombo,Karsten Sydow,Michele De Bonis,Florian Wagner,Hermann Reichenspurner,Stefan Blankenberg,Alberto Zangrillo,Dirk Westermann +16 more
TL;DR: Veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) support stabilizes patients with cardiogenic shock and may be impeded due to the increased afterload, resulting in a failing static left ventricle and in high mortality.