Article
Cardiac & Cardiovascular Systems
Omar Ellouze, Xavier Abbad, Tiberiu Constandache, Anis Missaoui, Vivien Berthoud, Theresa Daily, Serge Aho, Olivier Bouchot, Belaid Bouhemad, Pierre-Gregoire Guinot
Summary: The study identified factors like postcardiotomy VA ECMO, low levels of hemoglobin and fibrinogen, low pH value, and low body mass index as associated with a higher risk for early major bleeding events. Major bleeding events were also independently associated with mortality.
ANNALS OF THORACIC SURGERY
(2021)
Article
Surgery
Andre Y. Son, Linh Ngo Khanh, Hae Soo Joung, Andres Guerra, Azad S. Karim, Randy McGregor, Amit Pawale, Duc Thinh Pham, Karen J. Ho
Summary: ALI and significant bleeding are common occurrences after peripheral VA-ECMO cannulation. Cannulation in the operating room is associated with a decreased risk of ALI but an increased risk of bleeding, while ultrasound-guided cannulation decreases the risk of bleeding. DPC placement does not significantly affect the risk of ALI or bleeding.
JOURNAL OF VASCULAR SURGERY
(2021)
Article
Critical Care Medicine
Jason T. Chapman, Jeff Breeding, Stephen J. Kerr, Marko Bajic, Priya Nair, Hergen Buscher
Summary: A study from an Australian ECMO referral center revealed that acute CNS complications occur in 13.3% of ECMO patients, with ischemic stroke, intracerebral hemorrhage, hypoxic ischemic encephalopathy, and spinal cord injury being the main complications. Neurologic complications were associated with venoarterial ECMO and renal replacement therapy, and patients with these complications had a higher hospital mortality rate.
CRITICAL CARE MEDICINE
(2021)
Review
Pharmacology & Pharmacy
Mei-Juan Li, Jin-Ying Shi, Jin-Hua Zhang
Summary: The study suggests that Bivalirudin may be a potential alternative to unfractionated heparin in patients requiring ECMO, with lower risks of bleeding and mortality.
BRITISH JOURNAL OF CLINICAL PHARMACOLOGY
(2022)
Article
Pharmacology & Pharmacy
Jae Ha Lee, Dong-Hwan Lee, Jin Soo Kim, Won-Beom Jung, Woon Heo, Yong Kyun Kim, Se Hun Kim, Tae-Hoon No, Kyeong Min Jo, Junghae Ko, Ho Young Lee, Kyung Ran Jun, Hye Sook Choi, Ji Hoon Jang, Hang-Jea Jang
Summary: This study found that the pharmacokinetics of meropenem in critically ill patients receiving ECMO were similar to those in patients without ECMO. Monte Carlo simulations have determined appropriate dosage regimens for meropenem, but dose adjustments may be needed for more aggressive targets.
FRONTIERS IN PHARMACOLOGY
(2021)
Article
Critical Care Medicine
Anne Willers, Justyna Swol, Hergen Buscher, Zoe McQuilten, Sander M. J. van Kuijk, Hugo Ten Cate, Peter T. Rycus, Stephen McKellar, Roberto Lorusso, Joseph E. Tonna
Summary: Data on hospital outcomes in bleeding complications during extracorporeal life support (ECLS) have been lacking. This retrospective study analyzed data from 53,644 adult patients and found a steady decrease in bleeding complications over the past 20 years, mostly attributed to surgical and cannula-site-related bleeding. However, more data is needed to determine the exact reasons for the decrease in bleeding trends.
CRITICAL CARE MEDICINE
(2022)
Article
Engineering, Biomedical
Erica A. Sheridan, Michael E. Sekela, Komal A. Pandya, Aric Schadler, Ayesha Ather
Summary: Extracorporeal membrane oxygenation (ECMO) patients require systemic anticoagulation to prevent coagulopathy. This study compared the safety and efficacy of bivalirudin and unfractionated heparin (UFH) in ECMO patients. The results showed similar rates of bleeding and thrombosis, but bivalirudin demonstrated better control of therapeutic range.
Review
Biochemistry & Molecular Biology
Thomas Hughes, David Zhang, Priya Nair, Hergen Buscher
Summary: A systematic review on blood product administration in ECMO patients revealed that evidence is mainly drawn from single-center observational trials and shows wide variability in transfusion practice, with highly variable transfusion needs. Confounding factors influencing transfusion practice should be identified in prospective multicenter studies to mitigate potential harmful effects and generate hypotheses for interventional trials.
Review
Critical Care Medicine
Kate Hayes, Carol L. Hodgson, Melissa J. Webb, Lorena Romero, Anne E. Holland
Summary: This study conducted a comprehensive scoping review to map the literature related to the rehabilitation of adult patients on ECMO, identifying gaps and areas for future research. The research highlighted the need for more robust methodological designs and comprehensive reporting in the emerging field of rehabilitation during ECMO.
AUSTRALIAN CRITICAL CARE
(2022)
Article
Engineering, Biomedical
Nkosi H. Alvarez, Thomas J. O'Malley, Babak Abai, Dawn M. Salvatore, Paul J. DiMuzio, Hitoshi Hirose
Summary: The study found that obese patients with a BMI > 35 have a higher risk of bleeding during peripheral VA cannulation, while there is no difference in bleeding risk between BMI groups in VV ECMO. There was no significant difference in 30-day mortality and ECMO survival rates among different BMI groups in both VA and VV ECMO.
Article
Cardiac & Cardiovascular Systems
Anne-Kristin Schaefer, Michaela Latus, Julia Riebandt, Georg Goliasch, Martin H. Bernardi, Guenther Laufer, Daniel Zimpfer, Dominik Wiedemann
Summary: This study retrospectively analyzed patients undergoing post-cardiotomy extracorporeal life support (ECLS) and found that bleeding and thrombotic events were common and significantly affected survival. Preoperative dual antiplatelet therapy and ECLS duration were identified as independent risk factors for bleeding, while prior stroke/transient ischaemic attack and ECLS duration were identified as risk factors for thrombotic events.
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
(2023)
Article
Hematology
Julie Helms, Corinne Frere, Thomas Thiele, Kenichi A. Tanaka, Matthew D. Neal, Marie E. Steiner, Jean M. Connors, Jerrold H. Levy
Summary: This guidance document provides practical advice on anticoagulant selection, dosing, and monitoring strategy during extracorporeal membrane oxygenation support in adult patients. Due to the high risk of bleeding and thrombotic complications, anticoagulation management is challenging and often empirical for patients on extracorporeal membrane oxygenation. Therefore, there is considerable variation in practice.
JOURNAL OF THROMBOSIS AND HAEMOSTASIS
(2023)
Article
Critical Care Medicine
Mariusz Kowalewski, Kamil Zielinski, Giuseppe Maria Raffa, Paolo Meani, Valeria Lo Coco, Federica Jiritano, Dario Fina, Matteo Matteucci, Giovanni Chiarini, Anne Willers, Jorik Simons, Piotr Suwalski, Mario Gaudino, Michele Di Mauro, Jos Maessen, Roberto Lorusso
Summary: The study analyzed predictors of unfavorable outcomes in elderly patients (>= 70 yr) undergoing venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock. Despite high in-hospital mortality, the use of ECMO in elderly patients is still considered, as increasing age itself was not associated with higher mortality.
CRITICAL CARE MEDICINE
(2021)
Article
Medicine, General & Internal
Yang-Chao Zhao, Xi Zhao, Guo-Wei Fu, Ming-Jun Huang, Hui Zhao, Zhen-Qing Wang, Xing-Xing Li, Jun Li
Summary: This study analyzed the outcomes of ECMO transport patients and found that transportation for ECMO patients is feasible, although life-threatening complications may occur. The SOFA score and lactate level can be used to evaluate the risk of ICU mortality for transport ECMO patients.
FRONTIERS IN MEDICINE
(2022)
Article
Critical Care Medicine
Jose Nunez, Andre F. Gosling, Brian O'Gara, Kevin F. Kennedy, Peter Rycus, Darryl Abrams, Daniel Brodie, Shahzad Shaefi, A. Reshad Garan, E. Wilson Grandin
Summary: This study aimed to analyze the prevalence, mortality association, and risk factors for bleeding and thrombosis events among adults supported with venovenous extracorporeal membrane oxygenation. Bleeding and thrombotic events are common during VV-ECMO and have a strong, cumulative association with in-hospital mortality. While thrombotic events are more frequent, bleeding carries a higher risk of inpatient mortality. Differential risk factors for bleeding and thrombotic complications exist, suggesting the possibility of a tailored approach to VV-ECMO management.
INTENSIVE CARE MEDICINE
(2022)