scholarly journals Targeted high volume hemofiltration could avoid extracorporeal membrane oxygenation in some patients with severe Hantavirus cardiopulmonary syndrome

2021 ◽  
Author(s):  
René López ◽  
Rodrigo Pérez‐Araos ◽  
Álvaro Salazar ◽  
Mauricio Espinoza ◽  
Cecilia Vial ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
High Volume ◽  
Membrane Oxygenation ◽  
High Volume Hemofiltration

scholarly journals Targeted High Volume Hemofiltration Could Avoid Extracorporeal Membrane Oxygenation in Some Patients with Severe Hantavirus Cardiopulmonary Syndrome

2020 ◽  
Author(s):  
René López ◽  
Rodrigo Pérez-Araos ◽  
Álvaro Salazar ◽  
Mauricio Espinoza ◽  
Cecilia Vial ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Fluid Overload ◽  
Calcium Supplementation ◽  
High Volume ◽  
Serum Lactate ◽  
Vascular Complication ◽  
Maximum Serum ◽  
Membrane Oxygenation ◽  
High Volume Hemofiltration ◽  
Extracorporeal Support

Background: Hantavirus cardiopulmonary syndrome (HCPS) has a high lethality. About two-thirds of the severe cases may be rescued by extracorporeal membrane oxygenation (ECMO). However, about half of the patients supported by ECMO suffer major complications. High volume hemofiltration (HVHF) is a depurative extracorporeal support that provides homeostatic balance allowing hemodynamic stabilization in some critically ill patients. Methods: We implemented HVHF prior to ECMO consideration in the last five severe HCPS patients requiring mechanical ventilation and vasoactive drugs admitted to our intensive care unit. Patients were considered HVHF-responders if ECMO was avoided and nonresponders if ECMO support was needed. Results: The first two patients required ECMO, while the last three did not. Patients had a maximum serum lactate of 8.4 [4.3-14] mMol/L and a lowest cardiac index of 1.76 [1.45-2.9] L/min/m2. Nonresponders were connected later to HVHF, displayed progressive tachycardia and decreasing stroke volume. The opposite was true for HVHF-responders who also received targeted-HVHF compounded by aggressive hyperoncotic albumin, sodium bicarbonate and calcium supplementation plus ultrafiltration to avoid fluid overload. All patients survived, but one of the ECMO patients suffered a vascular complication. Conclusion: HVHF may contribute to support severe HCPS patients avoiding the need for ECMO in some of them. Early connection and targeted-HVHF may increase the chance of success.

Curriculum to Introduce Critical Care Nurses to Extracorporeal Membrane Oxygenation

2020 ◽  
Vol 29 (4) ◽  
pp. 262-269
Author(s):  
Whitney D. Gannon ◽  
Lynne Craig ◽  
Lindsey Netzel ◽  
Carmen Mauldin ◽  
Ashley Troutt ◽  
...  
Keyword(s):  
Critical Care ◽  
Extracorporeal Membrane Oxygenation ◽  
Reference Group ◽  
High Volume ◽  
Critical Care Nurses ◽  
Care Nurse ◽  
Membrane Oxygenation ◽  
Written Examination ◽  
Advanced User ◽  
Before And After

Background Despite the growing use of extracorporeal membrane oxygenation (ECMO) in intensive care units (ICUs), no standardized ECMO training pathways are available for ECMO-naive critical care nurses. Objectives To evaluate a critical care nurse ECMO curriculum that may be reproducible across institutions. Methods An ECMO curriculum consisting of a basic safety course and an advanced user course was designed for critical care nurses. Courses incorporated didactic and simulation components, written knowledge examinations, and electronic modules. Differences in examination scores before and after each course for the overall cohort and for participants from each ICU type were analyzed with t tests or nonparametric equality-of-medians tests. Differences in postcourse scores across ICU types were examined with multiple linear regression. Results Critical care nurses new to ECMO (n = 301) from various ICU types participated in the basic safety course; 107 nurses also participated in the advanced user course. Examination scores improved after completion of both courses for overall cohorts (P < .001 in all analyses). Median (interquartile range) individual score improvements were 23.1% (15.4%-38.5%) for the basic safety course and 8.4% (0%-16.7%) for the advanced user course. Postcourse written examination scores stratified by ICU type, compared with the medical ICU/cardiovascular ICU group (reference group), differed only in the neurovascular ICU group for the basic safety course (percent score difference, −3.0; 95% CI, −5.3 to −0.8; P = .01). Conclusions Implementation of an ECMO curriculum for a high volume of critical care nurses is feasible and effective.

scholarly journals Extracorporeal Membrane Oxygenation Retrieval in Coronavirus Disease 2019: A Case-Series of 19 Patients Supported at a High-Volume Extracorporeal Membrane Oxygenation Center

2020 ◽  
Vol 2 (10) ◽  
pp. e0228 ◽  
Author(s):  
Jordi Riera ◽  
Eduard Argudo ◽  
María Martínez-Martínez ◽  
Sandra García ◽  
Marina García-de-Acilu ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Case Series ◽  
High Volume ◽  
Membrane Oxygenation

Efficacy and Economic Assessment of Conventional Ventilatory Support versus Extracorporeal Membrane Oxygenation for Severe Adult Respiratory Failure (CESAR)

2018 ◽  
pp. 135-140
Author(s):  
Matthew Sigakis
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Clinical Case ◽  
Ventilatory Support ◽  
Length Of Hospital Stay ◽  
Economic Assessment ◽  
High Volume ◽  
Severe Disability ◽  
Membrane Oxygenation ◽  
High Volume Center

The CESAR trial aimed to determine whether extracorporeal membrane oxygenation (ECMO) increased survival without disability by six months in patients with severe but potentially reversible respiratory failure. Patients were randomized to either conventional ventilator support or care at an ECMO referral center. The primary outcome measured was death or severe disability at 6 months. Secondary outcomes were also described such as non-ECMO support, length of stay, and ECMO characteristics. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case. The CESAR trial results indicate that patients with severe but potentially reversible respiratory failure have improved survival without severe disability when transferred to a high volume center with expertise in ECMO. Although survival without severe disability was improved, it was at a significantly increased cost and length of hospital stay. Concerns regarding the generalizability of the findings warrant further investigation.

scholarly journals Inter-hospital transport on extracorporeal membrane oxygenation in various health systems

2021 ◽  
Vol 22 (2) ◽  
pp. 64-68
Author(s):  
V. V. Vasilev ◽  
I. S. Vasileva
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
High Volume ◽  
Transport Systems ◽  
Membrane Oxygenation ◽  
Hospital Transport ◽  
Safe Transport ◽  
In The Beginning ◽  
User Friendly ◽  
Central High ◽  
Ecmo Treatment

The feasibility and the recognition of the possibility to transport patients on extracorporeal membrane oxygenation (ECMO) aroused in the 1970s. The number of transporting facilities worldwide was less than 20 in the beginning of the second Millennium. In 2009 the H1N1 pandemic and a publication showing survival benefit for adult patients transported to a hospital with ECMO resource increased both awareness and interest for ECMO treatment. The number of transport organizations increased rapidly. As of today, the number of transport organizations increases world-wide, though some centers where ECMO is an established treatment report decreasing numbers of transports. Since the introduction of the more user-friendly equipment (ECMO-2 era) increasing numbers of low-volume ECMO centers perform these complex treatments. This overview is based on the current literature, personal experience in the field, and information from the authors’ network on the organization of ECMO transport systems in different settings of health care around the globe. Registry data since the entry into ECMO-2 shows that the number of ECMO treatments matter. The more treatments performed at a given center the better the patient outcome, and the better these resources are spent for the population served. A Hub-and-S poke model for national or regional organization for respiratory ECMO (rECMO) should be advocated where central high-volume ECMO center (Hub) serves a population of 10 to 15 million. Peripheral units (Spokes) play an important part in emergency cannulations keeping the patient on ECMO support till a mobile ECMO team retrieves the patient. This ECMO team is preferably organized from the Hub and brings competencies for assessment and decision to initiate ECMO treatment bedside at any hospital, for cannulation, and a safe transport to any destination.

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