scholarly journals Veno-Arterial Extracorporeal Membrane Oxygenation for Severe Heatstroke with Refractory Hemodynamic Failure

2021 ◽  
pp. 76-79
Author(s):  
Masahide Fujita ◽  
Keita Miyazaki ◽  
Momoko Horiguchi ◽  
Kouji Yamamoto ◽  
Shingo Ito ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Circulatory Failure ◽  
The Third ◽  
Ringer’S Solution ◽  
Membrane Oxygenation ◽  
Va Ecmo ◽  
Hemodynamic Failure

A 68-year-old male was found unconscious in a hot bathtub on a cold winter’s day and was brought to our hospital. On arrival, the patient’s systolic blood pressure was 65 mm hg, heart rate was 134 beats per min, and rectal temperature was 40.5°C. A large volume infusion of acetated Ringer’s solution and vasopressors were administered as an immediate treatment for circulatory failure due to heatstroke. Although the circulatory failure temporarily improved, the blood pressure dropped almost to the point of cardiac arrest. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was implemented and the hemodynamics were soon stabilized. Subsequently, VA-ECMO was withdrawn on the third hospital day. The patient recovered enough to feed normally on the 40th hospital day and was transferred to another hospital on the 116th hospital day. Based on this case study, we consider that VA-ECMO implementation before cardiac arrest might be a suitable strategy.

AP099 Venoarterial extracorporeal membrane oxygenation (VA-ECMO) for cardiac support after traumatic cardiac arrest (TCA)

Resuscitation ◽  
2011 ◽  
Vol 82 ◽  
pp. S32
Author(s):  
Vasilios Grosomanidis ◽  
Eleni Argyriadou ◽  
Barbara Fyntanidou ◽  
Omiros Halvatsoulis ◽  
Eleni Geka ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Traumatic Cardiac Arrest ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Va Ecmo

Peripheral cannulation for extracorporeal membrane oxygenation yields superior neurologic outcomes in adult patients who experienced cardiac arrest following cardiac surgery

Perfusion ◽  
2021 ◽  
pp. 026765912110181
Author(s):  
Lauren E Levy ◽  
David J Kaczorowski ◽  
Chetan Pasrija ◽  
Gregory Boyajian ◽  
Michael Mazzeffi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Surgery ◽  
Extracorporeal Membrane Oxygenation ◽  
Cause Of Death ◽  
Adult Patients ◽  
Membrane Oxygenation ◽  
Neurologic Outcomes ◽  
Va Ecmo ◽  
Central Cannulation ◽  
Post Cardiac Surgery

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest has improved mortality in post-cardiac surgery patients; however, loss of neurologic function remains one of the main and devastating complications. We reviewed our experience with ECPR and investigated the effect of cannulation strategy on neurologic outcome in adult patients who experienced cardiac arrest following cardiac surgery that was managed with ECPR. Methods: Patients were categorized by central versus percutaneous peripheral VA-extracorporeal membrane oxygenation (ECMO) cannulation strategy. We reviewed patient records and evaluated in-hospital mortality, cause of death, and neurologic status 72 hours after cannulation. Results: From January 2010 to September 2019, 44 patients underwent post-cardiac surgery ECPR for cardiac arrest. Twenty-six patients received central cannulation; 18 patients received peripheral cannulation. Mean post-operative day of the cardiac arrest was 3 and 9 days (p = 0.006), and mean time between initiation of CPR and ECMO was 40 ± 24 and 28 ± 22 minutes for central and peripheral cannulation, respectively. After 72 hours of VA-ECMO support, 30% of centrally cannulated patients versus 72% of peripherally cannulated patients attained cerebral performance status 1–2 (p = 0.01). Anoxic brain injury was the cause of death in 26.9% of centrally cannulated and 11.1% of peripherally cannulated patients. Survival to discharge was 31% and 39% for central and peripheral cannulation, respectively. Conclusions: Peripheral VA-ECMO allows for continuous CPR and systemic perfusion while obtaining vascular access. Compared to central cannulation, a peripheral cannulation strategy is associated with improved neurologic outcomes and decreased likelihood of anoxic brain death.

scholarly journals Complete percutaneous angio-guided approach using preclosing for venoarterial extracorporeal membrane oxygenation implantation and explantation in patients with refractory cardiogenic shock or cardiac arrest

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Anne-Sophie Martin-Tuffreau ◽  
François Bagate ◽  
Madjid Boukantar ◽  
Gabriel Saiydoun ◽  
Andrea Mangiameli ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Vascular Complications ◽  
Vascular Complication ◽  
Technical Success Rate ◽  
Surgical Closure ◽  
Membrane Oxygenation ◽  
Refractory Cardiogenic Shock ◽  
Va Ecmo

Abstract Background The approach for veno-arterial extracorporeal membrane oxygenation implantation (VA-ECMO) in patients with cardiogenic shock can be either surgical or percutaneous. Complete angio-guided percutaneous implantation and explantation could decrease vascular complications. We sought to describe the initial results of complete percutaneous angio-guided ECMO implantation and explantation using preclosing. Methods All consecutive patients who underwent peripheral femoro-femoral VA-ECMO percutaneous implantation for refractory cardiogenic shock or cardiac arrest were enrolled in a prospective registry (03/2018–12/2020). Percutaneous preclosing using two closing devices (Perclose ProGlide, Abbott) inserted before cannulation was used in both femoral artery and vein. Explantation was performed using a crossover technique under angiographic guidance. The occurrence of vascular complication was recorded. Results Among the 56 patients who underwent percutaneous VA-ECMO implantation for cardiogenic shock or refractory cardiac arrest, 41 underwent preclosing. Femoral vessel cannulation was successful in all patients and total cannulation time was 20 (10–40) min. Weaning from ECMO was possible in 22/41 patients (54%) and 12 (29%) patients were alive at day 30. Significant vascular complications occurred in 2/41 patients. Percutaneous decannulation was performed in 20 patients with 19/20 technical success rate. All femoral arteries and veins were properly closed using the pre-closing devices without bleeding on the angiographic control except for one patient in whom surgical closure of the artery was required. No patient required transfusion for access related significant bleeding and no other vascular complication occurred. Furthermore, no groin infection was observed after full percutaneous implantation and removal of ECMO. Conclusion Emergent complete percutaneous angio-guided VA-ECMO implantation and explantation using pre-closing technique can be an attractive strategy in patients referred for refractory cardiogenic shock.

scholarly journals Predictors of mortality in patients with VA-extracorporeal membrane oxygenation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Kang ◽  
H.S Lee ◽  
S.M Han ◽  
H.J Cho
Keyword(s):  
Heart Failure ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Acute Heart Failure ◽  
Baseline Characteristic ◽  
Coronary Syndrome ◽  
Membrane Oxygenation ◽  
History Of ◽  
Va Ecmo

Abstract Background Venoarterial extracorporeal membrane oxygenation (VA-ECMO) support is a lifesaving tool used in the treatment of cardiogenic shock, acute heart failure, or extracorporeal cardiopulmonary resuscitation (CPR). We report on a single center experience with ECMO and aim to identify the prognostic markers for in-hospital mortality and death at 72 hours after ECMO. Methods Between 2011 and 2019 we evaluated 131 patients, who received ECMO. Collected data was analyzed to identify baseline characteristic, outcomes including clinical variables predictive of poor outcome. Results The mean age was 62.5 years, 67.2% were male patients, with prior CPR in 61.8%. The annual number of VA-ECMO procedures steadily increased, whereas in-hospital mortality is decreasing. Within the total cohort, the indication for VA-ECMO was cardiac arrest in 19.1%, acute coronary syndrome in 41.2%, acute heart failure in 23.7%, and myocarditis in 10.7%. Overall in-hospital mortality was 58.8%. Multivariate logistic regression model revealed presence of malignancy, history of revascularization, duration of cardiac arrest, and low BMI as independent predictors for mortality in 72 hours after ECMO (table). On the other hand, predictors of in-hospital mortality were prior congestive heart failure, male, and history of malignancy. The C-statistic for discriminating mortality in 72 hours after ECMO with the duration of cardiac arrest was 0.67 (figure). Conclusions Although the use of ECMO as a last line in the treatment of critical patients measures constitutes an important improvement in their care; with 41.2% overall survival; patient selection and timing of ECMO initiation remains challenging. The importance of consideration for ECMO use earlier in course of illness rather than later. Funding Acknowledgement Type of funding source: None

scholarly journals Protocol for a multicentre randomised controlled trial evaluating the effects of moderate hypothermia versus normothermia on mortality in patients with refractory cardiogenic shock rescued by venoarterial extracorporeal membrane oxygenation (VA-ECMO) (HYPO-ECMO study)

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e031697
Author(s):  
Audrey Jacquot ◽  
Xavier Lepage ◽  
Ludovic Merckle ◽  
Nicolas Girerd ◽  
Bruno Levy
Keyword(s):  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Organ Failure ◽  
Mortality Data ◽  
Moderate Hypothermia ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
All Cause Mortality ◽  
Va Ecmo

IntroductionVenoarterial extracorporeal membrane oxygenation (VA-ECMO) is widely used to support the most severe forms of cardiogenic shock (CS). Nevertheless, despite extracorporeal membrane oxygenation (ECMO) use, mortality still remains high (50%). Moderate hypothermia (MH) (33°C–34°C) may improve cardiac performance and decrease ischaemia–reperfusion injuries. The use of MH during VA-ECMO is strongly supported by experimental and preliminary clinical data.Methods and analysisThe Hypothermia-Extracorporeal Membrane Oxygenation (HYPO-ECMO) study is a multicentre, prospective, controlled randomised trial between an MH group (33°C≤T°C≤34°C) and normothermia group (36°C≤T°C≤37°C). The primary endpoint is all-cause mortality at day 30 following randomisation. The study will also assess as secondary endpoints the effects of targeted temperature management strategies on (1) mortality rate at different time points, (2) organ failure and supportive treatment use and (3) safety. All intubated adults with refractory CS supported with VA-ECMO will be screened. Exclusion criteria are patients having undergone cardiac surgery for heart transplantation or left or biventricular assist device implantation, acute poisoning with cardiotoxic drugs, pregnancy, uncontrolled bleeding and refractory cardiac arrest.Three-hundred and thirty-four patients will be randomised and followed up to 6 months to detect a 15% difference in mortality. Data analysis will be intention to treat. The differences between the two study groups in the risk of all-cause mortality at day 30 following randomisation will be studied using logistic regression analysis adjusted for postcardiotomy setting, prior cardiac arrest, prior myocardial infarction, age, vasopressor dose, Sepsis-related Organ Failure Assessment (SOFA) score and lactate at randomisation.Ethics and disseminationEthics approval has been granted by the Comité de Protection des Personnes Est III Ethics Committee. The trial has been approved by the French Health Authorities (Agence Nationale de la Sécurité du Médicament et des Produits de Santé). Dissemination of results will be performed via journal articles and presentations at national and international conferences. Since this study is also the first step in the constitution of an ‘ECMO Trials Group’, its results will also be disseminated by the aforementioned group.Trial registration numberNCT 02754193.

SAVE score with lactate modification predicts in-hospital mortality in patients with ongoing cardiac arrest during VA-ECMO cannulation

2021 ◽  
pp. 039139882110218
Author(s):  
Lee Ann Santore ◽  
James W Schurr ◽  
Mohammad Noubani ◽  
Andrew Rabenstein ◽  
Kathleen Dhundale ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Significant Variable ◽  
Membrane Oxygenation ◽  
Va Ecmo

The survival after veno-arterial extracorporeal membrane oxygenation score and its lactate modification predict in-hospital mortality in patients based on pre-extracorporeal membrane oxygenation variables. Cardiac arrest history is a significant variable in these scores; however, patients with ongoing cardiac arrest during cannulation were excluded from these models. The goal of this study is to validate the survival after veno-arterial extracorporeal membrane oxygenation score with a lactate modification among patients with ongoing cardiac arrest. In our study, the survival after veno-arterial extracorporeal membrane oxygenation score predicted mortality in all patients, but did so with higher discrimination among ongoing cardiac arrest patients with a lactate modification.

scholarly journals FIRST EXPERIENCE OF ECMO-CPR IN EMERGENCY DEPARTMENT

2018 ◽  
Vol 19 (1) ◽  
pp. 67-71 ◽  
Author(s):  
V. M. Teplov ◽  
S. S. Komedev ◽  
A. E. Skvorcov ◽  
I. I. Kolachev ◽  
A. Yu. Shurov ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Russian Federation ◽  
Hospital Treatment ◽  
Emergency Situations ◽  
Membrane Oxygenation ◽  
Va Ecmo

There are a few cases of applying of extracorporeal membrane oxygenation in emergency situations in Russian Federation. This article  is about of first experience of using VA-ECMO for the treating patients, which were admitted with cardiac arrest in our ED. We are  faced with the problem of long transportation from out-of-hospital to  hospital treatment. There is necessity for harmonization algorithms of  CPR for amblulances while creating ECMO-centers for the patients with cardiac arrest in Russia.

Temporary Venoarterial Extracorporeal Membrane Oxygenation: Ten-Year Experience at a Cardiac Transplant Center

2016 ◽  
Vol 33 (5) ◽  
pp. 288-295 ◽  
Author(s):  
Bao G. Tran ◽  
Kim De La Cruz ◽  
Stuart Grant ◽  
Joseph Meltzer ◽  
Peyman Benharash ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Mortality Rate ◽  
Extracorporeal Membrane Oxygenation ◽  
Heart Transplant ◽  
Graft Failure ◽  
Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Membrane Oxygenation ◽  
Va Ecmo

Objective: Advances in extracorporeal membrane oxygenation (ECMO) have enabled rapid deployment in a wide range of clinical settings. We report our experience with venoarterial (VA) ECMO in adult patients over 10 years and aim to identify predictors of mortality. Design: This is a retrospective analysis of all adult patients undergoing VA ECMO at a tertiary care center from January 1, 2004, to December 31, 2013. Results: A total of 224 consecutive cases were reviewed. Eighty (35.7%) patients survived to discharge and 144 (64.3%) patients died. Patients requiring ECMO for heart transplant graft failure had lower mortality (51.6%) compared to all other etiologies (69.1%; P = .02). Forty-two percent (94 of the 224) of the patients required cardiopulmonary resuscitation (CPR) preceding ECMO and had higher rate of in-hospital mortality (74.5%) compared with patients without cardiac arrest (56.9%; P = .01). Patients with less than 30 minutes of CPR had a mortality rate of 40.0% compared to 91.4% for CPR > 30 minutes ( P = .001). In all, 24.1% of patients (54 of the 224) experienced ECMO-associated complications without significant increase in mortality, and 22.3% (50 of the 224) of the patients were transitioned to ventricular assist devices (VADs) or transplant. Patients bridged to a VAD including left ventricular assist devices and biventricular assist devices had a mortality rate of 56.1% versus 22.2% when bridged directly to transplant ( P = .01). Paradoxically, patients with an ejection fraction (EF) > 35% had a higher mortality compared to patients with an EF < 35% (75.3% vs 49.4%, respectively, P = .001). Conclusion: Extracorporeal membrane oxygenation in patients with heart transplant graft failure had the best outcome. In patients who had cardiac arrest, prolonged CPR > 30 minutes was associated with very high mortality. Paradoxically, patients with EF > 35% had a higher mortality than patients with EF < 35%, likely reflecting patients with diastolic heart failure or noncardiac causes necessitating ECMO. For transplant candidates, direct bridge from ECMO to transplant could achieve a very good outcome.

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