Early PaCO2 Changes after Initiating Extracorporeal Membrane Oxygenation: Considerations for Future Research.
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ABSTRACT:
SUBMITTER: Kikutani K
PROVIDER: S-EPMC7706159 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description: Not available
| S-EPMC7706155 | biostudies-literature
Project description:Prognosis for cardiogenic shock patients under ECMO was our study goal. Success defined as survived more than 7 days after ECMO installation and failure died or had multiple organ failure in 7 days. Total 34 cases were enrolled, 17 success and 17 failure. Peripheral blood mononuclear cells collected at ECMO installation were used analyzed.
2019-12-31 | GSE93101 | GEO
Project description:Extracorporeal membrane oxygenation (ECMO) is an advanced form of life support technology whereby venous blood is oxygenated outside of the body and returned to the patient. ECMO was initially used as last-resort rescue therapy for patients with severe respiratory failure. Over the last four decades, it has developed into a safe, standard therapy for newborns with progressive cardiorespiratory failure, as a resuscitation therapy after cardiac arrest, and in combination with other treatments such as hypothermia and various blood filtration therapies. ECMO has also become routine for children and adults with all forms of cardiogenic shock and is also routine in early graft failure after transplantation. The one area of ongoing debate is the role of ECMO in adults with hypoxemic respiratory failure. As ECMO equipment becomes safer, earlier use improves patient outcomes. Several modifications of the two basic venovenous and venoarterial ECMO systems are now occurring, as are many minor variations in cannulation strategies and systems of care for patients receiving ECMO. The indications and situations in which ECMO have been tried continue to change, and ECMO for sub-acute and chronic illnesses is now commonplace, as is the use of ECMO in patients with clinical problems previously regarded as contraindications, such as sepsis, malignancy, and immunosuppression.
| S-EPMC3876455 | biostudies-literature
Project description:BackgroundVenovenous extracorporeal membrane oxygenation (vv-ECMO) is an effective treatment for severe respiratory failure. The interaction between the cardiorespiratory system and the oxygenator can be explored with mathematical models. Understanding the physiology will help the clinician optimise therapy. As others have examined O2 exchange, the main focus of this study was on CO2 exchange.MethodsA model of the cardiorespiratory system during vv-ECMO was developed, incorporating O2, CO2 and N2 exchange in both the lung and the oxygenator. We modelled lungs with shunt fractions varying from 0 to 1, covering the plausible range from normal lung to severe acute respiratory distress syndrome. The effects on PaCO2 of varying the input parameters for the cardiorespiratory system and for the oxygenator were examined.ResultsPaCO2 increased as the shunt fraction in the lung and metabolic CO2 production rose. Changes in haemoglobin and FIO2 had minimal effect on PaCO2. The effect of cardiac output on PaCO2 was variable, depending on the shunt fraction in the lung. PaCO2 decreased as extracorporeal circuit blood flow was increased, but the changes were relatively small in the range used clinically for vv-ECMO of >?2 l/min. PaCO2 decreased as gas flow to the oxygenator rose and increased with recirculation. The oxygen fraction of gas flow to the oxygenator had minimal effect on PaCO2.ConclusionsThis mathematical model of gas exchange during vv-ECMO found that the main determinants of PaCO2 during vv-ECMO were pulmonary shunt fraction, metabolic CO2 production, gas flow to the oxygenator and extracorporeal circuit recirculation.
| S-EPMC6085277 | biostudies-literature
Project description:Overview: The use of extracorporeal membrane oxygenation (ECMO) is becoming commonplace worldwide in ICUs for the care of patients with respiratory and/or cardiac failure. Understanding the use of ECMO and the management of these complex patients will be vital to current and future clinicians as ECMO use continues to grow.
| S-EPMC8598290 | biostudies-literature
Project description:Extracorporeal membrane oxygenation (ECMO) for severe acute respiratory failure was proposed more than 40 years ago. Despite the publication of the ARDSNet study and adoption of lung protective ventilation, the mortality for acute respiratory failure due to acute respiratory distress syndrome has continued to remain high. This technology has evolved over the past couple of decades and has been noted to be safe and successful, especially during the worldwide H1N1 influenza pandemic with good survival rates. The primary indications for ECMO in acute respiratory failure include severe refractory hypoxemic and hypercarbic respiratory failure in spite of maximum lung protective ventilatory support. Various triage criteria have been described and published. Contraindications exist when application of ECMO may be futile or technically impossible. Knowledge and appreciation of the circuit, cannulae, and the physiology of gas exchange with ECMO are necessary to ensure lung rest, efficiency of oxygenation, and ventilation as well as troubleshooting problems. Anticoagulation is a major concern with ECMO, and the evidence is evolving with respect to diagnostic testing and use of anticoagulants. Clinical management of the patient includes comprehensive critical care addressing sedation and neurologic issues, ensuring lung recruitment, diuresis, early enteral nutrition, treatment and surveillance of infections, and multisystem organ support. Newer technology that delinks oxygenation and ventilation by extracorporeal carbon dioxide removal may lead to ultra-lung protective ventilation, avoidance of endotracheal intubation in some situations, and ambulatory therapies as a bridge to lung transplantation. Risks, complications, and long-term outcomes and resources need to be considered and weighed in before widespread application. Ethical challenges are a reality and a multidisciplinary approach that should be adopted for every case in consideration.
| S-EPMC4900379 | biostudies-literature
Project description:Neurologic complications following acute respiratory distress syndrome (ARDS) are well described, however, information on the neurologic outcome regarding peripheral nervous system complications in critically ill ARDS patients, especially those who received extracorporeal membrane oxygenation (ECMO) are lacking. In this prospective observational study 28 ARDS patients who survived after ECMO or conventional nonECMO treatment were examined for neurological findings. Nine patients had findings related to cranial nerve innervation, which differed between ECMO and nonECMO patients (p = 0.031). ECMO patients had severely increased patella tendon reflex (PTR) reflex levels (p = 0.027 vs. p = 0.125) as well as gastrocnemius tendon reflex (GTR) (p = 0.041 right, p = 0.149 left) were affected on the right, but not on the left side presumably associated with ECMO cannulation. Paresis (14.3% of patients) was only found in the ECMO group (p = 0.067). Paresthesia was frequent (nonECMO 53.8%, ECMO 62.5%; p = 0.064), in nonECMO most frequently due to initial trauma and polyneuropathy, in the ECMO group mainly due to impairments of N. cutaneus femoris lateralis (4 vs. 0; p = 0.031). Besides well-known central neurologic complications, more subtle complications were detected by thorough clinical examination. These findings are sufficient to hamper activities of daily living and impair quality of life and psychological health and are presumably directly related to ECMO therapy.
| S-EPMC6679149 | biostudies-literature
Project description:The timing of extracorporeal membrane oxygenation (ECMO) initiation and its outcome in the management of respiratory and cardiac failure have received considerable attention, but very little attention has been given to mechanical ventilation during ECMO. Mechanical ventilation settings in non-ECMO studies have been shown to have an effect on survival and may also have contributed to a treatment effect in ECMO trials. Protective lung ventilation strategies established for non-ECMO-supported respiratory failure patients may not be optimal for more severe forms of respiratory failure requiring ECMO support. The influence of positive end-expiratory pressure on the reduction of the left ventricular compliance may be a matter of concern for patients receiving ECMO support for cardiac failure. The objectives of this review were to describe potential mechanisms for lung injury during ECMO for respiratory or cardiac failure, to assess the possible benefits from the use of ultra-protective lung ventilation strategies and to review published guidelines and expert opinions available on mechanical ventilation-specific management of patients requiring ECMO, including mode and ventilator settings. Articles were identified through a detailed search of PubMed, Ovid, Cochrane databases and Google Scholar. Additional references were retrieved from the selected studies. Growing evidence suggests that mechanical ventilation settings are important in ECMO patients to minimize further lung damage and improve outcomes. An ultra-protective ventilation strategy may be optimal for mechanical ventilation during ECMO for respiratory failure. The effects of airway pressure on right and left ventricular afterload should be considered during venoarterial ECMO support of cardiac failure. Future studies are needed to better understand the potential impact of invasive mechanical ventilation modes and settings on outcomes.
| S-EPMC4057516 | biostudies-literature
Project description:BACKGROUND AND PURPOSE:The rate and outcomes of neurologic complications of patients receiving extracorporeal membrane oxygenation (ECMO) are poorly understood. The purpose of this study was to identify these parameters in ECMO patients. METHODS:All patients receiving ECMO were selected from the Nationwide Inpatient Sample between 2001-2011. The rate and outcomes of neurologic complications [acute ischemic stroke, intracranial hemorrhage (ICH), and seizures] among these patients was determined. Discharge status, mortality, length of stay, and hospitalization costs were compared between patients with and without neurologic complications using chi-squared tests for categorical variables and Student's t-test for continuous variables. RESULTS:In total, 23,951 patients were included in this study, of which 2,604 (10.9%) suffered neurologic complications of seizure (4.1%), stroke (4.1%), or ICH (3.6%). When compared to patients without neurologic complications, acute ischemic stroke patients had significantly higher rates of discharge to a long-term facility (12.2% vs. 6.8%, p<0.0001) and a significantly longer mean length of stay (41.6 days vs. 31.9 days, p<0.0001). ICH patients had significantly higher rates of discharge to a long-term facility (9.5% vs. 6.8%, p=0.007), significantly higher mortality rates (59.7% vs. 50.0%, p<0.0001), and a significantly longer mean length of stay (41.8 days vs. 31.9 days) compared to patients without neurologic complications. These outcomes did not differ significantly between seizure patients and patients without neurologic complications. CONCLUSIONS:Given the increasing utilization of ECMO and the high costs and poor outcomes associated with neurologic complications, more research is needed to help determine the best way to prevent these sequelae in this patient population.
| S-EPMC4596114 | biostudies-literature
Project description:Venoarterial extracorporeal membrane oxygenation (vaECMO) is a well-established treatment option for severe cardiogenic shock of various etiologies. Although trials have explored weaning strategies, a brief and conclusive overview is lacking. We present the different aspects of weaning and provide an evidence- and experienced-based guide for clinicians managing patients under vaECMO in the preweaning, weaning, and postweaning phases.
| S-EPMC7190048 | biostudies-literature