- Pulmonary
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Association of pulmonary arterial pressure with volume status in patients with acute respiratory distress syndrome receiving extracorporeal membrane oxygenation
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Tae Hwa Hong, Hyoung Soo Kim, Sunghoon Park
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Acute Crit Care. 2022;37(2):159-167. Published online March 11, 2022
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DOI: https://doi.org/10.4266/acc.2021.00927
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 Abstract
 PDF Supplementary Material
- Background
Data on pulmonary hemodynamic parameters in patients with acute respiratory distress syndrome (ARDS) receiving extracorporeal membrane oxygenation (ECMO) are scarce.
Methods
The associations between pulmonary artery catheter parameters for the first 7 days of ECMO, fluid balance, and hospital mortality were investigated in adult patients (aged ≥19 years) who received venovenous ECMO for refractory ARDS between 2015 and 2017.
Results
Twenty patients were finally included in the analysis (median age, 56.0 years; interquartile range, 45.5–68.0 years; female, n=10). A total of 140 values were collected for each parameter (i.e., 7 days×20 patients). Net fluid balance was weakly but significantly correlated with systolic and diastolic pulmonary arterial pressures (PAPs; r=0.233 and P=0.011; r=0.376 and P<0.001, respectively). Among the mechanical ventilation parameters, above positive end-expiratory pressure was correlated with systolic PAP (r=0.191 and P=0.025), and static compliance was negatively correlated with diastolic PAP (r=−0.169 and P=0.048). Non-survivors had significantly higher systolic PAPs than in survivors. However, in multivariate analysis, there was no significant association between mean systolic PAP and hospital mortality (odds ratio, 1.500; 95% confidence interval, 0.937–2.404; P=0.091).
Conclusions
Systolic PAP was weakly but significantly correlated with net fluid balance during the early ECMO period in patients with refractory ARDS receiving ECMO.
- Cardiology
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Blood Transfusion Strategies in Patients Undergoing Extracorporeal Membrane Oxygenation
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Hyoung Soo Kim, Sunghoon Park
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Korean J Crit Care Med. 2017;32(1):22-28. Published online February 28, 2017
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DOI: https://doi.org/10.4266/kjccm.2016.00983
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Crossref
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Abstract
PDF
- Extracorporeal membrane oxygenation (ECMO) is frequently associated with bleeding and coagulopathy complications, which may lead to the need for transfusion of multiple blood products. However, blood transfusions are known to increase morbidity and mortality, as well as hospital cost, in critically ill patients. In current practice, patients on ECMO receive a transfusion, on average, of 1-5 packed red blood cells (RBCs)/day, with platelet transfusion accounting for the largest portion of transfusion volume. Generally, adult patients require more transfusions than neonates or children, and patients receiving venovenous ECMO for respiratory failure tend to need smaller transfusion volumes compared to those receiving venoarterial ECMO for cardiac failure. Observation studies have reported that a higher transfusion volume was associated with increased mortality. To date, the evidence for transfusion in patients undergoing ECMO is limited; most knowledge on transfusion strategies was extrapolated from studies in critically ill patients. However, current data support a restrictive blood transfusion strategy for ECMO patients, and a low transfusion trigger seems to be safe and reasonable.
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Citations
Citations to this article as recorded by  - Oxygenation During Venoarterial Extracorporeal Membrane Oxygenation: Physiology, Current Evidence, and a Pragmatic Approach to Oxygen Titration
Lavienraj Premraj, Alastair Brown, John F. Fraser, Vincent Pellegrino, David Pilcher, Aidan Burrell
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Indian Journal of Thoracic and Cardiovascular Surgery.2021; 37(4): 411. CrossRef - Point-of-care testing of plasma free hemoglobin and hematocrit for mechanical circulatory support
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Scientific Reports.2021;[Epub] CrossRef - Systematic review and meta-analysis of the clinical effectiveness of point-of-care testing for anticoagulation management during ECMO
Federica Jiritano, Dario Fina, Roberto Lorusso, Hugo ten Cate, Mariusz Kowalewski, Matteo Matteucci, Raffaele Serra, Pasquale Mastroroberto, Giuseppe Filiberto Serraino
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Frantzeska G. Frantzeskaki, Stavros Dimopoulos, Dimitrios Konstantonis, Pelagia Katsibri, Kostantinos Kostopanagiotou, Maria Theodorakopoulou, Chrysi Diakaki, Dimitrios Dougenis, Dimitrios Boumpas, Andreas Karabinis, Apostolos Armaganidis, Iraklis Tsangar
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Frontiers in Pediatrics.2020;[Epub] CrossRef
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