Acute and Critical Care

Original Article

CPR/Resuscitation
Prognostic significance of respiratory quotient in patients undergoing extracorporeal cardiopulmonary resuscitation in Korea: Yun Im Lee, Ryoung-Eun Ko, Soo Jin Na, Jeong-Am Ryu, Yang Hyun Cho, Jeong Hoon Yang, Chi Ryang Chung, Gee Young Suh; Acute Crit Care. 2023;38(2):190-199. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2022.01438

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Abstract PDF: Background
Respiratory quotient (RQ) may be used as a tissue hypoxia marker in various clinical settings but its prognostic significance in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) is not known.
Methods
Medical records of adult patients admitted to the intensive care units after ECPR in whom RQ could be calculated from May 2004 to April 2020 were retrospectively reviewed. Patients were divided into good neurologic outcome and poor neurologic outcome groups. Prognostic significance of RQ was compared to other clinical characteristics and markers of tissue hypoxia.
Results
During the study period, 155 patients were eligible for analysis. Of them, 90 (58.1%) had a poor neurologic outcome. The group with poor neurologic outcome had a higher incidence of out-of-hospital cardiac arrest (25.6% vs. 9.2%, P=0.010) and longer cardiopulmonary resuscitation to pump-on time (33.0 vs. 25.2 minutes, P=0.001) than the group with good neurologic outcome. For tissue hypoxia markers, the group with poor neurologic outcome had higher RQ (2.2 vs. 1.7, P=0.021) and lactate levels (8.2 vs. 5.4 mmol/L, P=0.004) than the group with good neurologic outcome. On multivariable analysis, age, cardiopulmonary resuscitation to pump-on time, and lactate levels above 7.1 mmol/L were significant predictors for a poor neurologic outcome but not RQ.
Conclusions
In patients who received ECPR, RQ was not independently associated with poor neurologic outcome.

Review Article

Basic science and research
Extracorporeal circulation models in small animals: beyond the limits of preclinical research: Mukhammad Kayumov, Reverien Habimana, Dowan Kim, Francis O Obiweluozor, In Seok Jeong, Hwa Jin Cho; Acute Crit Care. 2023;38(1):1-7. Published online February 28, 2023; DOI: https://doi.org/10.4266/acc.2023.00381

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Abstract PDF: Extracorporeal membrane oxygenation (ECMO) use has remarkably increased in recent years. Although ECMO has become essential for patients with refractory cardiac and respiratory failure, extracorporeal circulation (ECC) is associated with significant complications. Small-animal models of ECC have been developed and widely used to better understand ECC-induced pathophysiology. This review article summarizes the development of small-animal ECC models, including the animal species, circuit configuration, priming, perioperative procedures, cannulation, and future perspectives of small-animal ECMO models.

Original Articles

Pediatrics
Characteristics and timing of mortality in children dying in pediatric intensive care: a 5-year experience: Edin Botan, Emrah Gün, Emine Kübra Şden, Cansu Yöndem, Anar Gurbanov, Burak Balaban, Fevzi Kahveci, Hasan Özen, Hacer Uçmak, Ali Genco Gençay, Tanil Kendirli; Acute Crit Care. 2022;37(4):644-653. Published online November 11, 2022; DOI: https://doi.org/10.4266/acc.2022.00395

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Abstract PDF

Background
Pediatric intensive care units (PICUs), where children with critical illnesses are treated, require considerable manpower and technological infrastructure in order to keep children alive and free from sequelae. Methods: In this retrospective comparative cohort study, hospital records of patients aged 1 month to 18 years who died in the study PICU between January 2015 and December 2019 were reviewed. Results: A total of 2,781 critically ill children were admitted to the PICU. The mean±standard deviation age of 254 nonsurvivors was 64.34±69.48 months. The mean PICU length of stay was 17 days (range, 1–205 days), with 40 children dying early (<1 day of PICU admission). The majority of nonsurvivors (83.9%) had comorbid illnesses. Children with early mortality were more likely to have neurological findings (62.5%), hypotension (82.5%), oliguria (47.5%), acidosis (92.5%), coagulopathy (30.0%), and cardiac arrest (45.0%) and less likely to have terminal illnesses (52.5%) and chronic illnesses (75.6%). Children who died early had a higher mean age (81.8 months) and Pediatric Risk of Mortality (PRISM) III score (37). In children who died early, the first three signs during ICU admission were hypoglycemia in 68.5%, neurological symptoms in 43.5%, and acidosis in 78.3%. Sixty-seven patients needed continuous renal replacement therapy, 51 required extracorporeal membrane oxygenation support, and 10 underwent extracorporeal cardiopulmonary resuscitation. Conclusions: We found that rates of neurological findings, hypotension, oliguria, acidosis, coagulation disorder, and cardiac arrest and PRISM III scores were higher in children who died early compared to those who died later.

Citations

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Descriptive and Clinical Characteristics of Nonsurvivors in a Tertiary Pediatric Intensive Care Unit in Turkey: 6 Years of Experience
Zeynep Karakaya, Merve Boyraz, Seyma Koksal Atis, Servet Yuce, Muhterem Duyu
Journal of Pediatric Intensive Care.2023;[Epub] CrossRef

Pulmonary
The role of nafamostat mesilate as a regional anticoagulant during extracorporeal membrane oxygenation: Jae Ha Lee, Jin Han Park, Ji Hoon Jang, Se Hun Kim, Sung Yong Hong, Woon Heo, Dong-Hwan Lee, Hye Sook Choi, Ki Hoon Kim, Hang-Jea Jang; Acute Crit Care. 2022;37(2):177-184. Published online April 20, 2022; DOI: https://doi.org/10.4266/acc.2021.01312

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Abstract PDF: Background
Anticoagulation during extracorporeal membrane oxygenation (ECMO) usually is required to prevent thrombosis. The aim of this study was to investigate the usefulness of nafamostat mesilate (NM) as a regional anticoagulant during veno-arterial ECMO (VA-ECMO) treatment. Methods: We retrospectively reviewed the medical records of 16 patients receiving VA-ECMO and NM from January 2017 to June 2020 at Haeundae Paik Hospital. We compared clinical and laboratory data, including activated partial thromboplastin time (aPTT), which was measured simultaneously in patients and the ECMO site, to estimate the efficacy of regional anticoagulation. Results: The median patient age was 68.5 years, and 56.3% of patients were men. Cardiovascular disease was the most common primary disease (75.0%) requiring ECMO treatment, followed by respiratory disease (12.5%). The median duration of ECMO treatment was 7.5 days. Among 16 patients, seven were switched to NM after first using heparin as an anticoagulation agent, and nine received only NM. When comparing aPTT values in the NM group between patients and the ECMO site, that in patients was significantly lower than that at the ECMO site (73.57 vs. 79.25 seconds; P=0.010); in contrast, no difference was observed in the heparin group. Conclusions: NM showed efficacy as a regional anticoagulation method by sustaining a lower aPTT value compared to that measured at the ECMO site. NM should be considered as a safer regional anticoagulation method in VA-ECMO for patients at high risk of bleeding.

Pulmonary
Association of pulmonary arterial pressure with volume status in patients with acute respiratory distress syndrome receiving extracorporeal membrane oxygenation: Tae Hwa Hong, Hyoung Soo Kim, Sunghoon Park; Acute Crit Care. 2022;37(2):159-167. Published online March 11, 2022; 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.

Review Article

Pulmonary
Awakening in extracorporeal membrane oxygenation as a bridge to lung transplantation: Su Hwan Lee; Acute Crit Care. 2022;37(1):26-34. Published online February 22, 2022; DOI: https://doi.org/10.4266/acc.2022.00031

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Abstract PDF

Although the rate of lung transplantation (LTx), the last treatment option for end-stage lung disease, is increasing, some patients waiting for LTx need a bridging strategy for LTx due to the limited number of available donor lungs. For a long time, mechanical ventilation has been employed as a bridge to LTx because the outcome of using extracorporeal membrane oxygenation (ECMO) as a bridging strategy has been poor. However, the outcome after mechanical ventilation as a bridge to LTx was poor compared with that in patients without bridges. With advances in technology and the accumulation of experience, the outcome of ECMO as a bridge to LTx has improved, and the rate of ECMO use as a bridging strategy has increased over time. However, whether the use of ECMO as a bridge to LTx can achieve survival rates similar to those of non-bridged LTx patients remains controversial. In 2010, one center introduced awake ECMO strategy for LTx bridging, and its use as a bridge to LTx has been showing favorable outcomes to date. Awake ECMO has several advantages, such as maintenance of physical activity, spontaneous breathing, avoidance of endotracheal intubation, and reduced use of sedatives and analgesics, but it may cause serious problems. Nonetheless, several studies have shown that awake ECMO performed by a multidisciplinary team is safe. In cases where ECMO or mechanical ventilation is required due to unavoidable exacerbation in patients awaiting LTx, the application of awake ECMO performed by an appropriately trained ECMO multi-disciplinary team can be useful.

Citations

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Long-Term Follow-Up of Patients Needing Extracorporeal Membrane Oxygenation Following a Critical Course of COVID-19
Samuel Genzor, Pavol Pobeha, Martin Šimek, Petr Jakubec, Jan Mizera, Martin Vykopal, Milan Sova, Jakub Vaněk, Jan Praško
Life.2023; 13(4): 1054. CrossRef
Dangers in using beta-blockers in patients with venovenous extracorporeal membrane oxygenation
Diego Rodríguez Álvarez, Elena Pérez-Costa, Juan José Menéndez Suso
Acute and Critical Care.2022; 37(4): 683. CrossRef

Case Reports

Basic science and research
COVID-19–related acute respiratory distress syndrome treated with veno-venous extracorporeal membrane oxygenation and programmed multi-level ventilation: a case report: Filip Depta, Anton Turčan, Pavol Török, Petra Kapraľová, Michael A. Gentile; Acute Crit Care. 2022;37(3):470-473. Published online January 21, 2022; DOI: https://doi.org/10.4266/acc.2021.01109

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1 Citations

Abstract PDF

We report a patient with severe coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) treated with veno-venous extracorporeal membrane oxygenation (VV ECMO) and programmed multi-level ventilation (PMLV). VV ECMO as a treatment modality for severe ARDS has been described multiple times as a rescue therapy for refractory hypoxemia. It is well known that conventional ventilation can cause ventilator-induced lung injury. Protective ventilation during VV ECMO seems to be beneficial, translating to using low tidal volumes, prone positioning with general concept of open lung approach. However, mechanical ventilation is still required as ECMO per se is usually not sufficient to maintain adequate gas exchange due to hyperdynamic state of the patient and limitation of blood flow via VV ECMO. This report describes ventilation strategy using PMLV during “resting” period of the lung. In short, PMLV is a strategy for ventilating non-homogenous lungs that incorporates expiratory time constants and multiple levels of positive end-expiratory pressure. Using this approach, most affected acute lung injury/ARDS areas can be recruited, while preventing overdistension in healthy areas. To our knowledge, case report using such ventilation strategy for lung resting period has not been previously published.

Citations

Citations to this article as recorded by

Treatment of acute respiratory failure: extracorporeal membrane oxygenation
Jin-Young Kim, Sang-Bum Hong
Journal of the Korean Medical Association.2022; 65(3): 157. CrossRef

Pharmacology
Successful treatment of propofol-related infusion syndrome in critically ill patient receiving low-dose propofol infusion: a case report: Nahyeon Park, Tae Sun Ha; Acute Crit Care. 2023;38(1):144-148. Published online November 26, 2021; DOI: https://doi.org/10.4266/acc.2021.00829

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Abstract PDF: Propofol is widely used to sedate agitated patients in intensive care units. However, it can cause a rare but fatal complication, propofol-related infusion syndrome (PRIS). The pathophysiology of PRIS is not clear, and there is no definitive diagnosis and treatment. We report a successfully treated case of PRIS in a critically ill patient receiving low-dose propofol infusion. A 59-year-old male patient complaining of sudden chest pain repeatedly collapsed in an ambulance and the emergency room, and veno-arterial extracorporeal membrane oxygenation was delivered. He was diagnosed with a total occluded left anterior descending coronary artery in coronary angiography. On day 20, he showed arrhythmia, increased creatinine kinase (CK), and increased CK-MB and troponin I, accompanied by unstable hemodynamic status despite high-dose vasopressors. He was administered propofol for 20 days at an average dose of 1.3 mg/kg/hr owing to issues with agitation and ventilator synchrony. We strongly suspected PRIS and immediately discontinued propofol infusion, and he was successfully treated with aggressive supportive care. PRIS can occur in patients administered propofol for a prolonged period at low doses. Thus, clinicians should use propofol with caution for PRIS and change to alternative sedatives for long-term sedation.

Review Articles

Pulmonary
Critical care management of pulmonary arterial hypertension in pregnancy: the pre-, peri- and post-partum stages: Vorakamol Phoophiboon, Monvasi Pachinburavan, Nicha Ruamsap, Natthawan Sanguanwong, Nattapong Jaimchariyatam; Acute Crit Care. 2021;36(4):286-293. Published online November 26, 2021; DOI: https://doi.org/10.4266/acc.2021.00458

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2 Citations

Abstract PDF

The mortality rate of pulmonary hypertension in pregnancy is 25%–56%. Pulmonary arterial hypertension is the highest incidence among this group, especially in young women. Despite clear recommendation of pregnancy avoidance, certain groups of patients are initially diagnosed during the gestational age step into the third trimester. While the presence of right ventricular failure in early gestation is usually trivial, it can be more severe in the late trimester. Current evidence shows no consensus in the management and serious precautions for each stage of the pre-, peri- and post-partum periods of this specific group. Pulmonary hypertension-targeted drugs, mode of delivery, type of anesthesia, and some avoidances should be planned among a multidisciplinary team to enhance maternal and fetal survival opportunities. Sudden circulatory collapse from cardiac decompensation during the peri- and post-partum phases is detrimental, and mechanical support such as extracorporeal membrane oxygenation should be considered for mitigating hemodynamics and extending cardiac recovery time. Our review aims to explain the pathophysiology of pulmonary arterial hypertension and summarize the current evidence for critical management and precautions in each stage of pregnancy.

Citations

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Maternal Outcomes Among Pregnant Women With Congenital Heart Disease–Associated Pulmonary Hypertension
Qian Zhang, Fang Zhu, Guocheng Shi, Chen Hu, Weituo Zhang, Puzhen Huang, Chunfeng Zhu, Hong Gu, Dong Yang, Qiangqiang Li, Yonghua Niu, Hao Chen, Ruixiang Ma, Ziyi Pan, Huixian Miao, Xin Zhang, Genxia Li, Yabing Tang, Guyuan Qiao, Yichen Yan, Zhongqun Zhu,
Circulation.2023; 147(7): 549. CrossRef
Pregnancy in Patients with Pulmonary Arterial Hypertension in Light of New ESC Guidelines on Pulmonary Hypertension
Karolina Barańska-Pawełczak, Celina Wojciechowska, Wojciech Jacheć
International Journal of Environmental Research and Public Health.2023; 20(5): 4625. CrossRef

CPR/Resuscitation
Role of extracorporeal cardiopulmonary resuscitation in adults: Hongsun Kim, Yang Hyun Cho; Acute Crit Care. 2020;35(1):1-9. Published online February 29, 2020; DOI: https://doi.org/10.4266/acc.2020.00080

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15 Citations

Abstract PDF

Extracorporeal cardiopulmonary resuscitation (ECPR) has been performed with increasing frequency worldwide to improve the low survival rate of conventional cardiopulmonary resuscitation (CCPR). Several studies have shown that among patients who experience in-hospital cardiac arrest, better survival outcomes and neurological outcomes can be expected after ECPR than after CCPR. However, studies have not clearly shown a short-term survival benefit of ECPR for patients who experience out-of-hospital cardiac arrest. Favorable outcomes are associated with a shorter low-flow time, an initial shockable rhythm, lower serum lactate levels, higher blood pH, and a lower Sequential Organ Failure Assessment score. Indications for ECPR include young age, witnessed arrest with bystander cardiopulmonary resuscitation, an initial shockable rhythm, correctable causes such as a cardiac etiology, and no return of spontaneous circulation within 10–20 minutes of CCPR. ECPR is a complex intervention that requires a highly trained team, specialized equipment, and multidisciplinary support within a healthcare system, and it has the risk of several life-threatening complications. Therefore, physicians should carefully select patients for ECPR who can gain the most benefit, instead of applying ECPR indiscriminately.

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Clinician Perspectives on Cannulation for Extracorporeal Cardiopulmonary Resuscitation: A Mixed Methods Analysis
Devindi Wanigasekara, Vincent A. Pellegrino, Aidan JC. Burrell, Nyein Aung, Shaun D. Gregory
ASAIO Journal.2023; 69(3): 332. CrossRef
Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with cardiac arrest: a comparative meta-analysis and trial sequential analysis
Christopher Jer Wei Low, Kollengode Ramanathan, Ryan Ruiyang Ling, Maxz Jian Chen Ho, Ying Chen, Roberto Lorusso, Graeme MacLaren, Kiran Shekar, Daniel Brodie
The Lancet Respiratory Medicine.2023;[Epub] CrossRef
Extended cardiopulmonary resuscitation: from high fidelity simulation scenario to the first clinical applications in Poznan out-of-hospital cardiac arrest program
Maciej Sip, Mateusz Puslecki, Marek Dabrowski, Tomasz Klosiewicz, Radoslaw Zalewski, Marcin Ligowski, Ewa Goszczynska, Christopher Paprocki, Marek Grygier, Maciej Lesiak, Marek Jemielity, Bartłomiej Perek
Perfusion.2022; 37(1): 46. CrossRef
Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: first results and outcomes of a newly established ECPR program in a large population area
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Christopher Gaisendrees, Ilija Djordjevic, Anton Sabashnikov, Christopher Adler, Kaveh Eghbalzadeh, Borko Ivanov, Sebastian Walter, Georg Schlachtenberger, Julia Merkle‐Storms, Stephen Gerfer, Henning Carstens, Antje‐Christin Deppe, Elmar Kuhn, Thorsten W
Artificial Organs.2022; 46(3): 451. CrossRef
Vascular complications based on mode of extracorporeal membrane oxygenation
Juliet Blakeslee-Carter, Connie Shao, Ryan LaGrone, Irina Gonzalez-Sigler, Danielle C. Sutzko, Benjamin Pearce, Kyle Eudailey, Emily Spangler, Adam W. Beck, Graeme E. McFarland
Journal of Vascular Surgery.2022; 75(6): 2037. CrossRef
Efficacy of a temporary CentriMag ventricular assist device in acute fulminant myocarditis patients revived with extracorporeal cardiopulmonary resuscitation
Ying-Hsiang Wang, Chien-Sung Tsai, Jia-Lin Chen, Yi-Ting Tsai, Chih-Yuan Lin, Hsiang-Yu Yang, Po-Shun Hsu
Journal of the Formosan Medical Association.2022; 121(10): 1917. CrossRef
Anticoagulation Strategies during Extracorporeal Membrane Oxygenation: A Narrative Review
Sasa Rajsic, Robert Breitkopf, Dragana Jadzic, Marina Popovic Krneta, Helmuth Tauber, Benedikt Treml
Journal of Clinical Medicine.2022; 11(17): 5147. CrossRef
Outcomes of Pediatric Extracorporeal Cardiopulmonary Resuscitation: A Systematic Review and Meta-Analysis
Abdelaziz Farhat, Ryan Ruiyang Ling, Christopher L. Jenks, Wynne Hsing Poon, Isabelle Xiaorui Yang, Xilong Li, Yulun Liu, Cindy Darnell-Bowens, Kollengode Ramanathan, Ravi R. Thiagarajan, Lakshmi Raman
Critical Care Medicine.2021; 49(4): 682. CrossRef
Prediction of successful weaning off ECMO support after ECPR: Is pulse pressure crucial for success?
Ilija Djordjevic, Thorsten Wahlers
Journal of Cardiac Surgery.2021; 36(8): 2751. CrossRef
Impact of age on the outcomes of extracorporeal cardiopulmonary resuscitation: analysis using inverse probability of treatment weighting
Young Su Kim, Yang Hyun Cho, Jeong Hoon Yang, Ji-Hyuk Yang, Suryeun Chung, Gee Young Suh, Kiick Sung
European Journal of Cardio-Thoracic Surgery.2021; 60(6): 1318. CrossRef
Features of Patients Receiving Extracorporeal Membrane Oxygenation Relative to Cardiogenic Shock Onset: A Single-Centre Experience
Dong-Geum Shin, Sang-Deock Shin, Donghoon Han, Min-Kyung Kang, Seung-Hun Lee, Jihoon Kim, Jung-Rae Cho, Kunil Kim, Seonghoon Choi, Namho Lee
Medicina.2021; 57(9): 886. CrossRef
Critical care management of pulmonary arterial hypertension in pregnancy: the pre-, peri- and post-partum stages
Vorakamol Phoophiboon, Monvasi Pachinburavan, Nicha Ruamsap, Natthawan Sanguanwong, Nattapong Jaimchariyatam
Acute and Critical Care.2021; 36(4): 286. CrossRef
Brain natriuretic peptide levels predict 6-month mortality in patients with cardiogenic shock who were weaned off extracorporeal membrane oxygenation
Hyoung Soo Kim, Kyu Jin Lee, Sang Ook Ha, Sang Jin Han, Kyoung-Ha Park, Sun Hee Lee, Yong Il Hwang, Seung Hun Jang, Sunghoon Park
Medicine.2020; 99(29): e21272. CrossRef
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Seong Soon Kwon, Byoung-Won Park, Min-Ho Lee, Duk Won Bang, Min-Su Hyon, Won-Ho Chang, Hong Chul Oh, Young Woo Park
The Korean Journal of Thoracic and Cardiovascular Surgery.2020; 53(5): 277. CrossRef

Original Article

Thoracic Surgery
How small is enough for the left heart decompression cannula during extracorporeal membrane oxygenation?: Sua Kim, Jin Seok Kim, Jae Seung Shin, Hong Ju Shin; Acute Crit Care. 2019;34(4):263-268. Published online November 29, 2019; DOI: https://doi.org/10.4266/acc.2019.00577

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Abstract PDF

Background
Left ventricular (LV) distension is a recognizable problem accompanied by subsequent complications during venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, no gold standard for LV decompression has been established, and no minimal flow requirement has been designated. Thus, we evaluated the efficacy of the 8-Fr Mullins sheath for left heart decompression during VA-ECMO in adult patients.
Methods
Left heart decompression was performed when severe pulmonary edema was detected on chest radiography or when no generation of pulse pressure followed severe LV dysfunction in patients receiving VA-ECMO. We punctured the interatrial septum and inserted an 8-Fr Mullins sheath into the left atrium via the femoral vein. The sheath was connected to the venous catheter used for ECMO. The catheter was maintained during VA-ECMO.
Results
The left heart decompression procedure was performed in seven of 35 patients who received VA-ECMO between February 2017 and June 2018. Three patients had acute myocardial infarction; three, fulminant myocarditis; and one, dilated cardiomyopathy. Four patients showed noticeable improvement of pulmonary edema within 3 days, and three patients with a pulse pressure of <10 mm Hg showed an increase in pulse pressure of >20 mm Hg within 24 hours from the left heart decompression procedure. All seven patients were successfully weaned from VA-ECMO. No complications related to the left heart decompression procedure occurred.
Conclusions
An 8-Fr sheath may be a possible option for left heart decompression in adult patients with LV distension under VA-ECMO who are expecting recovery of LV function.

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Clinical Research in Cardiology.2023; 112(4): 464. CrossRef
Hemodynamic Management During Veno-Arterial Extracorporeal Membrane Oxygenation in Patients with Cardiogenic Shock: A Review
Chengfen Yin, Lei Xu
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Satisfactory outcome with activated clotting time <160 seconds in extracorporeal cardiopulmonary resuscitation
Beong Ki Kim, Jeong In Hong, Jinwook Hwang, Hong Ju Shin
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Outcomes of left ventricular unloading with a transseptal cannula during extracorporeal membrane oxygenation in adults
Ah‐Ram Kim, Hanbit Park, Sang‐Eun Lee, Jung‐Min Ahn, Duk‐Woo Park, Seung‐Whan Lee, Jae‐Joong Kim, Seung‐Jung Park, Jung Ae Hong, Pil‐Je Kang, Sung‐Ho Jung, Min‐Seok Kim
Artificial Organs.2021; 45(4): 390. CrossRef
Surgical minimal invasive left atrial decompression during venoarterial extracorporeal membrane oxygenation for pediatric acute fulminant myocarditis
Li Fen Ye, Qiang Shu, Chenmei Zhang, Yong Fan, Liyang Ying, Lijun Yang, Ru Lin
World Journal of Pediatric Surgery.2021; 4(4): e000291. CrossRef
Increasing venoarterial extracorporeal membrane oxygenation flow puts higher demands on left ventricular work in a porcine model of chronic heart failure
Pavel Hála, Mikuláš Mlček, Petr Ošťádal, Michaela Popková, David Janák, Tomáš Bouček, Stanislav Lacko, Jaroslav Kudlička, Petr Neužil, Otomar Kittnar
Journal of Translational Medicine.2020;[Epub] CrossRef
Advanced Pulmonary and Cardiac Support of COVID-19 Patients
Keshava Rajagopal, Steven P. Keller, Bindu Akkanti, Christian Bime, Pranav Loyalka, Faisal H. Cheema, Joseph B. Zwischenberger, Aly El Banayosy, Federico Pappalardo, Mark S. Slaughter, Marvin J. Slepian
Circulation: Heart Failure.2020;[Epub] CrossRef
Advanced Pulmonary and Cardiac Support of COVID-19 Patients: Emerging Recommendations From ASAIO—A “Living Working Document”
Keshava Rajagopal, Steven P. Keller, Bindu Akkanti, Christian Bime, Pranav Loyalka, Faisal H. Cheema, Joseph B. Zwischenberger, Aly El Banayosy, Federico Pappalardo, Mark S. Slaughter, Marvin J. Slepian
ASAIO Journal.2020; 66(6): 588. CrossRef

Case Report

Cardiology
Percutaneous bicaval dual lumen cannula for extracorporeal life support: Woojung Kim, Hye Won Kwon, Jooncheol Min, Sungkyu Cho, Jae Gun Kwak, June Dong Park, Woong-Han Kim; Acute Crit Care. 2020;35(3):207-212. Published online September 23, 2019; DOI: https://doi.org/10.4266/acc.2019.00584

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Abstract PDF

Veno-venous extracorporeal membrane oxygenation (ECMO) is a useful mechanical device for pediatric patients with severe respiratory failure. Conventional veno-venous ECMO using double cannulation, however, is not feasible due to size limitations in pediatric patients who have small femoral vessels. Recently, percutaneous bicaval dual-lumen cannula can be inserted using single cannulation via the right internal jugular vein. Herein, we report the case of a pediatric patient with severe respiratory failure who was weaned off the ECMO successfully after treatment with bicaval dual-lumen cannulation for 5 days despite the small body size and immunocompromised condition due to chemotherapy for hemophagocytic lymphohistiocytosis.

Citations

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Lipid Emulsion Treatment for Drug Toxicity Caused by Nonlocal Anesthetic Drugs in Pediatric Patients
Soo Hee Lee, Sunmin Kim, Ju-Tae Sohn
Pediatric Emergency Care.2023; 39(1): 53. CrossRef

Original Article

Pulmonary
Use of extracorporeal membrane oxygenation in patients with acute high-risk pulmonary embolism: a case series with literature review: You Na Oh, Dong Kyu Oh, Younsuck Koh, Chae-Man Lim, Jin-Won Huh, Jae Seung Lee, Sung-Ho Jung, Pil-Je Kang, Sang-Bum Hong; Acute Crit Care. 2019;34(2):148-154. Published online May 31, 2019; DOI: https://doi.org/10.4266/acc.2019.00500

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16 Citations

Abstract PDF

Background
Although extracorporeal membrane oxygenation (ECMO) has been used for the treatment of acute high-risk pulmonary embolism (PE), there are limited reports which focus on this approach. Herein, we described our experience with ECMO in patients with acute high-risk PE.
Methods
We retrospectively reviewed medical records of patients diagnosed with acute highrisk PE and treated with ECMO between January 2014 and December 2018.
Results
Among 16 patients included, median age was 51 years (interquartile range [IQR], 38 to 71 years) and six (37.5%) were male. Cardiac arrest was occurred in 12 (75.0%) including two cases of out-of-hospital arrest. All patients underwent veno-arterial ECMO and median ECMO duration was 1.5 days (IQR, 0.0 to 4.5 days). Systemic thrombolysis and surgical embolectomy were performed in seven (43.8%) and nine (56.3%) patients, respectively including three patients (18.8%) received both treatments. Overall 30-day mortality rate was 43.8% (95% confidence interval, 23.1% to 66.8%) and 30-day mortality rates according to the treatment groups were ECMO alone (33.3%, n=3), ECMO with thrombolysis (50.0%, n=4) and ECMO with embolectomy (44.4%, n=9).
Conclusions
Despite the vigorous treatment efforts, patients with acute high-risk PE were related to substantial morbidity and mortality. We report our experience of ECMO as rescue therapy for refractory shock or cardiac arrest in patients with PE.

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6 Citations

Abstract PDF

Takotsubo cardiomyopathy is a transient systolic and diastolic left ventricular dysfunction that presents several wall-motion abnormalities, while the coronary artery shows normal findings. Because patients with Takotsubo cardiomyopathy present with symptoms similar to acute coronary syndrome, the initial diagnosis and treatment are often difficult. The condition is often precipitated by acute emotional or physical stress and frequently occurs in postmenopausal women. Takotsubo cardiomyopathy may also occur in the perioperative period after cardiac and noncardiac surgery; surgery-associated Takotsubo cardiomyopathy reportedly accounts for 3%–23% of all cases. Of these perioperative cases, cardiothoracic surgery accounted for 16%. However, few cases have been reported in patients undergoing cardiac surgery and managed with extracorporeal membrane oxygenation (ECMO). We report a case of Takotsubo cardiomyopathy managed with ECMO in a patient in the intensive care unit after mitral valve replacement.

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259 Download
14 Citations

Abstract PDF

Right heart decompensation is a fatal complication in patients with respiratory failure, particularly in those transitioned to lung transplantation using veno-venous extracorporeal membrane oxygenation (V-V ECMO). In these patients, veno-arterial (V-A ECMO) or veno-arterialvenous extracorporeal membrane oxygenation (V-AV ECMO) is used to support both cardiac and respiratory function. However, these processes may increase the risk of device-related complications such as bleeding, thromboembolism, and limb ischemia. In the present case, a 64-year-old male patient with idiopathic pulmonary fibrosis developed respiratory failure and commenced treatment with V-V ECMO as a bridge to lung transplantation. Unfortunately, the patient developed right heart decompensation and required both cardiac and respiratory support during treatment with V-V ECMO. Instead of adding arterial cannulation, he was switched to a novel configuration, a right ventricular assist device with an oxygenator (Oxy- RVAD) using ECMO, with drainage cannulation from the femoral vein and return cannulation to the main pulmonary artery. The patient was successfully bridged to lung transplantation without serious complications after 10 days of Oxy-RVAD support. To the best of our knowledge, this is an extreme rare and challenging case of Oxy-RVAD using ECMO in a patient successfully bridged to lung transplantation.

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