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Review Article
Cardiology
Left ventricle unloading during veno-arterial extracorporeal membrane oxygenation: review with updated evidence
Yongwhan Lim, Min Chul Kim, In-Seok Jeong
Acute Crit Care. 2024;39(4):473-487.   Published online November 18, 2024
DOI: https://doi.org/10.4266/acc.2024.00801
  • 11,757 View
  • 497 Download
  • 4 Web of Science
  • 8 Crossref
AbstractAbstract PDF
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is widely used to treat medically refractory cardiogenic shock and cardiac arrest, and its usage has increased exponentially over time. Although VA-ECMO has many advantages over other mechanical circulatory supports, it has the unavoidable disadvantage of increasing retrograde arterial flow in the afterload, which causes left ventricular (LV) overload and can lead to undesirable consequences during VA-ECMO treatment. Weak or no antegrade flow without sufficient opening of the aortic valve increases the LV end-diastolic pressure, and that can cause refractory pulmonary edema, blood stagnation, thrombosis, and refractory ventricular arrhythmia. This hemodynamic change is also related to an increase in myocardial energy consumption and poor recovery, making LV unloading an essential management issue during VA-ECMO treatment. The principal factors in effective LV unloading are its timing, indications, and modalities. In this article, we review why LV unloading is required, when it is indicated, and how it can be achieved.

Citations

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  • Routine Left Ventricular Unloading During Venoarterial Extracorporeal Membrane Oxygenation—A Therapeutic Conundrum
    Alice Bottussi, Jacopo D'Andria Ursoleo, Enrica Piazza, Edoardo Mongardini, Fabrizio Monaco
    Journal of Cardiothoracic and Vascular Anesthesia.2025; 39(3): 860.     CrossRef
  • Transaortic Catheter Venting for Left Ventricular Unloading in Veno-Arterial Extracorporeal Life Support: A Porcine Cardiogenic Shock Model
    Sang Yoon Kim, Hyoung Woo Chang, Jae Hang Lee, Jae Hyun Jeon, Yoohwa Hwang, Hwan Hee Park, Dong Jung Kim
    Medicina.2025; 61(4): 552.     CrossRef
  • Left Heart Venting or Unloading Strategies for VA-ECMO Patients: Indications, Timing, and Techniques: A Narrative Review
    YeongEun Jo, Jiae Seong, Hwa Jin Cho, Do Wan Kim, Yongwhan Lim, Yang Hyun Cho, Seunghwan Song, Min Chul Kim, Inseok Jeong
    Journal of Cardiovascular Intervention.2025; 4(3): 184.     CrossRef
  • Strategies of Revascularization and Mechanical Circulatory Support for Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Systematic Review With Updated Evidence
    Yongwhan Lim, Min Chul Kim, Seok Oh, Joon Ho Ahn, Seung Hun Lee, Dae Young Hyun, Kyung Hoon Cho, Doo Sun Sim, Young Joon Hong, Juhan Kim, Youngkeun Ahn
    Journal of Cardiovascular Intervention.2025; 4(3): 212.     CrossRef
  • Left ventricular unloading strategies in venoarterial extracorporeal membrane oxygenation patients: how much do we truly understand?
    Jihyuk Chung, Su Yong Kim, Juhyun Lee, Yang Hyun Cho
    Acute and Critical Care.2025; 40(2): 357.     CrossRef
  • Combined mechanical circulatory support: when and why?
    Hrvoje Topalović, Romana Ivelić, Ana Marinić
    Cardiologia Croatica.2025; 20(11-12): 286.     CrossRef
  • Beyond Standard Parameters: Precision Hemodynamic Monitoring in Patients on Veno-Arterial ECMO
    Debora Emanuela Torre, Carmelo Pirri
    Journal of Personalized Medicine.2025; 15(11): 541.     CrossRef
  • Year 2025 in review - Cardiovascular issues in intensive care and perioperative medicine
    M Pořízka, J Šoltéš, J Pudil, J Horejsek
    Anesteziologie a intenzivní medicína.2025; 36(5): 328.     CrossRef
Original Article
Epidemiology
Outcomes of extracorporeal membrane oxygenation support in pediatric hemato-oncology patients
Hong Yul An, Hyoung Jin Kang, June Dong Park
Acute Crit Care. 2024;39(1):108-116.   Published online January 24, 2024
DOI: https://doi.org/10.4266/acc.2023.01088
  • 5,823 View
  • 193 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDFSupplementary Material
Background
In this study, we reviewed the outcomes of pediatric patients with malignancies who underwent hematopoietic stem cell transplantation (HSCT) and extracorporeal membrane oxygenation (ECMO).
Methods
We retrospectively analyzed the records of pediatric hemato-oncology patients treated with chemotherapy or HSCT and who received ECMO in the pediatric intensive care unit (PICU) at Seoul National University Children’s Hospital from January 2012 to December 2020.
Results
Over a 9-year period, 21 patients (14 males and 7 females) received ECMO at a single pediatric institute; 10 patients (48%) received veno-arterial (VA) ECMO for septic shock (n=5), acute respiratory distress syndrome (ARDS) (n=3), stress-induced myopathy (n=1), or hepatopulmonary syndrome (n=1); and 11 patients (52%) received veno-venous (VV) ECMO for ARDS due to pneumocystis pneumonia (n=1), air leak (n=3), influenza (n=1), pulmonary hemorrhage (n=1), or unknown etiology (n=5). All patients received chemotherapy; 9 received anthracycline drugs and 14 (67%) underwent HSCT. Thirteen patients (62%) were diagnosed with malignancies and 8 (38%) were diagnosed with non-malignant disease. Among the 21 patients, 6 (29%) survived ECMO in the PICU and 5 (24%) survived to hospital discharge. Among patients treated for septic shock, 3 of 5 patients (60%) who underwent ECMO and 5 of 10 patients (50%) who underwent VA ECMO survived. However, all the patients who underwent VA ECMO or VV ECMO for ARDS died.
Conclusions
ECMO is a feasible treatment option for respiratory or heart failure in pediatric patients receiving chemotherapy or undergoing HSCT.

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  • Extracorporeal Membrane Oxygenation in the Management of Tumor Lysis Syndrome in Children: A Review of Cases
    Zere Aidynbek, Erken Kakenov, Olga Mironova, Karlygash Ydyrysheva, Tatyana Li, Vitaliy Sazonov
    Journal of Clinical Medicine.2025; 14(8): 2771.     CrossRef
Review Article
CPR/Resuscitation
Plasma biomarkers for brain injury in extracorporeal membrane oxygenation
Shrey Kapoor, Anna Kolchinski, Aaron M. Gusdon, Lavienraj Premraj, Sung-Min Cho
Acute Crit Care. 2023;38(4):389-398.   Published online November 29, 2023
DOI: https://doi.org/10.4266/acc.2023.01368
  • 5,644 View
  • 142 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDF
Extracorporeal membrane oxygenation (ECMO) is a life-saving intervention for patients with refractory cardiorespiratory failure. Despite its benefits, ECMO carries a significant risk of neurological complications, including acute brain injury (ABI). Although standardized neuromonitoring and neurological care have been shown to improve early detection of ABI, the inability to perform neuroimaging in a timely manner is a major limitation in the accurate diagnosis of neurological complications. Therefore, blood-based biomarkers capable of detecting ongoing brain injury at the bedside are of great clinical significance. This review aims to provide a concise review of the current literature on plasma biomarkers for ABI in patients on ECMO support.

Citations

Citations to this article as recorded by  
  • Predictive Markers of Neurological Complications in Patients Treated With Extracorporeal Membrane Oxygenation
    Adeel Abbasi, Linn Ayers, Ron Balczon, Amy R. Nelson, Allison J. Bauman, Maya Cohen, Neelia Abadi, John R. Priest, Saraschandra Vallabhajosyula, Grayson L. Baird, Troy Stevens, Corey E. Ventetuolo
    CHEST Critical Care.2025; 3(3): 100170.     CrossRef
Original Articles
Pulmonary
Outcomes of patients with COVID-19 requiring extracorporeal membrane oxygenation and continuous renal replacement therapy in the United States
Carlos R Franco Palacios, Rudiona Hoxhaj, Catlyn Thigpen, Jeffrey Jacob, Atul Bhatnagar, Asif Saberi
Acute Crit Care. 2023;38(3):308-314.   Published online August 30, 2023
DOI: https://doi.org/10.4266/acc.2023.00115
  • 5,592 View
  • 82 Download
  • 2 Web of Science
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AbstractAbstract PDF
Background
Coronavirus disease 2019 (COVID-19) infection is associated with significant morbidity and mortality. Some patients develop severe acute respiratory distress syndrome and kidney failure requiring the combination of extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT).
Methods
Retrospective cohort study of 127 consecutive patients requiring combined ECMO and CRRT support in intensive care units at an ECMO center in Marietta, GA, United States.
Results
Sixty and 67 patients with and without COVID-19, respectively, required ECMO-CRRT support. After adjusting for confounding variables, patients with COVID-19 had increased mortality at 30 days (hazard ratio [HR], 5.19; 95% confidence interval [CI], 2.51–10.7; P<0.001) and 90 days (HR, 6.23; 95% CI, 2.60–14.9; P<0.001).
Conclusions
In this retrospective study, patients with COVID-19 who required ECMO-CRRT had increased mortality when compared to patients without COVID-19.

Citations

Citations to this article as recorded by  
  • Higher mortality in Extracorporeal Membrane Oxygenation patients during the COVID-19 pandemic compared with H1N1 influenza: implications for future pandemics
    Harriet J. Caterson, Lauren Troy, Moin Ahmed, Paul Torzillo, Rebecca Davis, Stuart Duffin, Paul Forrest, Timothy Southwood, Richard Totaro, Helen Jo, Edmund Lau, Emma Gray
    Respiratory Medicine.2025; 248: 108311.     CrossRef
  • Factors associated with post-hospitalization dialysis dependence in ECMO patients who required continuous renal replacement therapy
    Carlos Rodrigo Franco Palacios, Rudiona Hoxhaj, Catlyn Thigpen, Jeffrey Jacob
    Renal Failure.2024;[Epub]     CrossRef
Cardiology
Risk factors for cannula-associated arterial thrombosis following extracorporeal membrane oxygenation support: a retrospective study
Ngan Hoang Kim Trieu, Xuan Thi Phan, Linh Thanh Tran, Huy Minh Pham, Dai Quang Huynh, Tuan Manh Nguyen, Anh Tuan Mai, Quan Quoc Minh Du, Bach Xuan Nguyen, Thao Thi Ngoc Pham
Acute Crit Care. 2023;38(3):315-324.   Published online August 23, 2023
DOI: https://doi.org/10.4266/acc.2023.00500
  • 8,735 View
  • 194 Download
  • 7 Web of Science
  • 6 Crossref
AbstractAbstract PDF
Background
Hemostatic dysfunction during extracorporeal membrane oxygenation (ECMO) due to blood-circuit interaction and the consequences of shear stress imposed by flow rates lead to rapid coagulation cascade and thrombus formation in the ECMO system and blood vessels. We aimed to identify the incidence and risk factors for cannula-associated arterial thrombosis (CaAT) post-decannulation.
Methods
A retrospective study of patients undergoing arterial cannula removal following ECMO was performed. We evaluated the incidence of CaAT and compared the characteristics, ECMO machine parameters, cannula sizes, number of blood products transfused during ECMO, and daily hemostasis parameters in patients with and without CaAT. Multivariate analysis identified the risk factors for CaAT.
Results
Forty-seven patients requiring venoarterial ECMO (VA-ECMO) or hybrid methods were recruited for thrombosis screening. The median Sequential Organ Failure Assessment score was 11 (interquartile range, 8–13). CaAT occurred in 29 patients (61.7%), with thrombosis in the superficial femoral artery accounting for 51.7% of cases. The rate of limb ischemia complications in the CaAT group was 17.2%. Multivariate analysis determined that the ECMO flow rate–body surface area (BSA) ratio (100 ml/min/m2) was an independent factor for CaAT, with an odds ratio of 0.79 (95% confidence interval, 0.66–0.95; P=0.014).
Conclusions
We found that the incidence of CaAT was 61.7% following successful decannulation from VA-ECMO or hybrid modes, and the ECMO flow rate–BSA ratio was an independent risk factor for CaAT. We suggest screening for arterial thrombosis following VA-ECMO, and further research is needed to determine the risks and benefits of such screening.

Citations

Citations to this article as recorded by  
  • Assessment of percutaneous closure for decannulation of veno-arterial extracorporeal membrane oxygenation: A retrospective study
    Diana Martins-Fernandes, João Rocha-Neves, Ana Rita Ferreira, Hélio Martins, Sérgio Gaião, José Artur Paiva
    The Journal of Vascular Access.2025; 26(5): 1651.     CrossRef
  • Machine learning‐based prediction of bleeding risk in extracorporeal membrane oxygenation patients using transfusion as a surrogate marker
    Tadashi Kamio, Masaru Ikegami, Megumi Mizuno, Seiichiro Ishii, Hayato Tajima, Yoshihito Machida, Kiyomitsu Fukaguchi
    Transfusion.2025; 65(6): 1051.     CrossRef
  • Peripheral VA-ECMO: from Evolving Indications to Perioperative Implications
    Ngan Hoang Kim Trieu, Huy Minh Pham, Dai Quang Huynh, Linh Thanh Tran, Ngoc Tu Nguyen, Anh Tuan Mai, Thao Thi Ngoc Pham
    Anesthesiology and Perioperative Science.2025;[Epub]     CrossRef
  • Factors related to mortality in patients with acute respiratory distress syndrome (ARDS) in a lower middle-income country: A retrospective observational study
    Co Xuan Dao, Chinh Quoc Luong, Toshie Manabe, My Ha Nguyen, Dung Thi Pham, Quynh Thi Pham, Tai Thien Vu, Hau Thi Truong, Dai Quoc Khuong, Hien Duy Dang, Tuan Anh Nguyen, Thach The Pham, Giang Thi Huong Bui, Cuong Van Bui, Quan Huu Nguyen, Thong Huu Tran,
    PLOS One.2025; 20(11): e0337071.     CrossRef
  • Has the role of veno-arterial extracorporeal membrane oxygenation in patients with cardiogenic shock following acute myocardial infarction been fully determined? A case report
    Kha Minh Nguyen, Hai Phuong Nguyen Tran, Vi Tuong Dang, Sy Van Hoang, Josip Andelo Borovac, Dmitry Duplyakov, Chiara De Biase, Pok-Tin Tang
    European Heart Journal - Case Reports.2024;[Epub]     CrossRef
  • Vaskuläre Komplikationen unter venoarterieller extrakorporaler Membranoxygenierung
    J. Ajouri, N. Abdal-Daem, V. Scriba, A. A. Peivandi, R. M. Muellenbach, Y. D. Sagban, T. A. Sagban
    Gefässchirurgie.2024; 29(7): 410.     CrossRef
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
  • 5,422 View
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  • 4 Web of Science
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AbstractAbstract 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.

Citations

Citations to this article as recorded by  
  • Post-resuscitation care after adult extracorporeal cardiopulmonary resuscitation: A scoping review
    Tommaso Scquizzato, Gioia Moscoloni, Alexander Supady, Darryl Abrams, Fabio Silvio Taccone, Claudio Sandroni, Jason Bartos, Natalie Kruit, Arianna Gazzato, Alex Rosenberg, Jae-Seung Jung, Steven Ling, Aidan Burrell, Mark Dennis, Anna Mara Scandroglio
    Resuscitation.2025; 217: 110880.     CrossRef
  • Risk factors for neurological disability outcomes in patients under extracorporeal membrane oxygenation following cardiac arrest: An observational study
    Amir Vahedian-Azimi, Ibrahim Fawzy Hassan, Farshid Rahimi-Bashar, Hussam Elmelliti, Anzila Akbar, Ahmed Labib Shehata, Abdulsalam Saif Ibrahim, Ali Ait Hssain
    Intensive and Critical Care Nursing.2024; 83: 103674.     CrossRef
  • What factors are effective on the CPR duration of patients under extracorporeal cardiopulmonary resuscitation: a single-center retrospective study
    Amir Vahedian-Azimi, Ibrahim Fawzy Hassan, Farshid Rahimi-Bashar, Hussam Elmelliti, Anzila Akbar, Ahmed Labib Shehata, Abdulsalam Saif Ibrahim, Ali Ait Hssain
    International Journal of Emergency Medicine.2024;[Epub]     CrossRef
  • Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest and in-hospital cardiac arrest with return of spontaneous circulation: be careful when comparing apples to oranges
    Hwa Jin Cho, In Seok Jeong, Jan Bělohlávek
    Acute and Critical Care.2023; 38(2): 242.     CrossRef
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
  • 7,410 View
  • 289 Download
  • 6 Web of Science
  • 7 Crossref
AbstractAbstract 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.

Citations

Citations to this article as recorded by  
  • Reversal of ACLF and ALF using whole blood extracorporeal system combining HLA-depleted liver organoids with granulocyte-monocyte apheresis
    Hitomi Yamaguchi, Yosuke Yoneyama, Kentaro Ichimura, Kanae Ohtsu, Mika Soen, Chiharu Moriya, Maki Kumagai, Robert P. Myers, G. Mani Subramanian, Takanori Takebe
    Journal of Hepatology.2026; 84(2): 293.     CrossRef
  • A systematic review of adult animal models investigating ECMO use for ARDS: where to from here
    Muhtadi Alnababteh, Xizhong Cui, Mark Jeakle, Yan Li, Nancy Terry, Tom Gamble, Junfeng Sun, Shreya Kanth, Peter Q. Eichacker, Parizad Torabi-Parizi
    Intensive Care Medicine Experimental.2025;[Epub]     CrossRef
  • A Miniaturized Centrifugal Pump ECMO System Enhances Hemocompatibility in Small Animal Models
    Zhen Yang, Yiai Li, Jingyi Peng, Danhe Jia, Youpeng Zhang, Wenxing Huo, Zhigang Liu, Xian Huang
    Biotechnology Journal.2025;[Epub]     CrossRef
  • Silk-based multilayer coatings for anticoagulation and durability improvement in ECMO hollow fiber membranes
    Wenbo Zhang, Yilin Zhang, Chenlu Wang, Xingji Fu, Yuan Li, Hongyu Wang, Xiuyuan Luo, Linhao Li, Yubo Fan, Zengsheng Chen
    Acta Biomaterialia.2025; 207: 205.     CrossRef
  • Venoarterial Extracorporeal Membrane Oxygenation Implementation in Septic Shock Rat Model
    Tianlong Wang, Mingru Zhang, Wenhao Dong, Jing Wang, Han Zhang, Yuefu Wang, Bingyang Ji
    ASAIO Journal.2024; 70(8): 653.     CrossRef
  • Multiorgan recovery in a cadaver body using mild hypothermic ECMO treatment in a murine model
    Nodir Madrahimov, Vitalii Mutsenko, Ruslan Natanov, Dejan Radaković, André Klapproth, Mohamed Hassan, Mathias Rosenfeldt, Florian Kleefeldt, Ivan Aleksic, Süleyman Ergün, Christoph Otto, Rainer G. Leyh, Constanze Bening
    Intensive Care Medicine Experimental.2023;[Epub]     CrossRef
  • Post-Mortem Extracorporeal Membrane Oxygenation Perfusion Rat Model: A Feasibility Study
    Matthias Manfred Deininger, Carl-Friedrich Benner, Lasse Johannes Strudthoff, Steffen Leonhardt, Christian Simon Bruells, Gernot Marx, Christian Bleilevens, Thomas Breuer
    Animals.2023; 13(22): 3532.     CrossRef
Original Articles
Epidemiology
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
  • 8,087 View
  • 162 Download
  • 7 Web of Science
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AbstractAbstract 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

Citations to this article as recorded by  
  • Being broken: A qualitative study exploring unexpected death in the Paediatric Intensive Care Unit and the family experience of care
    Arielle Jolly, Ashleigh E. Butler, Simon Erickson, Kristen Gibbons, Kylie Davies, Nick Williams, Yetunde Odutolu, Jacqueline Reid, Kelly Higgins, Linda Thomas, Fenella J. Gill
    Australian Critical Care.2026; 39(1): 101515.     CrossRef
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    Tinnapat Buranapattama, Suwannee Phumeetham, Nuntawan Piyaphanee, Maynart Sukharomana, Sirirat Charuvanij
    Pediatric Rheumatology.2025;[Epub]     CrossRef
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    Haifa Ali BinDahman
    Journal of Epidemiology and Global Health.2025;[Epub]     CrossRef
  • Parents’ and nurses’ experiences of end-of-life care in intensive care for children: A systematic review
    Melissa J. Bloomer, Ashleigh E. Butler, Laura A. Brooks, Alysia Coventry, Stephen McKeever, Kristen Ranse, Jessie Rowe, Shontelle Thomas, Rebecca Thornton
    Australian Critical Care.2025; 38(6): 101455.     CrossRef
  • Characteristics and Outcomes of Patients Admitted to a Tertiary Pediatric Intensive Care Unit in Western Black Sea Region of Turkey
    Hamdi Metin, Akın Seçkin, Eylem Sevinç
    Experimental and Applied Medical Science.2024; 5(4): 193.     CrossRef
  • Association between phosphate and 30-day in-hospital mortality in paediatric ICU: a retrospective cohort study
    Yiyi Ding, Yaqin Lei, Yufang Zhu, Hongwei Zhang, Yunbin Xiao
    BMJ Paediatrics Open.2024; 8(1): e003171.     CrossRef
  • 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
  • Association between mortality and critical events within 48 hours of transfer to the pediatric intensive care unit
    Huan Liang, Kyle A. Carey, Priti Jani, Emily R. Gilbert, Majid Afshar, L. Nelson Sanchez-Pinto, Matthew M. Churpek, Anoop Mayampurath
    Frontiers in Pediatrics.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
  • 9,215 View
  • 296 Download
  • 18 Web of Science
  • 15 Crossref
AbstractAbstract 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.

Citations

Citations to this article as recorded by  
  • Catheter diameter and infection control are important in neonatal continuous kidney replacement therapy: a single-center retrospective study
    Hiroki Otsuka, Masaya Kibe, Chie Ishihara, Takuya Tokuhisa
    Renal Replacement Therapy.2025;[Epub]     CrossRef
  • Anticoagulation with Nafamostat Mesilate During Impella Support: A Case Report
    Makiko Nakamura, Teruhiko Imamura, Yuki Hida, Toshihide Izumida, Masaki Nakagaito, Saori Nagura, Toshio Doi, Koichiro Kinugawa
    Medicina.2025; 61(2): 309.     CrossRef
  • Comparison of regional citrate anticoagulation and nafamostat mesylate anticoagulation during plasma exchange for children at high bleeding risk: a retrospective study
    Dan Peng, Zili Cai, Jie He, Wei Duan, Xinping Zhang
    Italian Journal of Pediatrics.2025;[Epub]     CrossRef
  • Pharmacokinetic and pharmacodynamic analyses of nafamostat in ECMO patients: comparing central vein and ECMO machine samples
    Dong Hwan Lee, Jae Ha Lee, Ji Hoon Jang, Yong Kyun Kim, Gaeun Kang, So Young Jung, Minyoung Her, Hang Jea Jang
    Frontiers in Pharmacology.2025;[Epub]     CrossRef
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    Jan-Sören Padberg, Jannik Feld, Leonie Padberg, Jeanette Köppe, Lena Makowski, Joachim Gerß, Patrik Dröge, Thomas Ruhnke, Christian Günster, Stefan Andreas Lange, Holger Reinecke
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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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AbstractAbstract PDFSupplementary 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.

Citations

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  • Storage duration of packed red blood cells transfused during veno-venous extracorporeal membrane oxygenation is associated with elevated pulmonary artery pressure and lung injury in a sheep model
    Fergal T. Temple, Gabriela Simonova, Margaret R. Passmore, Samuel R. Foley, Sara D. Diab, Kimble R. Dunster, Charles I. McDonald, Kiran Shekar, Yoke-Lin Fung, John-Paul Tung, John F. Fraser
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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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  • 13 Web of Science
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AbstractAbstract 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.

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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
  • 6,481 View
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AbstractAbstract 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

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  • 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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AbstractAbstract 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.

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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
  • 15,762 View
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  • 6 Web of Science
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AbstractAbstract 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.

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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
  • 14,736 View
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AbstractAbstract 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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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
  • 11,659 View
  • 156 Download
  • 8 Web of Science
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AbstractAbstract 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.

Citations

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    Enzo Lüsebrink, Leonhard Binzenhöfer, Antonia Kellnar, Christoph Müller, Clemens Scherer, Benedikt Schrage, Dominik Joskowiak, Tobias Petzold, Daniel Braun, Stefan Brunner, Sven Peterss, Jörg Hausleiter, Sebastian Zimmer, Frank Born, Dirk Westermann, Holg
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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
  • 10,629 View
  • 179 Download
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AbstractAbstract 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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    Soo Hee Lee, Sunmin Kim, Ju-Tae Sohn
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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
  • 11,452 View
  • 237 Download
  • 26 Web of Science
  • 29 Crossref
AbstractAbstract 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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Case Reports
Cardiology
Extracorporeal membrane oxygenation for takotsubo cardiomyopathy that developed after mitral valve replacement
Jeong-Hyun Choi, In Duk Oh, Eunsil Shin, Sangho Lee, Jong-Mi Jeon, Hyung-Tak Kim, Hyo-Chul Youn
Acute Crit Care. 2020;35(1):51-55.   Published online April 12, 2019
DOI: https://doi.org/10.4266/acc.2018.00304
  • 11,746 View
  • 136 Download
  • 6 Web of Science
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AbstractAbstract 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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Pulmonary
Right ventricular assist device with an oxygenator using extracorporeal membrane oxygenation as a bridge to lung transplantation in a patient with severe respiratory failure and right heart decompensation
Dong Kyu Oh, Tae Sun Shim, Kyung-Wook Jo, Seung-Il Park, Dong Kwan Kim, Sehoon Choi, Geun Dong Lee, Sung-Ho Jung, Pil-Je Kang, Sang-Bum Hong
Acute Crit Care. 2020;35(2):117-121.   Published online April 8, 2019
DOI: https://doi.org/10.4266/acc.2018.00416
  • 13,483 View
  • 304 Download
  • 24 Web of Science
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AbstractAbstract 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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  • Intraoperative Management of Adult Patients on Extracorporeal Membrane Oxygenation: an Expert Consensus Statement From the Society of Cardiovascular Anesthesiologists—Part I, Technical Aspects of Extracorporeal Membrane Oxygenation
    Michael A. Mazzeffi, Vidya K. Rao, Jeffrey Dodd-o, Jose Mauricio Del Rio, Antonio Hernandez, Mabel Chung, Amit Bardia, Rebecca M. Bauer, Joseph S. Meltzer, Sree Satyapriya, Raymond Rector, James G. Ramsay, Jacob Gutsche
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  • Intraoperative Management of Adult Patients on Extracorporeal Membrane Oxygenation: An Expert Consensus Statement From the Society of Cardiovascular Anesthesiologists—Part I, Technical Aspects of Extracorporeal Membrane Oxygenation
    Michael A. Mazzeffi, Vidya K. Rao, Jeffrey Dodd-o, Jose Mauricio Del Rio, Antonio Hernandez, Mabel Chung, Amit Bardia, Rebecca M. Bauer, Joseph S. Meltzer, Sree Satyapriya, Raymond Rector, James G. Ramsay, Jacob Gutsche
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Cardiology
Acute fulminant myocarditis following influenza vaccination requiring extracorporeal membrane oxygenation
Youn-Jung Kim, Jun-Il Bae, Seung Mok Ryoo, Won Young Kim
Acute Crit Care. 2019;34(2):165-169.   Published online November 7, 2018
DOI: https://doi.org/10.4266/acc.2017.00045
  • 14,665 View
  • 212 Download
  • 27 Web of Science
  • 29 Crossref
AbstractAbstract PDF
The inactivated influenza vaccination is generally safe with mostly mild side effects. We report a rare but fatal adverse event following influenza vaccination. A previously healthy 27-yearold woman who received the influenza vaccination 3 days before presenting to the emergency department had rapidly aggravating dyspnea and mental deterioration. She was diagnosed as having acute fulminant myocarditis with refractory cardiogenic shock, which was successfully managed with veno-arterial extracorporeal membrane oxygenation. The cardiac function of the patient recovered in 3 weeks.

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Pulmonary
Central extracorporeal membrane oxygenation and early rehabilitation for persistent severe pulmonary hypertension following pulmonary endarterectomy
Gil Myeong Seong, Sang-Bum Hong, Jin Won Huh, Chae-Man Lim, Younsuck Koh, Jae Won Lee, Sung-Ho Jung, Duck-Woo Park, Jae Seung Lee
Acute Crit Care. 2019;34(2):158-164.   Published online November 7, 2018
DOI: https://doi.org/10.4266/acc.2016.01032
  • 8,484 View
  • 128 Download
  • 2 Web of Science
  • 3 Crossref
AbstractAbstract PDF
Chronic thromboembolic pulmonary hypertension is potentially curable with a pulmonary endarterectomy. However, approximately 20% of patients have persistent pulmonary hypertension after pulmonary endarterectomy, which is a major risk factor for postoperative death. Here, we report a 34-year-old woman who suffered persistent severe pulmonary hypertension following a successful pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. Extracorporeal membrane oxygenation (ECMO) and atrial septostomy were successfully performed as rescue treatments, and active rehabilitation during ECMO was prescribed to facilitate recovery.

Citations

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  • Effects of postoperative rehabilitation on functional exercise capacity, dyspnea, and quality of life after pulmonary endarterectomy: a systematic review
    Massimiliano Polastri
    Journal of Yeungnam Medical Science.2025; 42: 32.     CrossRef
  • Transatrial balloon atrial septostomy to facilitate weaning off venoarterial ECMO after pulmonary endarterectomy
    Koray Ak, Gökhan Arslanhan, Yakup Tire, Sinan Tosun, Alper Kararmaz, İsmail Hanta, Bedrettin Yıldızeli
    The International Journal of Artificial Organs.2022; 45(10): 883.     CrossRef
  • Cardiac Rehabilitation in Heart Failure
    Kyeong-hyeon Chun, Seok-Min Kang
    International Journal of Heart Failure.2021; 3(1): 1.     CrossRef
Infection
A successful application of adult polymyxin B-immobilized fiber column hemoperfusion to a neonate with septic shock
Young A Kim, Hyungtae Kim, Yu-Mi Kim, Su Eun Park
Acute Crit Care. 2019;34(4):284-288.   Published online November 6, 2018
DOI: https://doi.org/10.4266/acc.2017.00528
Correction in: Acute Crit Care 2023;38(4):515
  • 32,121 View
  • 195 Download
  • 7 Web of Science
  • 7 Crossref
AbstractAbstract PDF
Direct hemoperfusion therapy with a polymyxin B-immobilized fiber column (PMX-HP) has been introduced as a therapeutic option for gram negative bacterial septic shock in adults. However, its use in neonates and children has not yet been established. We successfully performed hemoperfusion therapy using an adult polymyxin B-immobilized fiber column in a neonate with carbapenem resistant Acinetobacter baumannii septic shock. The application was technically feasible because the neonate was on extracorporeal membrane oxygenation (ECMO). Although it did not rescue the patient, there was significant short-lasting improvement in pulmonary oxygenation and hemodynamics, leading to wean the patient from ECMO. PMX-HP could be used as an adjunctive treatment for selected neonatal and pediatric patients with gram negative bacterial septic shock.

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  • A review of gut failure as a cause and consequence of critical illness
    Danielle E. Soranno, Craig M. Coopersmith, Jessica F. Brinkworth, Faith N. F. Factora, Julia H. Muntean, Monty G. Mythen, Jacob Raphael, Andrew D. Shaw, Vidula Vachharajani, Jeannette S. Messer
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    Hansol Song, Seong Jong Park
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    Patcharin Saetang, Rujipat Samransamruajkit, Kanokwan Singjam, Tawatchai Deekajorndech
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    Joung-Hee Byun, Su Eun Park, Minhae Seo, Jeungmi Jang, Mi Sun Hwang, Ju Yeoun Song, Chulhun L. Chang, Young A Kim
    Journal of Korean Medical Science.2021;[Epub]     CrossRef
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    Naoto Nishizaki, Riko Ueno, Yuki Nagayama, Hanako Abe, Akina Matsuda, Akira Mizutani, Kaoru Obinata, Tadaharu Okazaki, Toshiaki Shimizu
    Renal Replacement Therapy.2020;[Epub]     CrossRef
  • Suggestions and tips regarding polymyxin B-immobilized fiber column direct hemoperfusion of neonates with sepsis
    Naoto Nishizaki
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  • Case Report: Successful Use of Extracorporeal Therapies After ECMO Resuscitation in a Pediatric Kidney Transplant Recipient
    Andrey Rybalko, Anna Pytal, Mikhail Kaabak, Nadejda Rappoport, Anuar Bidzhiev, Vasilii Lastovka
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Rapid response system
Successful percutaneous coronary intervention with extracorporeal membrane oxygenation support after right coronary artery dissection in an eisenmenger syndrome patient
Byung Gyu Kim, Sung Woo Cho, Jong Chun Nah
Acute Crit Care. 2020;35(1):46-50.   Published online November 6, 2018
DOI: https://doi.org/10.4266/acc.2017.00024
  • 12,573 View
  • 117 Download
  • 4 Web of Science
  • 4 Crossref
AbstractAbstract PDF
The presentation of coronary artery disease in a patient with Eisenmenger syndrome (ES) is relatively rare. Cardiogenic shock due to coronary artery dissection during percutaneous coronary intervention (PCI) can be more critical in these patients. Here, we report a case of successful PCI under mechanical circulation support in a patient with ES who experienced potentially fatal right coronary artery dissection. This case emphasizes that use of extracorporeal membrane oxygenation (ECMO) can lead to successful management of critical complication during PCI, and that the immediate decision to apply of ECMO is important in ES patients who face impending cardiogenic shock with acute heart failure.

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  • Bridge to recovery: A case of V-V ECMO following V-A ECMO in Eisenmenger syndrome
    Alessandra M. Riccio, Nathnael Feleke, Nicole Palmer, Linjia Jia, Natalia I. Girardi, Charles A. Mack, Ningxin Wan, Iosif M. Gulkarov, Berhane M. Worku, Ankur Srivastava
    Perfusion.2025;[Epub]     CrossRef
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    Vivek Gupta, K. R. Ramanathan
    Indian Journal of Cardiovascular Disease in Women.2024; 9: 176.     CrossRef
  • Blunt traumatic right coronary artery dissection presenting with second-degree atrioventricular block and late-onset severe cardiogenic shock
    Maria Paparoupa, Lenard Conradi, Malte Lennart Warncke, Lennart Well, Christoph Burdelski, Christopher Cramer, Hanno Grahn, Mathias Kubik, Stefan Kluge
    BMC Cardiovascular Disorders.2022;[Epub]     CrossRef
  • Successful Implementation of Extracorporeal Membrane Oxygenation Support as a Bridge to Heart-Lung Transplantation in an Eisenmenger’s Syndrome Patient With Paradoxical Coronary Embolism
    James Zhang, Sumit Patel, Leonardo Clavijo, David Laughrun
    Journal of Investigative Medicine High Impact Case Reports.2019;[Epub]     CrossRef
Basic science and research
Spinal Cord Infarction in a Patient Undergoing Veno-arterial Extracorporeal Membrane Oxygenation
Beomsu Shin, Yang Hyun Cho, Jin-Ho Choi, Jeong Hoon Yang
Acute Crit Care. 2018;33(3):187-190.   Published online August 31, 2018
DOI: https://doi.org/10.4266/acc.2016.00556
  • 9,523 View
  • 131 Download
  • 11 Web of Science
  • 11 Crossref
AbstractAbstract PDF
Spinal cord infarction is an uncommon, but serious disorder characterized by severe motor impairment and bladder and bowel dysfunction. Spinal cord infarction is likely caused by hypoperfusion at the thoraco-lumbar spinal cord due to diverse reasons. An 81-year-old woman without motor or neurologic dysfunction presented with cardiogenic shock due to acute myocardial infarction. We performed veno-arterial extracorporeal membrane oxygenation (VA ECMO) to maintain adequate organ perfusion. Lower limb weakness was noted on day 1 of ECMO support. Although the symptom persisted, we could not carry out further evaluation because of her hemodynamic instability. After removal of ECMO, spinal magnetic resonance imaging was performed and showed a signal abnormality extending from the level of T5 to the conus medullaris. The patient underwent conservative management, but eventually experienced limb paralysis. Herein, we report a case of spinal cord infarction in a patient with myocardial infarction during VA ECMO support.

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    Eric Bain, Roopa Rao, Maya Guglin
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    Frauke Johannes, Rahel Frohofer-Vollenweider, Yvonne Teuschl
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    Alison Zhu, Charis Tan, Richard Chard, Yishay Orr
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    Hideya Itagaki, Kohei Suzuki, Tomoya Oizumi, Keiko Nakagawa, Yoshinobu Abe, Tomoyuki Endo
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    Ramya Gaddikeri, Jennifer Febbo, Palmi Shah
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    Shih-Chao Chien, Li-Kuo Kuo, Shih-Chun Chien, Yu-Jang Su
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    Michael Salna, James Beck, Josh Willey, Koji Takeda
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  • Intraoperative Management of Adult Patients on Extracorporeal Membrane Oxygenation: An Expert Consensus Statement From the Society of Cardiovascular Anesthesiologists—Part I, Technical Aspects of Extracorporeal Membrane Oxygenation
    Michael A. Mazzeffi, Vidya K. Rao, Jeffrey Dodd-o, Jose Mauricio Del Rio, Antonio Hernandez, Mabel Chung, Amit Bardia, Rebecca M. Bauer, Joseph S. Meltzer, Sree Satyapriya, Raymond Rector, James G. Ramsay, Jacob Gutsche
    Anesthesia & Analgesia.2021; 133(6): 1459.     CrossRef
  • Spinal cord infarction and peripheral extracorporeal membrane oxygenation: a case series
    Shivanand Gangahanumaiah, Michael Zhu, Robyn Summerhayes, Silvana F Marasco, Kyriakos Dimitriadis, Milenko Zoran Cankovic, Vasilios Giampatzis, Panagiotis Xaplanteris, Hibba Kurdi, Aiste Monika Jakstaite
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Original Article
Thoracic surgery
Safety of Surgical Tracheostomy during Extracorporeal Membrane Oxygenation
Hye Ju Yeo, Seong Hoon Yoon, Seung Eun Lee, Doosoo Jeon, Yun Seong Kim, Woo Hyun Cho, Dohyung Kim
Korean J Crit Care Med. 2017;32(2):197-204.   Published online May 31, 2017
DOI: https://doi.org/10.4266/kjccm.2017.00059
  • 11,511 View
  • 184 Download
  • 5 Web of Science
  • 7 Crossref
AbstractAbstract PDF
Background
The risk of bleeding during extracorporeal membrane oxygenation (ECMO) is a potential deterrent in performing tracheostomy at many centers. To evaluate the safety of surgical tracheostomy (ST) in critically ill patients supported by ECMO, we reviewed the clinical correlation between preoperative coagulation status and bleeding complication-related ST during ECMO.
Methods
From April 1, 2012 to March 31, 2016, ST was performed on 38 patients supported by ECMO. We retrospectively reviewed and analyzed the medical records including complications related to ST.
Results
Heparin was administered to 23 patients (60.5%) for anticoagulation during ECMO, but 15 patients (39.5%) underwent ECMO without anticoagulation. Of the 23 patients administered anticoagulation therapy, heparin infusion was briefly paused in 13 prior to ST. The median platelet count, international normalized ratio, and activated partial thromboplastin time before ST were 126 ×109/L (range, 46 to 434 ×109/L), 1.2 (range, 1 to 2.3) and 62 seconds (27 to 114.2 seconds), respectively. No peri-procedural clotting complications related to ECMO were observed. Two patients (5.3%) suffering from ST-related major bleeding required surgical hemostasis. Minor bleeding after ST occurred in two cases (5.3%). No significant difference was found according to anticoagulation management (P = 0.723). No fatality was attributable to ST.
Conclusions
The complication rates of ST in the patients supported by ECMO were low. Therefore, ST performed by an experienced operator, and with careful optimization of coagulation status, is a relatively safe procedure; the use of ST with ECMO should thus not be dismissed on account of the potential for bleeding caused by the administration of anticoagulants.

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  • Assessing Clinical Feasibility and Safety of Percutaneous Dilatational Tracheostomy During Extracorporeal Membrane Oxygenation Support in the Intensive Care Unit
    Tae Hwa Hong, Hyung Won Kim, Hyoung Soo Kim, Sunghoon Park
    Journal of Acute Care Surgery.2022; 12(1): 18.     CrossRef
  • Retrospective analysis of open bedside tracheotomies in a German tertiary care university hospital
    Maximilian Riekert, Matthias Kreppel, Philipp Schminke, Annelies Weckx, Joachim E. Zöller, Volker C. Schick
    Journal of Cranio-Maxillofacial Surgery.2021; 49(2): 140.     CrossRef
  • Otolaryngology during COVID-19: Preventive care and precautionary measures
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    American Journal of Otolaryngology.2020; 41(4): 102508.     CrossRef
  • Tracheostomy while on Extracorporeal Membrane Oxygenation: A Comparison of Percutaneous and Open Procedures
    Ismael A. Salas De Armas, Kha Dinh, Bindu Akkanti, Pushan Jani, Reshma Hussain, Lisa Janowiak, Kayla Kutilek, Manish K. Patel, Mehmet H. Akay, Rahat Hussain, Jayeshkumar Patel, Chandni Patel, Yafen Liang, John Zaki, Biswajit Kar, Igor D. Gregoric
    The Journal of ExtraCorporeal Technology.2020; 52(4): 266.     CrossRef
Review Article
Cardiology
Blood Transfusion Strategies in Patients Undergoing Extracorporeal Membrane Oxygenation
Hyoung Soo Kim, Sunghoon Park
Korean J Crit Care Med. 2017;32(1):22-28.   Published online February 28, 2017
DOI: https://doi.org/10.4266/kjccm.2016.00983
  • 24,297 View
  • 741 Download
  • 24 Web of Science
  • 19 Crossref
AbstractAbstract 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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  • Red Blood Cell Transfusion Practices: College of American Pathologists Q-Probes Studies of Red Blood Cell Utilization and Single and Double Red Blood Cell Unit Transfusions
    Paul F. Lindholm, Rasleen K. Saluja, Thomas Long, Suzanne Coulter, Barbara J. Blond, Peter L. Perrotta
    Archives of Pathology & Laboratory Medicine.2025; 149(8): 709.     CrossRef
  • Letter to the editor regarding ‘Liberal or restrictive transfusion for veno-arterial extracorporeal membrane oxygenation patients: a target trial emulation using the OBLEX study data’
    Tessa A. van der Meer, Senta Jorinde Raasveld, Marcella C. A. Müller, Alexander P. J. Vlaar, Jimmy Schenk
    Critical Care.2025;[Epub]     CrossRef
  • 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
    Critical Care Medicine.2024; 52(4): 637.     CrossRef
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  • ECMO Retrieval Program: What Have We Learned So Far
    Ihor Krasivskyi, Clara Großmann, Marit Dechow, Ilija Djordjevic, Borko Ivanov, Stephen Gerfer, Walid Bennour, Elmar Kuhn, Anton Sabashnikov, Navid Mader, Kaveh Eghbalzadeh, Thorsten Wahlers
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    Jacob A. Braaten, Bridget S. Dillon, Jillian K. Wothe, Conner P. Olson, Elizabeth R. Lusczek, Kristiana J. Sather, Gregory J. Beilman, Melissa E. Brunsvold
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Original Article
Cardiology/Emergency
Five-year Experience of Extracorporeal Life Support in Emergency Physicians
Yong Soo Cho, Kyoung Hwan Song, Byung Kook Lee, Kyung Woon Jeung, Yong Hun Jung, Dong Hun Lee, Sung Min Lee
Korean J Crit Care Med. 2017;32(1):52-59.   Published online February 28, 2017
DOI: https://doi.org/10.4266/kjccm.2016.00885
  • 9,399 View
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  • 4 Web of Science
  • 4 Crossref
AbstractAbstract PDF
Background
This study aimed to present our 5-year experience of extracorporeal cardiopulmonary resuscitation (ECPR) performed by emergency physicians.
Methods
We retrospectively analyzed 58 patients who underwent ECPR between January 2010 and December 2014. The primary parameter analyzed was survival to hospital discharge. The secondary parameters analyzed were neurologic outcome at hospital discharge, cannulation time, and ECPR-related complications.
Results
Thirty-one patients (53.4%) were successfully weaned from extracorporeal membrane oxygenation, and 18 (31.0%) survived to hospital discharge. Twelve patients (20.7%) were discharged with good neurologic outcomes. The median cannulation time was 25.0 min (interquartile range 20.0-31.0 min). Nineteen patients (32.8%) had ECPR-related complications, the most frequent being distal limb ischemia. Regarding the initial presentation, 52 patients (83.9%) collapsed due to a cardiac etiology, and acute myocardial infarction (33/62, 53.2%) was the most common cause of cardiac arrest.
Conclusions
The survival to hospital discharge rate for cardiac arrest patients who underwent ECPR conducted by an emergency physician was within the acceptable limits. The cannulation time and complications following ECPR were comparable to those found in previous studies.

Citations

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  • Extracorporeal cardiopulmonary resuscitation location, coronary angiography and survival in out-of-hospital cardiac arrest
    Yoonjic Kim, Jeong Ho Park, Sun Young Lee, Young Sun Ro, Ki Jeong Hong, Kyoung Jun Song, Sang Do Shin
    The American Journal of Emergency Medicine.2023; 64: 142.     CrossRef
  • Extracorporeal cardiopulmonary resuscitation for adult out-of-hospital cardiac arrest patients: time-dependent propensity score-sequential matching analysis from a nationwide population-based registry
    Yeongho Choi, Jeong Ho Park, Joo Jeong, Yu Jin Kim, Kyoung Jun Song, Sang Do Shin
    Critical Care.2023;[Epub]     CrossRef
  • Time from arrest to extracorporeal cardiopulmonary resuscitation and survival after out‐of‐hospital cardiac arrest
    Jeong Ho Park, Kyoung Jun Song, Sang Do Shin, Young Sun Ro, Ki Jeong Hong
    Emergency Medicine Australasia.2019; 31(6): 1073.     CrossRef
  • Pre-hospital extra-corporeal cardiopulmonary resuscitation
    Ben Singer, Joshua C. Reynolds, David J. Lockey, Ben O’Brien
    Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.2018;[Epub]     CrossRef
Case Reports
Trauma
Long-term extracorporeal membrane oxygenation after severe blunt traumatic lung injury in a child
Ok Jeong Lee, Yang Hyun Cho, Jinwook Hwang, Inae Yoon, Young-Ho Kim, Joongbum Cho
Acute Crit Care. 2019;34(3):223-227.   Published online February 10, 2017
DOI: https://doi.org/10.4266/acc.2016.00472
  • 30,780 View
  • 191 Download
  • 3 Web of Science
  • 2 Crossref
AbstractAbstract PDF
Managing acute respiratory distress syndrome (ARDS) after severe blunt traumatic lung injury can be challenging. In cases where patients are refractory to conventional therapy, extracorporeal membrane oxygenation (ECMO) should be considered. In addition, the heparin-coated circuit can reduce hemorrhagic complications in patients with multiple traumas. Although prolonged ECMO may be necessary, excellent outcomes are frequently associated. In this study, we report long-term support with venovenous-ECMO applied in a child with severe blunt trauma in Korea. This 10-year-old and 30-kg male with severe blunt thoracic trauma after a car accident developed severe ARDS a few days later, and ECMO was administered for 33 days. Because of pulmonary hemorrhage during ECMO support, heparin was stopped for 3 days and then restarted. He was weaned from ECMO successfully and has been able to run without difficulty for the 2 years since discharge.

Citations

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  • Traumatic main airway rupture successfully rescued by extracorporeal membrane oxygenation: A case report
    Lijun Cao, Jun Xu, Linfeng Tang, Yuli Zhou, Xianhua Xiang
    Experimental and Therapeutic Medicine.2023;[Epub]     CrossRef
  • Extracorporeal membrane oxygenation in trauma patients: a systematic review
    Changtian Wang, Lei Zhang, Tao Qin, Zhilong Xi, Lei Sun, Haiwei Wu, Demin Li
    World Journal of Emergency Surgery.2020;[Epub]     CrossRef
Pulmonary/Cardiology
Successful Use of Extracorporeal Membrane Oxygenation in Diffuse Alveolar Hemorrhage Secondary to Systemic Lupus Erythematosus
Gyu Ho Choi, Mi Il Kang
Korean J Crit Care Med. 2016;31(4):364-368.   Published online November 30, 2016
DOI: https://doi.org/10.4266/kjccm.2016.00451
  • 10,093 View
  • 151 Download
AbstractAbstract PDF
Diffuse alveolar hemorrhage (DAH) is an uncommon complication in patients with systemic lupus erythematosus (SLE), and mortality remains high. In recent years, cases of DAH due to SLE treated with extracorporeal membrane oxygenation (ECMO) have rarely been reported. The authors present a case of a 43-year-old woman with SLE who had rapidly aggravating dyspnea and hemoptysis. She was diagnosed as having DAH with refractory respiratory failure and was successfully managed with veno-venous ECMO. We propose ECMO as a useful salvage therapy in patients with alveolar hemorrhage secondary to SLE who are failing conventional ventilatory support.
Neurology/Cardiology
Extracorporeal Membrane Oxygenation for the Support of a Potential Organ Donor with a Fatal Brain Injury before Brain Death Determination
Sung Wook Chang, Sun Han, Jung Ho Ko, Jae-Wook Ryu
Korean J Crit Care Med. 2016;31(2):169-172.   Published online May 31, 2016
DOI: https://doi.org/10.4266/kjccm.2016.31.2.169
  • 8,538 View
  • 116 Download
  • 1 Crossref
AbstractAbstract PDF
The shortage of available organ donors is a significant problem and various efforts have been made to avoid the loss of organ donors. Among these, extracorporeal membrane oxygenation (ECMO) has been introduced to help support and manage potential donors. Many traumatic brain injury patients have healthy organs that might be eligible for donation for transplantation. However, the condition of a donor with a fatal brain injury may rapidly deteriorate prior to brain death determination; this frequently results in the loss of eligible donors. Here, we report the use of venoarterial ECMO to support a potential donor with a fatal brain injury before brain death determination, and thereby preserve donor organs. The patient successfully donated his liver and kidneys after brain death determination.

Citations

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  • Outcomes of Extracorporeal Membrane Oxygenation in Children: An 11-Year Single-Center Experience in Korea
    Hongsun Kim, Ji-Hyuk Yang, Yang Hyun Cho, Tae-Gook Jun, Kiick Sung, Woosik Han
    The Korean Journal of Thoracic and Cardiovascular Surgery.2017; 50(5): 317.     CrossRef
Infection/Cardiology
Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome following HAART Initiation in an HIV-infected Patient Being Treated for Severe Pneumocystis jirovecii Pneumonia: Case Report and Literature Review
Dong Won Park, Dae Hyun Lim, Bongyoung Kim, Ji Young Yhi, Ji-Yong Moon, Sang-Heon Kim, Tae-Hyung Kim, Jang Won Shon, Ho Joo Yoon, Dong Ho Shin, Hyunjoo Pai
Korean J Crit Care Med. 2016;31(2):162-168.   Published online May 31, 2016
DOI: https://doi.org/10.4266/kjccm.2016.31.2.162
  • 10,017 View
  • 104 Download
  • 1 Crossref
AbstractAbstract PDF
Pnuemocystis jirovecii pneumonia (PJP) is one of leading causes of acute respiratory failure in patients infected with human immunodeficiency virus (HIV), and the mortality rate remains high in mechanically ventilated HIV patients with PJP. There are several reported cases who received extracorporeal membrane oxygenation (ECMO) treatment for respiratory failure associated with severe PJP in HIV-infected patients. We report a patient who was newly diagnosed with HIV and PJP whose condition worsened after highly active antiretroviral therapy (HAART) initiation and progressed to acute respiratory distress syndrome requiring veno-venous ECMO. The patient recovered from PJP and is undergoing treatment with HAART. ECMO support can be an effective life-saving salvage therapy for acute respiratory failure refractory to mechanical ventilation following HAART in HIV-infected patients with severe PJP.

Citations

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  • Extracorporeal life support for immune reconstitution inflammatory syndrome in HIV patients with Pneumocystis jirovecii pneumonia
    Kollengode Ramanathan, Julian K. Svasti, Graeme MacLaren
    Journal of Artificial Organs.2018; 21(3): 371.     CrossRef
Pulmonary/Thoracic surgery
Extracorporeal Membrane Oxygenation Therapy for Aspiration Pneumonia in a Patient following Left Pneumonectomy for Lung Cancer
Jangwhan Jo, Yang Gi Ryu
Korean J Crit Care Med. 2016;31(2):156-161.   Published online May 31, 2016
DOI: https://doi.org/10.4266/kjccm.2016.31.2.156
  • 10,524 View
  • 131 Download
  • 1 Crossref
AbstractAbstract PDF
A patient had undergone left pneumonectomy for lung cancer and had an increased risk of fatal complications such as pneumonia, including acute respiratory distress syndrome (ARDS). The treatment effects of veno-venous extracorporeal membrane oxygenation (VV-ECMO) for ARDS of postpneumonectomy patient are uncertain. A 74-year-old man with one lung experienced aspiration pneumonia while swallowing pills after the operation, and his condition progressed to ARDS within a day. He was successfully treated with VV-ECMO support and intensive care unit care.

Citations

Citations to this article as recorded by  
  • The Future of Research on Extracorporeal Membrane Oxygenation (ECMO)
    Ji Young Lee
    Korean Journal of Critical Care Medicine.2016; 31(2): 73.     CrossRef
Cardiology/Pediatric
Extracorporeal Membrane Oxygenation Cannula Malposition in the Azygos Vein in a Neonate with Right-Sided Congenital Diaphragmatic Hernia
Seung Jun Choi, Chun-Soo Park, Won Kyoung Jhang, Seong Jong Park
Korean J Crit Care Med. 2016;31(2):152-155.   Published online May 31, 2016
DOI: https://doi.org/10.4266/kjccm.2016.31.2.152
  • 10,076 View
  • 94 Download
  • 4 Crossref
AbstractAbstract PDF
Malposition of the extracorporeal membrane oxygenation (ECMO) venous cannula in the azygos vein is not frequently reported. We hereby present such a case, which occurred in a neonate with right-sided congenital diaphragmatic hernia. Despite ECMO application, neither adequate flow nor sufficient oxygenation was achieved. On the cross-table lateral chest radiograph, the cannula tip was identified posterior to the heart silhouette, which implied malposition of the cannula in the azygos vein. After repositioning the cannula, the target flow and oxygenation were successfully achieved. When sufficient venous flow is not achieved, as in our case, clinicians should be alerted so they can identify the cannula tip location on lateral chest radiograph and confirm whether malposition in the azygos vein is the cause of the ineffective ECMO.

Citations

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  • Inadvertent cannulation of the azygos vein during eCPR
    Shelina M. Jamal, Deborah S. Fruitman, Kevin M. Lichtenstein, Darren H. Freed, Natalie L. Yanchar
    Journal of Pediatric Surgery Case Reports.2021; 71: 101941.     CrossRef
  • Identification of Inadvertent Azygous Vein Cannulation Using Transthoracic Echocardiography During Venoarterial Extracorporeal Membrane Oxygenation Initiation
    Bethany G. Runkel, Jason D. Fraser, John M. Daniel, Karina M. Carlson
    CASE.2019; 3(2): 67.     CrossRef
  • Successful Extracorporeal Membrane Oxygenation After Incidental Azygos Vein Cannulation in a Neonate With Right-Sided Congenital Diaphragmatic Hernia Interruption of the Inferior Vena Cava and Azygos Continuation
    Alessandra Mayer, Genny Raffaeli, Federico Schena, Valeria Parente, Gabriele Sorrentino, Francesco Macchini, Anna Maria Colli, Lucia Mauri, Simona Neri, Irene Borzani, Ernesto Leva, Fabio Mosca, Giacomo Cavallaro
    Frontiers in Pediatrics.2019;[Epub]     CrossRef
  • The Future of Research on Extracorporeal Membrane Oxygenation (ECMO)
    Ji Young Lee
    Korean Journal of Critical Care Medicine.2016; 31(2): 73.     CrossRef
Cardiology
Use of Polymyxin B Hemoperfusion in a Patient with Septic Shock and Septic Cardiomyopathy Who Was Placed on Extracorporeal Membrane Oxygen Support
Sun Hye Shin, Hyun Lee, Aeng Ja Choi, Kylie Hae Jin Chang, Gee Young Suh, Chi Ryang Chung
Korean J Crit Care Med. 2016;31(2):123-128.   Published online May 31, 2016
DOI: https://doi.org/10.4266/kjccm.2016.31.2.123
  • 22,106 View
  • 188 Download
AbstractAbstract PDF
Although shock in sepsis is usually managed successfully by conventional medical treatment, a subset of cases do not respond and may require salvage therapies such as veno-arterial extracorporeal membrane oxygenation (VA ECMO) support as well as an attempt to remove endotoxins. However, there are limited reports of attempts to remove endotoxins in patients with septic shock on VA ECMO support. We recently experienced a case of septic shock with severe myocardial injury whose hemodynamic improvement was unsatisfactory despite extracorporeal membrane oxygenation (ECMO) support. Since the cause of sepsis was acute pyelonephritis and blood cultures grew gram-negative bacilli, we additionally applied polymyxin B direct hemoperfusion (PMX-DHP) to the ECMO circuit and were able to successfully taper off vasopressors and wean off ECMO support. To the best of our knowledge, this is the first adult case in which PMX-DHP in addition to ECMO support was successfully utilized in a patient with septic shock. This case indicates that additional PMX-DHP therapy may be beneficial and technically feasible in patients with septic shock with severe myocardial injury refractory to ECMO support.
Cardiology/Thoracic surgery
The Use of Extracorporeal Membrane Oxygenation in the Surgical Repair of Bronchial Rupture
Ju-Hee Park, Junghyeon Lim, Jaejin Lee, Hee Sung Lee
Korean J Crit Care Med. 2016;31(1):54-57.   Published online February 29, 2016
DOI: https://doi.org/10.4266/kjccm.2016.31.1.54
  • 6,069 View
  • 84 Download
AbstractAbstract PDF
Extracorporeal membrane oxygenation (ECMO) has been used successfully in critically ill patients with traumatic lung injury and offers an additional treatment modality. ECMO is mainly used as a bridge treatment to delayed surgical management; however, only a few case reports have presented the successful application of ECMO as intraoperative support during the surgical repair of traumatic bronchial injury. A 38-year-old man visited our hospital after a blunt chest trauma. His chest imaging showed hemopneumothorax in the left hemithorax and a finding suspicious for left main bronchus rupture. Bronchoscopy was performed and confirmed a tear in the left main bronchus and a congenital tracheal bronchus. We decided to provide venovenous ECMO support during surgery for bronchial repair. We successfully performed main bronchial repair in this traumatic patient with a congenital tracheal bronchus. We suggest that venovenous ECMO offers a good option for the treatment of bronchial rupture when adequate ventilation is not possible.
Cardiology/Obstetric
Successful Application of Extracorporeal Membrane Oxygenation for a Patient with Clinical Amniotic Fluid Embolism
Hye Seon Kang, Hwa Young Lee, Hea Yon Lee, Seok Chan Kim
Korean J Crit Care Med. 2015;30(4):303-307.   Published online November 30, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.4.303
  • 8,182 View
  • 106 Download
  • 4 Crossref
AbstractAbstract PDF
Amniotic fluid embolism (AFE) is a rare but potentially fatal complication that occurs acutely during pregnancy or within 12 h of delivery. The management of AFE focuses initially on supportive measures for cardiopulmonary stabilization. Extracorporeal membrane oxygenation should be considered in patients who are unresponsive to medical treatment in order to prevent additional hypoxia and subsequent organ failure. We present a 41-year-old woman with clinical AFE who developed acute respiratory distress syndrome and was treated successfully with extracorporeal membrane oxygenation.

Citations

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  • Amniotic fluid embolism rescued using venoarterial extracorporeal membrane oxygenation without initial anticoagulation: A case report and literature review
    Hiroshi Araki, Motohiro Sekino, Yuri Hasegawa, Masaya Kurobe, Tetsufumi Motokawa, Akihiko Tanigawa, Takashi Egashira, Naoya Iwasaki, Miki Suzumura, Rintaro Yano, Sojiro Matsumoto, Taiga Ichinomiya, Ushio Higashijima, Naohiro Kanayama, Kiyonori Miura, Tets
    Medicine.2024; 103(20): e38176.     CrossRef
  • Extracorporeal Therapies for Amniotic Fluid Embolism
    Julien Viau-Lapointe, Niall Filewod
    Obstetrics & Gynecology.2019; 134(5): 989.     CrossRef
  • Venous Air Embolism Not Amniotic Fluid Embolism
    Charles Her
    Korean Journal of Critical Care Medicine.2016; 31(1): 68.     CrossRef
  • Urgent Application of Extracorporeal Membrane Oxygenation in Amniotic Fluid Embolism
    Moo Suk Park
    The Korean Journal of Critical Care Medicine.2016; 31(3): 179.     CrossRef
Cardiology
Catecholamine-Induced Cardiomyopathy associated with Neuroblastoma and Treated with Extracorporeal Membrane Oxygenation as a Bridge to Recovery
Junggu Yi, Si Oh Kim, Jun-mo Park, Sung-hye Byun, Hoon Jung, Seong Wook Hong
Korean J Crit Care Med. 2015;30(4):299-302.   Published online November 30, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.4.299
  • 7,113 View
  • 94 Download
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AbstractAbstract PDF
Catecholamine-induced cardiomyopathy associated with neuroblastoma is rarely reported. We report a case of catecholamine-induced cardiomyopathy associated with neuroblastoma in a 33-month-old female that was treated with extracorporeal membrane oxygenation (ECMO). She was tentatively diagnosed with acute myocarditis and presented with hypertension. Because of rapid patient deterioration despite pharmacological treatments, ECMO was applied. ECMO can be helpful in cases of catecholamine-induced cardiomyopathy associated with neuroblastoma.

Citations

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  • COVID-19 and cardiovascular disease: manifestations, pathophysiology, vaccination, and long-term implication
    Adel Abdel Moneim, Marwa A. Radwan, Ahmed I. Yousef
    Current Medical Research and Opinion.2022; 38(7): 1071.     CrossRef
Cardiology/Thoracic surgery
Extracorporeal Membrane Oxygenation for 67 Days as a Bridge to Heart Transplantation in a Postcardiotomy Patient with Failing Heart and Mediastinitis
Hyoung Woo Chang, Yang Hyun Cho, Suhyun Cho, Kiick Sung, Pyo Won Park
Korean J Crit Care Med. 2015;30(4):295-298.   Published online November 30, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.4.295
  • 5,940 View
  • 60 Download
AbstractAbstract PDF
We report a case of successful heart transplantation after 67 days of support with venoarterial extracorporeal membrane oxygenation (ECMO) in a patient who underwent surgery for type A aortic dissection and myocardial infarction complicated by irreversible myocardial damage and a deep sternal wound infection. During ECMO support, left heart vent and distal limb perfusion were performed. Mediastinitis was treated with mediastinal washout and irrigation. Multiple complications from peripheral ECMO were successfully managed.
Original Article
Pulmonary/Cardiology
Perioperative Risk Factors associated with Immediate Postoperative Extracorporeal Membrane Oxygenation in Lung Transplants
Ha Yeon Kim, Sungwon Na, Hyo Chae Paik, Jonglin Ha, Jeongmin Kim
Korean J Crit Care Med. 2015;30(4):286-294.   Published online November 30, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.4.286
  • 7,262 View
  • 57 Download
  • 1 Crossref
AbstractAbstract PDF
Background
Extracorporeal membrane oxygenation (ECMO) is administered for a few days after lung transplantation (LTx) in recipients who are expected to have early graft dysfunction. Despite its life-saving potential, immediate postoperative ECMO has life-threatening complications such as postoperative bleeding. We investigated the risk factors related to the use of immediate postoperative ECMO.
Methods
We retrospectively reviewed the records of 60 LTx patients who were at our institution from October 2012 to May 2015. Perioperative variables associated with postoperative ECMO were compared between the two groups.
Results
There were 26 patients who received postoperative ECMO (ECMO group) and 34 patients who did not (control group). Multivariate regression analysis revealed preoperative ECMO (odds ratio [OR] 12.55, 95% confidence intervals [CI] 1.34 – 117.24, p = 0.027) and lower peripheral pulse oxymetry saturation (SpO2) at the end of surgery (OR 0.71, 95% CI 0.54 – 0.95, p = 0.019) were independent risk factors for postoperative ECMO in LTx patients. The incidences of complications, such as re-operation, tracheostomy, renal failure and postoperative atrial fibrillation, were higher in the ECMO group. There was no difference in the duration of postoperative intensive care unit stay or postoperative 30-day mortality between the two groups.
Conclusions
The preoperative ECMO and lower SpO2 at the end of surgery were associated with postoperative ECMO. Further, postoperative adverse events were higher in the ECMO group compared with the control group. This study suggests that determination of postoperative ECMO requires careful consideration because of the risks of postoperative ECMO in LTx patients.

Citations

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  • The Future of Research on Extracorporeal Membrane Oxygenation (ECMO)
    Ji Young Lee
    Korean Journal of Critical Care Medicine.2016; 31(2): 73.     CrossRef
Case Reports
Toxicology
Management of Cyanide Intoxication with Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy
Jin Park, Seung-Yeob Lee, Hyun-Sik Choi, Yoon Hee Choi, Young-Joo Lee
Korean J Crit Care Med. 2015;30(3):218-221.   Published online August 31, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.3.218
  • 10,446 View
  • 118 Download
  • 1 Crossref
AbstractAbstract PDF
Cyanide intoxication results in severe metabolic acidosis and catastrophic prognosis with conventional treatment. Indications of extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) are expanding to poisoning cases. A 50-year-old male patient arrived in the emergency room due to mental change after ingestion of cyanide as a suicide attempt 30 minutes prior. He was comatose, and brain stem reflexes were absent. Initial laboratory analysis demonstrated severe metabolic acidosis with increased lactic acid of 25 mM/L. Shock and acidosis were not corrected despite a large amount of fluid resuscitation with high-dose norepinephrine and continuous renal replacement therapy. We decided to apply ECMO and CRRT to allow time for stabilization of hemodynamic status. After administration of antidote infusion, although the patient had the potential to progress to brain death status, vital signs were improved with correction of acidosis. We considered the evaluation for organ donation. We report a male patient who showed typical cyanide intoxication as lethal metabolic acidosis and cardiac impairment, and the patient recovered after antidote administration during vital organ support through ECMO and CRRT.

Citations

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  • Cyanogenic glycoside amygdalin influences functions of human osteoblasts in vitro
    Radoslav Omelka, Veronika Kovacova, Vladimira Mondockova, Birgit Grosskopf, Adriana Kolesarova, Monika Martiniakova
    Journal of Environmental Science and Health, Part B.2021; 56(2): 109.     CrossRef
Lung Transplantation in Acute Respiratory Distress Syndrome Caused by Influenza Pneumonia
Youjin Chang, Sang Oh Lee, Tae Sun Shim, Sae Hoon Choi, Hyung Ryul Kim, Yong-Hee Kim, Dong Kwan Kim, Seung-Il Park, Sang-Bum Hong
Korean J Crit Care Med. 2015;30(3):196-201.   Published online August 31, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.3.196
  • 3,155 View
  • 5 Download
  • 2 Crossref
AbstractAbstract PDF
Severe acute respiratory distress syndrome (ARDS) is a life-threatening disease with a high mortality rate. Although many therapeutic trials have been performed for improving the mortality of severe ARDS, limited strategies have demonstrated better outcomes. Recently, advanced rescue therapies such as extracorporeal membrane oxygenation (ECMO) made it possible to consider lung transplantation (LTPL) in patients with ARDS, but data is insufficient. We report a 62-year-old man who underwent LTPL due to ARDS with no underlying lung disease. He was admitted to the hospital due to influenza A pneumonia-induced ARDS. Although he was supported by ECMO, he progressively deteriorated. We judged that his lungs were irreversibly damaged and decided he needed to undergo LTPL. Finally, bilateral sequential double-lung transplantation was successfully performed. He has since been alive for three years. Conclusively, we demonstrate that LTPL can be a therapeutic option in patients with severe ARDS refractory to conventional therapies.

Citations

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  • Lung transplantation for acute respiratory distress syndrome: a retrospective European cohort study
    Jens Gottlieb, Philipp M. Lepper, Cristina Berastegui, Beatriz Montull, Alexandra Wald, Jasvir Parmar, Jesper M. Magnusson, Felix Schönrath, Tanel Laisaar, Sebastian Michel, Hillevi Larsson, Robin Vos, Assad Haneya, Tim Sandhaus, Erik Verschuuren, Jérôme
    European Respiratory Journal.2022; 59(6): 2102078.     CrossRef
  • Comment on “Lung Transplantation for Elderly Patients With End-Stage COVID-19 Pneumonia”
    Michael K. Hsin, See Ching Chan, Huiqing Lin
    Annals of Surgery.2021; 274(6): e829.     CrossRef
Infection/Surgery
Refractory Septic Shock Treated with Nephrectomy under the Support of Extracorporeal Membrane Oxygenation
Young Kun Lee, Jeong Am Ryu, Jeong Hoon Yang, Chi-Min Park, Gee Young Suh, Kyeongman Jeon, Chi Ryang Chung
Korean J Crit Care Med. 2015;30(3):176-179.   Published online August 31, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.3.176
  • 6,254 View
  • 75 Download
AbstractAbstract PDF
Conventional medical therapies have not been very successful in treating adults with refractory septic shock. The effects of direct hemoperfusion using polymyxin B and veno-arterial extracorporeal membrane oxygenation (ECMO) for refractory septic shock remain uncertain. A 66-year-old man was admitted to the emergency department and suffered from sepsis-induced hemodynamic collapse. For hemodynamic improvement, we performed direct hemoperfusion using polymyxin B. Computed tomography scan of this patient revealed emphysematous pyelonephritis (EPN), for which he underwent emergent nephrectomy with veno-arterial ECMO support. To the best of our knowledge, this is the first report of successful treatment of EPN with refractory septic shock using polymyxin B hemoperfusion and nephrectomy under the support of ECMO.
Pulmonary/Thoracic surgery
Successful Management of Airway Emergency in a Patient with Esophageal Cancer
Samina Park, Hyun Joo Lee, Chang Hyun Kang, Young Tae Kim
Korean J Crit Care Med. 2015;30(2):135-138.   Published online May 31, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.2.135
  • 11,512 View
  • 130 Download
  • 2 Crossref
AbstractAbstract PDF
A 60-year-old man with advanced esophageal cancer was admitted for surgical placement of a feeding jejunostomy tube before commencement of chemoradiotherapy. His esophageal cancer had directly invaded the posterior tracheal wall, inducing a nearly total obstruction of the distal trachea. On the day before the surgery, respiratory failure developed due to tumor progression and tracheal edema. Tracheal intubation and mechanical ventilation were attempted without success. Application of veno-venous extracorporeal membrane oxygenation (ECMO) corrected the patient’s respiratory acidosis and relieved his dyspnea. With full ECMO support, he underwent tracheal stent insertion. Two hours later, he was weaned from ECMO support uneventfully. This was a successful case of tracheal stenting for airway obstruction under rescue veno-venous ECMO.

Citations

Citations to this article as recorded by  
  • An esophageal tumor producing life-threatening tracheal compression in a young adult was resuscitated with a self-inflating resuscitation bag
    Rajnish Kumar, Nishant Sahay, Neeraj Kumar, Soumya Singh
    Perioperative Care and Operating Room Management.2024; 34: 100365.     CrossRef
  • Thoracic oesophageal cancer as a cause of stridor: a literature review
    Robert Munashe Maweni, Venughanan Manikavasagar, Nicholas Sunderland, Sajid Chaudhry
    BMJ Case Reports.2018; 2018: bcr-2018-224872.     CrossRef
Cardiology/Pediatric
Transfusion Associated Hyperkalemia and Cardiac Arrest in an Infant after Extracorporeal Membrane Oxygenation
Do Wan Kim, Kyeong Ryeol Cheon, Duck Cho, Kyo Seon Lee, Hwa Jin Cho, In Seok Jeong
Korean J Crit Care Med. 2015;30(2):132-134.   Published online May 31, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.2.132
  • 10,642 View
  • 105 Download
  • 5 Crossref
AbstractAbstract PDF
Cardiac arrest associated with hyperkalemia during red blood cell transfusion is a rare but fatal complication. Herein, we report a case of transfusion-associated cardiac arrest following the initiation of extracorporeal membrane oxygenation support in a 9-month old infant. Her serum potassium level was increased to 9.0 mEq/L, soon after the newly primed circuit with pre-stored red blood cell (RBC) was started and followed by sudden cardiac arrest. Eventually, circulation was restored and the potassium level decreased to 5.1 mEq/L after 5 min. Extracorporeal membrane oxygenation (ECMO) priming is a relatively massive transfusion into a pediatric patient. Thus, to prevent cardiac arrest during blood-primed ECMO in neonates and infants, freshly irradiated and washed RBCs should be used when priming the ECMO circuit, to minimize the potassium concentration. Also, physicians should be aware of all possible complications associated with transfusions during ECMO.

Citations

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  • Transfusion-associated graft-versus-host disease, transfusion-associated hyperkalemia, and potassium filtration: advancing safety and sufficiency of the blood supply
    Kenneth E. Nollet, Alain M. Ngoma, Hitoshi Ohto
    Transfusion and Apheresis Science.2022; 61(2): 103408.     CrossRef
  • Transfusion-Associated Hyperkalemic Cardiac Arrest in Neonatal, Infant, and Pediatric Patients
    Morgan Burke, Pranava Sinha, Naomi L. C. Luban, Nikki Gillum Posnack
    Frontiers in Pediatrics.2021;[Epub]     CrossRef
  • Double-filtered leukoreduction as a method for risk reduction of transfusion-associated graft-versus-host disease
    Sejong Chun, Minh-Trang Thi Phan, Saetbyul Hong, Jehoon Yang, Yeup Yoon, Sangbin Han, Jungwon Kang, Mark H. Yazer, Jaehyun Kim, Duck Cho, Senthilnathan Palaniyandi
    PLOS ONE.2020; 15(3): e0229724.     CrossRef
  • Anticoagulation Therapy during Extracorporeal Membrane Oxygenator Support in Pediatric Patients
    Hwa Jin Cho, Do Wan Kim, Gwan Sic Kim, In Seok Jeong
    Chonnam Medical Journal.2017; 53(2): 110.     CrossRef
  • Blood Transfusion Strategies in Patients Supported by Extracorporeal Membrane Oxygenation
    Yoon Hee Kim
    The Korean Journal of Critical Care Medicine.2015; 30(3): 139.     CrossRef
Cardiology/Anesthesiology
Early Extracorporeal Membrane Oxygenation for Massive Aspiration during Anesthesia Induction
Namo Kim, Kwan Hyung Kim, Jeong Min Kim, Su Youn Choi, Sungwon Na
Korean J Crit Care Med. 2015;30(2):109-114.   Published online May 31, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.2.109
  • 9,941 View
  • 106 Download
  • 2 Crossref
AbstractAbstract PDF
Although the incidence is not high in the general surgical population, pulmonary aspiration of gastric contents can result in serious long-term morbidity and mortality. We report a case of early use of extracorporeal membrane oxygenation (ECMO) to correct severe hypoxemia refractory to conventional mechanical ventilation in a patient with massive aspiration of gastric contents immediately followed by acute lung injury during general anesthesia induction. A 64-year-old woman diagnosed with stomach cancer was scheduled for elective diagnostic laparoscopy. Although there was no sign of gastrointestinal tract obstruction and midnight Nil per Os (NPO) was performed before the operation, pulmonary aspiration occurred during the induction of anesthesia. Despite the endotracheal intubation with mechanical ventilation, severe hypoxemia with hypercapnea persisted. Medical team agreed with applying veno-venous (VV) ECMO, and her blood gas analysis results became stable. ECMO was weaned successfully 9 days after the first aspiration event had occurred. Based on this case, early application of extracorporeal life support can have survival benefits.

Citations

Citations to this article as recorded by  
  • Massive aspiration syndrome: a possible indication for “emergent” veno-venous extracorporeal membrane oxygenation?: a case report
    Emiliano Gamberini, Venerino Poletti, Emanuele Russo, Alessandro Circelli, Marco Benni, Giovanni Scognamiglio, Domenico Pietro Santonastaso, Costanza Martino, Linda Domenichini, Romina Biondi, Giorgia Bastoni, Etrusca Brogi, Luca Ansaloni, Federico Coccol
    Journal of Medical Case Reports.2021;[Epub]     CrossRef
  • Extracorporeal Membrane Oxygenation Therapy for Aspiration Pneumonia in a Patient following Left Pneumonectomy for Lung Cancer
    Jangwhan Jo, Yang Gi Ryu
    Korean Journal of Critical Care Medicine.2016; 31(2): 156.     CrossRef
Cardiology
Extracorporeal Membrane Oxygenation for Complicated Scrub Typhus
Eun Sun Kim, Jinwoo Lee
Korean J Crit Care Med. 2015;30(1):52-55.   Published online February 28, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.1.52
  • 7,700 View
  • 81 Download
  • 1 Crossref
AbstractAbstract PDF
Scrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi . Although early diagnosis and appropriate antibiotic therapy improve the prognosis for the majority of patients, life-threatening complications are not uncommon. Here, we present a case of successful veno-veno-type extracorporeal membrane oxygenation for scrub typhus-induced complications, including acute respiratory distress syndrome, myocarditis and multi-organ dysfunction. To our knowledge, this is the first case report of successful extracorporeal membrane oxygenation in complicated scrub typhus in Korea.

Citations

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  • Extracorporeal membrane oxygenation support for tropical infections: a scoping review
    Zachary S. Jarrett, Joseph E. Marcus, Leonardo Salazar, Kollengode Ramanathan, David A. Thomson, Graeme MacLaren
    Journal of Intensive Care.2026;[Epub]     CrossRef
Cardiology/Allergy
Management of Cardiac Arrest following Anaphylactic Reaction to Cisatracurium Using Extracorporeal Membrane Oxygenation
Dae Sung Ma, Tae-Hyun Kim, Min Ae Keum, Dong Kwan Kim, Suk-Kyung Hong
Korean J Crit Care Med. 2015;30(1):42-45.   Published online February 28, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.1.42
  • 14,504 View
  • 131 Download
  • 1 Crossref
AbstractAbstract PDF
Anaphylactic reaction during the perioperative period typically exhibits rapid onset, varying clinical manifestations, and an expected mortality rate of 1.5-9%. Neuromuscular blocking agents are the leading cause of perioperative anaphylaxis. Here, we report a severe case of anaphylaxis that developed in a 66-year-old man due to cisatracurium administration. And he was successfully managed by extracorporeal membrane oxygenation. Cardiopulmonary resuscitation was performed by extracorporeal membrane oxygenation, and the patient was successfully weaned off 24 hours later.

Citations

Citations to this article as recorded by  
  • Case report: management of differential diagnosis and treatment of severe anaphylaxis in the setting of spinal anesthesia
    Brian M. Osman, Joni M. Maga, Sebastian M. Baquero
    Journal of Clinical Anesthesia.2016; 35: 145.     CrossRef
Original Article
Cardiology/Pulmonary
Clinical Characteristics of Respiratory Extracorporeal Life Support in Elderly Patients with Severe Acute Respiratory Distress Syndrome
Woo Hyun Cho, Dong Wan Kim, Hye Ju Yeo, Seong Hoon Yoon, Seung Eun Lee, Doo Soo Jeon, Yun Seong Kim, Bong Soo Son, Do Hyung Kim
Korean J Crit Care Med. 2014;29(4):266-272.   Published online November 30, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.4.266
  • 6,259 View
  • 55 Download
  • 1 Crossref
AbstractAbstract PDF
BACKGROUND
Extracorporeal membrane oxygenation (ECMO) strategy is proposed to reduce the ventilator-induced lung injury in acute respiratory distress syndrome (ARDS). As ECMO use has increased, a number of studies on prognostic factors have been published. Age is estimated to be an important prognostic factor. However, clinical evidences about ECMO use in elderly patients are limited. Therefore, we investigated clinical courses and outcomes of ECMO in elderly patients with ARDS.
METHODS
We reviewed medical records of patients with severe ARDS who required ECMO support. Study patients were classified into an elderly group (> or = 65 years) and a non-elderly group (< 65 years). Baseline characteristics, ECMO related outcomes and associated factors were retrospectively analyzed according to group.
RESULTS
From February 2011 to June 2013, a total of 31 patients with severe ARDS were treated with ECMO. Overall, 14 (45.2%) were weaned from ECMO, 9 (29.0%) survived to the general ward and 7 (22.6%) survived to discharge. Among the 18 elderly group patients, 7 (38.9%) were weaned from ECMO, 4 (22.2%) were survived to the general ward and 2 (11.1%) were survived to discharge. Overall intensive care unit survival was inversely correlated with concomitant acute kidney injury or septic shock.
CONCLUSIONS
In this study, ECMO outcome was poor in severe ARDS patients aged over 65 years. Therefore, the routine use of ECMO in elderly patients with severe ARDS is not warranted except in highly selective cases.

Citations

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  • Venovenous Extracorporeal Membrane Oxygenation for Negative Pressure Pulmonary Hemorrhage in an Elderly Patient
    Kenichiro Ishida, Mitsuhiro Noborio, Nobutaka Iwasa, Taku Sogabe, Yohei Ieki, Yuki Saoyama, Kyosuke Takahashi, Yumiko Shimahara, Daikai Sadamitsu
    Case Reports in Critical Care.2015; 2015: 1.     CrossRef
Case Report
Cardiology/Pulmonary
Recovery from Acute Respiratory Distress Syndrome with Long-Run Extracorporeal Membrane Oxygenation
Jin Jeon, Jin Won Huh, Chae Man Lim, Younsuck Koh, Sang Bum Hong
Korean J Crit Care Med. 2014;29(3):212-216.   Published online August 31, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.3.212
  • 8,948 View
  • 72 Download
  • 1 Crossref
AbstractAbstract PDF
Acute respiratory distress syndrome (ARDS) is a severe lung disease associated with high mortality despite recent advances in management. Significant advances in extracorporeal membrane oxygenation (ECMO) devices and management allow short-term support for patients with acute reversible respiratory failure and can serve as a bridge to transplantation in patients with irreversible respiratory failure. When ARDS does not respond to conventional treatment, ECMO and the interventional lung assist membrane (iLA) are the most widely used complementary treatment options. Here, we report a clinical case of an adult patient who required prolonged duration venovenous (VV)-ECMO for severe ARDS resulting in improvement while waiting for lung transplantation.

Citations

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  • 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
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