Disclaimer: The use of venovenous extracorporeal membrane oxygenation (VV ECMO) in adults has rapidly increased worldwide. This ELSO guideline is intended to be a practical guide to patient selection, initiation, cannulation, management, and weaning of VV ECMO for adult respiratory failure. This is a consensus document which has been updated from the previous version to provide guidance to the clinician.

Bleeding and red blood cell transfusion occur frequently during adult extracorporeal life support, but only the amount of red blood cell transfusion is associated with inhospital mortality after controlling for confounding variables.

In a large health system in the United States, investigators examined whether mortality, receipt of mechanical ventilation, and patient acuity changed over time among adult patients with COVID-19–related critical illness admitted to intensive care units.

Purpose To characterize the current scope and practices of centers performing extracorporeal cardiopulmonary resuscitation (eCPR) on the undifferentiated patient with cardiac arrest in the emergency department. Methods We contacted all US centers in January 2016 that had submitted adult eCPR cases to the Extracorporeal Life Support Organization (ELSO) registry and surveyed them, querying for programs that had performed eCPR in the Emergency Department (ED ECMO). Our objective was to characterize the following domains of ED ECMO practice: program characteristics, patient selection, devices and techniques, and personnel. Results Among 99 centers queried, 70 responded. Among these, 36 centers performed ED ECMO. Nearly 93% of programs are based at academic/teaching hospitals. 65% of programs are less than 5 years old, and 60% of programs perform ≤ 3 cases per year. Most programs (90%) had inpatient eCPR or salvage ECMO programs prior to starting ED ECMO programs. The majority of programs do not have formal inclusion and exclusion criteria. Most programs preferentially obtain vascular access via the percutaneous route (70%) and many (40%) use mechanical CPR during cannulation. The most commonly used console is the Maquet Rotaflow®. Cannulation is most often performed by cardiothoracic (CT) surgery, and nearly all programs (>85%) involve CT surgeons, perfusionists, and pharmacists. Conclusions Over a third of centers that submitted adult eCPR cases to ELSO have performed ED ECMO. These programs are largely based at academic hospitals, new, and have low volumes. They do not have many formal inclusion or exclusion criteria, and devices and techniques are variable.

The purpose of this study was to examine changes in performance and metabolic parameters in collegiate soccer players during preseason preparation and to determine the impact of a nutraceutical blend proposed to reduce oxidative stress. Male Division I college soccer players (n = 22) performed a progressive maximal treadmill test at the beginning and end of preseason to assess changes in Vo2max, velocity at lactate threshold (VLT), time-to-exhaustion, lipid hydroperoxide (LPO), 8-isoprostane, and creatine kinase (CK) response. After baseline testing, athletes were randomly assigned to receive the nutraceutical blend (EXP; n = 12) or an isocaloric equivalent (CON; n = 10) for 20 days of preseason training. DeltaVo2max (2.1 +/- 3.3 ml.kg.min, p = 0.007), DeltaVLT (0.8 +/- 1.4 km.h, p = 0.045), and Deltatime-to-exhaustion (39.4 +/- 77.4 seconds, p = 0.033) were improved across groups, but a significant effect of supplementation on performance was not seen. Changes in resting levels of CK from the beginning to end of preseason were significantly lower (p = 0.044) in EXP (64.8 +/- 188.4 U.L) than in CON (292.8 +/- 304.8 U.L). Additionally, EXP demonstrated a significant decrease in the magnitude of the 8-isoprostane response at Trial 2 compared with Trial 1 (effect size [ES] = -0.74), whereas CON had an increased response (ES = 0.20). A similar pattern was seen for LPO (p = 0.067). Preseason training in male college soccer players resulted in significant improvements in Vo2max, VLT, and time-to-exhaustion. Supplementing with a proprietary antioxidant and nutraceutical blend may enhance some of these effects as indicated by magnitude of the responses. However, it appears that the most notable effects of supplementation were seen for reduced CK and oxidative stress, at least with short-term supplementation.