Extracorporeal Membrane Oxygenation: Beyond Cardiac Surgery and Intensive Care Unit: Unconventional Uses and Future Perspectives

Monaco, Fabrizio; Belletti, Alessandro; Bove, Tiziana; Landoni, Giovanni; Zangrillo, Alberto

doi:10.1053/j.jvca.2018.03.031

Cited by 29 publications

(10 citation statements)

References 159 publications

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“…Although reports on the use of ECMO from previous epidemics exist 1,[3][4][5][6][7][8][9][10] , dedicated guidelines were produced during the COVID-19 pandemic to help triage patients in the face of reduced resources 11 .…”

Section: Introductionmentioning

confidence: 99%

ECMO in COVID-19 Patients: A Systematic Review and Meta-analysis

Bertini

Guarracino

Falcone

et al. 2022

Journal of Cardiothoracic and Vascular Anesthesia

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Section: Introductionmentioning

confidence: 99%

ECMO in COVID-19 Patients: A Systematic Review and Meta-analysis

Bertini

Guarracino

Falcone

et al. 2022

Journal of Cardiothoracic and Vascular Anesthesia

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“…Despite growing worldwide utilization and experience in mechanical circulatory support (MCS), in particular, in-hospital outcomes while on ECMO have not shown substantial progress [6]. While little is still known on who benefits most from ECMO support which is a long and advanced therapy [7], European Society of Cardiology guidelines cautiously assigned ECMO class of recommendation IIb, level of evidence C for the management of cardiogenic shock in STEMI [8].…”

Section: Introductionmentioning

confidence: 99%

The impact of Centre’s heart transplant status and volume on in-hospital outcomes following extracorporeal membrane oxygenation for refractory post-cardiotomy cardiogenic shock: a meta-analysis

Kowalewski

Raffa

Zieliński

et al. 2020

BMC Cardiovasc Disord

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Background: Postcardiotomy cardiogenic shock (PCS) that is refractory to inotropic support remains a major concern in cardiac surgery and is almost universally fatal unless treated with mechanical support. While reported mortality rates on ECMO vary from center to center, aim of the current report is assess if the outcomes differ between centres according to volume and heart transplantation status. Methods: A systematic search was performed according to PRISMA statement using PubMed/Medline databases between 2010 and 2018. Relevant articles were scrutinized and included in the meta-analysis only if reporting inhospital/30-day mortality and heart transplantation status of the centre. Paediatric and congenital heart surgeryrelated studies along with those conducted in the setting of veno-venous ECMO for respiratory distress syndrome were excluded. Differences were assessed by means of subgroup meta-analysis and meta-regression. Results: Fifty-four studies enrolling N = 4421 ECMO patients were included. Of those, 6 series were performed in non-HTx centres (204 pts.;4.6%). Overall 30-day survival (95% Confidence Intervals) was 35.3% (32.5-38.2%) and did not statistically differ between non-HTx: 33.3% (26.8-40.4%) and HTx centres: 35.7% (32.7-38.8%); P interaction = 0.531. There was no impact of centre volume on survival as well: ß coef = 0.0006; P = 0.833. No statistical differences were seen between HTx and non-HTx with respect to ECMO duration, limb complications, reoperations for bleeding, kidney injury and sepsis. There were however significantly less neurological complications in the HTx as compared to non-HTx centres: 11.9% vs 19.5% respectively; P = 0.009; an inverse relationship was seen for neurologic complications in centres performing more ECMOs annually ß coef = − 0.0066; P = 0.031. Weaning rates and bridging to HTx and/or VADs were higher in HTx facilities. Conclusions: There was no apparent difference in survival after ECMO implantation for refractory PCS according to centre's ECMO volume and transplantation status. Potentially different risk profiles of patients in these centres must be taken account for before definite conclusions are drawn.

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“…19 This approach is in the opposite direction of our study and already well-argued by Schweiger et al 20 In the last few years, ECMO assistance was conceived for severe cardiorespiratory failure management, cardiac surgery, lung transplant, and tracheal/carinal resection, mostly applied to neonatal-pediatric surgery. 9,21,22 In the oncological setting, ECMO assisted surgery was rarely described, and, to the best of our knowledge, in the last 10 years, only three studies reported ECMO-assisted TSP for lung cancer, with only three patients described (►Table 5). The advantages of this approach include hemodynamic stability with a lower risk of bleeding complications, resulting in a better brain and myocardial oxygenation, and a clean operating field, since cannulas can be placed peripherally and maintained if needed.…”

Section: Discussionmentioning

confidence: 99%

“…The postoperative complication risk (e.g., recirculation, SVC syndrome, and vasoplegia) reported in the literature is lower than with traditional cardiopulmonary bypass. 21 Nonetheless, a v-v ECMO procedure can also be switched to a venoarterial procedure to obtain protective lung ventilation and reduce pressure on the anastomosis if mechanical ventilation with high volumes is required. 22 ECMO can allow enough surgical exposure and adequate ventilation control in TSP procedures that require selective ventilation.…”

Section: Discussionmentioning

confidence: 99%

Preliminary Results of Extracorporeal Membrane Oxygenation Assisted Tracheal Sleeve Pneumonectomy for Cancer

Spaggiari

Sedda

Petrella

et al. 2020

Thorac Cardiovasc Surg

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Objective Tracheal sleeve pneumonectomy is a challenge in lung cancer management and in achieving long-term oncological results. In November 2018, we started a prospective study on the role of extracorporeal membrane oxygenation (ECMO) in tracheal sleeve pneumonectomy. We aim to present our preliminary results. Methods From November 2018 to November 2019, six patients (three men and three women; median age: 61 years) were eligible for tracheal sleeve pneumonectomy for lung cancer employing the veno-venous ECMO during tracheobronchial anastomosis. Results Only in one patient, an intrapericardial pneumonectomy without ECMO support was performed, but cannulas were maintained during surgery. The median length of surgery was 201 minutes (range: 162–292 minutes), and the average duration of the apneic phase was 38 minutes (range: 31–45 minutes). No complications correlated to the positioning of the cannulas were recorded. There was only one major postoperative complication (hemothorax). At the time of follow-up, all patients were alive; one patient alive with bone metastasis was being treated with radiotherapy. Conclusion ECMO-assisted oncological surgery was rarely described, and its advantages include hemodynamic stability with low bleeding complications and a clean operating field. As suggested by our preliminary data, ECMO-assisted could be a useful alternative strategy in select lung cancer patients.

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Extracorporeal Membrane Oxygenation: Beyond Cardiac Surgery and Intensive Care Unit: Unconventional Uses and Future Perspectives

Cited by 29 publications

References 159 publications

ECMO in COVID-19 Patients: A Systematic Review and Meta-analysis

ECMO in COVID-19 Patients: A Systematic Review and Meta-analysis

The impact of Centre’s heart transplant status and volume on in-hospital outcomes following extracorporeal membrane oxygenation for refractory post-cardiotomy cardiogenic shock: a meta-analysis

Preliminary Results of Extracorporeal Membrane Oxygenation Assisted Tracheal Sleeve Pneumonectomy for Cancer

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