Extracorporeal membrane oxygenation support for life-threatening acute severe status asthmaticus

Lascio, Gabriella Di; Prifti, Edvin; Messai, Elmi; Peris, Adriano; Harmelin, Guy; Xhaxho, Roland; Fico, Albana; Sani, Guido; Bonacchi, Massimo

doi:10.1177/0267659116670481

Cited by 36 publications

(24 citation statements)

References 27 publications

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“…Traditionally, protective mechanical ventilation with rescue therapy, including neuromuscular blockade, has been the mainstay treatment for NFA. However, technical advances in extracorporeal membrane oxygenation (ECMO) have made it a promising alternative therapy in the treatment of life-threatening NFA [ 11 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Extracorporeal membrane oxygenation for life-threatening asthma refractory to mechanical ventilation: analysis of the Extracorporeal Life Support Organization registry

et al. 2017

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BackgroundThe use of extracorporeal membrane oxygenation (ECMO) in cases of near-fatal asthma (NFA) has increased, but the benefits and potential complications of this therapy have yet to be fully investigated.MethodsCases were extracted from the Extracorporeal Life Support Organization Registry between March 1992 and March 2016. All patients with a diagnosis of asthma (according to the International Classification of Diseases 9th edition), who also received ECMO, were extracted. Exclusion criteria included patients who underwent multiple courses of ECMO; those who received ECMO for cardiopulmonary resuscitation or cardiac dysfunction; and those with another primary diagnosis, such as sepsis. We analyzed survival to hospital discharge, complications, and clinical factors associated with in-hospital mortality, in patients with severe life-threatening NFA requiring ECMO support.ResultsIn total 272 patients were included. The mean time spent on ECMO was 176.4 hours. Ventilator settings, including rate, fraction of inspired oxygen (FiO2), peak inspiratory pressure (PIP), and mean airway pressure, significantly improved after ECMO initiation (rate (breaths/min), 19.0 vs. 11.3, p < 0.001; FiO2 (%), 81.2 vs. 48.8, p < 0.001; PIP (cmH2O), 38.2 vs. 25.0, p < 0.001; mean airway pressure (cmH2O): 21.4 vs. 14.2, p < 0.001). In particular, driving pressure was significantly decreased after ECMO support (29.5 vs. 16.8 cmH2O, p < 0.001). The weaning success rate was 86.7%, and the rate of survival to hospital discharge was 83.5%. The total complication rate was 65.1%, with hemorrhagic complications being the most common (28.3%). Other complications included renal (26.8%), cardiovascular (26.1%), mechanical (24.6%), metabolic (22.4%), infection (16.5%), neurologic (4.8%), and limb ischemia (2.6%). Of the hemorrhagic complications, cannulation site hemorrhage was the most common (13.6%). Using multivariate logistic regression analysis, it was found that hemorrhage was associated with increased in-hospital mortality (odds ratio, 2.97; 95% confidence interval, 1.07–8.24; p = 0.036). Hemorrhage-induced death occurred in four patients (1.5%). The most common reason for death was organ failure (37.8%).ConclusionsECMO can provide adequate gas exchange and prevent lung injury induced by mechanical ventilation, and may be an effective bridging strategy to avoid aggressive ventilation in refractory NFA. However, careful management is required to avoid complications.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1886-8) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

“…The low incidence of NFA may preclude large-scale, prospective randomized trials on the effectiveness of ECMO in this context. Nevertheless, an increasing number of reports suggest ECMO may be an effective rescue therapy for NFA [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal membrane oxygenation for life-threatening asthma refractory to mechanical ventilation: analysis of the Extracorporeal Life Support Organization registry

et al. 2017

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“…However, the conclusions are limited by an inability to compare ECMO to other therapies and limited external validity as the database had included data from an earlier era in which the ECMO technology was not as advanced as it is now. One multicentre European case series of 16 patients of ECMO use in SA had demonstrated good efficacy in improving gas exchange parameters and leading to successful extubation without neurological sequelae in all study patients 19. In addition, there are case reports highlighting application of ECMO for SA in unique clinical scenarios including patients who with plastic bronchitis,20 in the setting of secondary pneumothorax,21 in pregnancy22 and following atracurium administration 23…”

Section: Discussionmentioning

confidence: 99%

Adjunctive extracorporeal carbon dioxide removal in refractory status asthmaticus

et al. 2017

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Status asthmaticus (SA) is a life-threatening disorder. Severe respiratory failure may require extracorporeal membrane oxygenation (ECMO). Previous reports have demonstrated utility of ECMO in SA in various patients with varying success. A 25-year-old man was admitted with status asthmatics and severe hypercapnic respiratory failure. Despite tailored ventilator therapies, such as pressure control ventilation and maximal pharmacological therapy, including general anaesthesia, the patientâ€™s condition deteriorated rapidly. Veno-venous ECMO (VV-ECMO) was provided for respiratory support. The patientâ€™s clinical condition improved over the following 72â€‰hours and was discharged from the intensive care unit on day 3. This case report demonstrates the successful use of VV-ECMO in a patient with severe respiratory failure due to SA, who failed to respond to maximal therapy. This case adds support to a growing body of literature that shows that ECMO can be used with success for refractory status asthmaticus.

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“…In this study, they used data from the multicenter Extracorporeal Life Support Organization (ELSO), but included only a small number of patients. In 2017, there was another review of the same database, confirming that the use of ECMO is an acceptable option, and resulted in acceptable survival rates, although it is necessary to understand and reduce the ECMO related complications [280]. Di Lascio et al, using ECMO for asthmatic patients receiving IMV, showed that it could provide adjunctive pulmonary support for patients who remain severely acidotic and hypercapnic despite aggressive conventional therapy [281].…”

Section: Pharmacological and Non-pharmacological Managementmentioning

confidence: 99%

Acute Severe Asthma in Adolescent and Adult Patients: Current Perspectives on Assessment and Management

Kostakou

Kaniaris

Filiou

et al. 2019

JCM

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Asthma is a chronic airway inflammatory disease that is associated with variable expiratory flow, variable respiratory symptoms, and exacerbations which sometimes require hospitalization or may be fatal. It is not only patients with severe and poorly controlled asthma that are at risk for an acute severe exacerbation, but this has also been observed in patients with otherwise mild or moderate asthma. This review discusses current aspects on the pathogenesis and pathophysiology of acute severe asthma exacerbations and provides the current perspectives on the management of acute severe asthma attacks in the emergency department and the intensive care unit.

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Extracorporeal membrane oxygenation support for life-threatening acute severe status asthmaticus

Cited by 36 publications

References 27 publications

Extracorporeal membrane oxygenation for life-threatening asthma refractory to mechanical ventilation: analysis of the Extracorporeal Life Support Organization registry

Extracorporeal membrane oxygenation for life-threatening asthma refractory to mechanical ventilation: analysis of the Extracorporeal Life Support Organization registry

Adjunctive extracorporeal carbon dioxide removal in refractory status asthmaticus

Acute Severe Asthma in Adolescent and Adult Patients: Current Perspectives on Assessment and Management

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