Extracorporeal membrane oxygenation with spontaneous breathing as a bridge to lung transplantation

Nosotti, Mario; Rosso, Lorenzo; Tosi, Davide; Palleschi, Alessandro; Mendogni, Paolo; Nataloni, Ilaria; Crotti, Stefania; Tarsia, Paolo

doi:10.1093/icvts/ivs433

Cited by 96 publications

(79 citation statements)

References 21 publications

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“…14,16,17 In a single-center study, subjects who were spontaneously breathing while supported with ECMO had better 1-y survival rates post-transplant than did their mechanically ventilated counterparts who were supported with ECMO and proceeded to lung transplantation. 18 While deconditioning, critical illness myopathy, and length of stay for these critically ill patients supported with ECMO as a bridge to lung transplantation may be improved by an ambulatory approach, 14 the economics of this strategy have not been investigated previously. ECMO is a therapy that is associated with significant cost and resource utilization, 19 and even without ECMO, data comparing cost and quality-adjusted life-years continue to demonstrate that lung transplantation is expensive.…”

Section: See the Related Editorial On Page 117mentioning

confidence: 99%

Economic Outcomes of Extracorporeal Membrane Oxygenation With and Without Ambulation as a Bridge to Lung Transplantation

et al. 2015

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Section: See the Related Editorial On Page 117mentioning

confidence: 99%

Economic Outcomes of Extracorporeal Membrane Oxygenation With and Without Ambulation as a Bridge to Lung Transplantation

et al. 2015

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“…Traditional outcomes for ECMO patients bridged to lung transplant are poor, [4][5][6][7] but there are increasing reports of successful bridge to transplant using awake and ambulatory ECMO approaches in patients with chronic respiratory conditions. [8][9][10][11][12][13][14][15][16][17][18][19] We report the first successful bridge to lung transplant with ambulatory ECMO in a previously healthy pediatric patient with acute refractory respiratory failure.…”

mentioning

confidence: 93%

“…[8][9][10][11][12][13][14][15][16][17][18][19] Chronic respiratory insufficiency leads to greater tolerance for dyspnea, as evidenced by the patients supported with ambulatory ECMO who have been managed with minimal respiratory support or even extubated. 8,[15][16][17]19 The impact of weaning both sedation and ventilatory support in children without chronic respiratory disease must be addressed when ambulatory ECMO is considered for previously healthy children.This report indicates that ambulatory ECMO is a feasible strategy in pediatric patients without chronic respiratory illness presenting with acute respiratory failure. Despite challenges associated with awake and ambulatory ECMO in children, the early success of this strategy warrants additional investigation of this approach for refractory pediatric respiratory failure.…”

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confidence: 99%

Ambulatory ECMO as a Bridge to Lung Transplant in a Previously Well Pediatric Patient With ARDS

et al. 2014

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Ambulatory ECMO as a Bridge to Lung Transplant in a Previously Well Pediatric Patient With ARDS abstractExtracorporeal membrane oxygenation (ECMO) is increasingly implemented in patients with end-stage pulmonary disease as a bridge to lung transplant. Several centers have instituted an approach that involves physical rehabilitation and ambulation for patients supported with ECMO. Recent reports describe the successful use of ambulatory ECMO in patients with chronic respiratory illnesses being bridged to lung transplant. We describe the first case of a previously healthy pediatric patient with acute respiratory failure successfully supported with ambulatory ECMO as a bridge to lung transplant after an unsuccessful bridge to recovery. Although there are challenges associated with awake and ambulatory ECMO in children, this strategy represents an exciting breakthrough and a potential paradigm shift in ECMO management for pediatric acute respiratory failure. Extracorporeal membrane oxygenation (ECMO) is an important therapeutic modality for patients with refractory respiratory failure. Despite extremely high predicted mortality in patients with refractory respiratory failure, survival for some populations supported with ECMO exceeds 70%. [1][2][3] However, in patients with irreversible pulmonary injury, lung transplant may be necessary. Traditional outcomes for ECMO patients bridged to lung transplant are poor, 4-7 but there are increasing reports of successful bridge to transplant using awake and ambulatory ECMO approaches in patients with chronic respiratory conditions. [8][9][10][11][12][13][14][15][16][17][18][19] We report the first successful bridge to lung transplant with ambulatory ECMO in a previously healthy pediatric patient with acute refractory respiratory failure. CASE DESCRIPTIONA 16-year-old, previously healthy, physically active girl presented to a community hospital with right lower lobe pneumonia and respiratory failure (Fig 1). Her condition deteriorated rapidly, prompting transfer to our quaternary care center for possible ECMO. Upon admission to our institution, the patient' s chest radiograph demonstrated diffuse infiltrates, bilateral pneumothoracies, and pneumomediastinum (Fig 2). She was immediately placed on high-frequency oscillatory ventilation, but because of an oxygen index persistently .40, frequent desaturations, and worsening air leak, venovenous ECMO was initiated via a 27-French double-lumen right internal jugular vein cannula (Avalon Laboratories, Rancho Domingo, CA) ∼30 hours after admission. For the next 4 weeks she needed deep pharmacologic sedation, intermittent neuromuscular blockade, and mechanical ventilation in conjunction with ECMO to maintain gas exchange. During this 4-week period, her air leak resolved, but she continued to have persistent acute respiratory distress syndrome and no improvement. A transbronchial biopsy revealed no infectious etiology, and the pathology results demonstrated organizing and proliferative diffuse alveolar damage and neutrophilic alveolitis...

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“…This strategy allows to significantly decrease (I) the duration of mechanical ventilation after LTx; (II) the ICU length of stay; and (III) the post-LTx hospital length of stay (20,21).…”

Section: Ecls As Bridge To Lung Transplantation (Ltx)mentioning

confidence: 99%

Vascular access for extracorporeal life support: tips and tricks

et al. 2016

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In thoracic surgery, extracorporeal life support (ECLS) techniques are performed to (I) provide a short to mid term extracorporeal mechanical support; (II) realize the gas exchanges; and (III)-depending the configuration of the circuit-substitute the failed heart function. The objective of this review is to describe the rational of the different ECLS techniques used in thoracic surgery and lung transplantation (LTx) with a specific attention to the vascular access. Venovenous extracorporeal membrane oxygenation (VV ECMO)is the most common ECLS technique used in thoracic surgery and represents the best strategy to support the lung function. VV ECMO needs peripheral vascular access. The selection between his double-site or single-site configuration should be decided according the level of O 2 requirements, the nosological context, and the interest to perform an ECLS ambulatory strategy. Venoarterial (VA) ECMO uses peripheral and/or central cannulation sites. Central VA ECMO is mainly used in LTx instead a conventional cardiopulmonary bypass (CPB) to decrease the risk of hemorrhagic issues and the rate of primary graft dysfunction (PGD).Peripheral VA ECMO is traditionally realized in a femoro-femoral configuration. Femoro-femoral VA ECMO allows a cardiocirculatory support but does not provide an appropriate oxygenation of the brain and the heart. The isolated hypercapnic failure is currently supported by extracorporeal CO 2 removal (ECCO 2 R) devices inserted in jugular or subclavian veins. The interest of the Novalung (Novalung GmbH, Hechingen, Germany) persists due to his central configuration indicated to bridge to LTx patients suffering from pulmonary hypertension. The increasing panel of ECLS technologies available in thoracic surgery is the results of a century of clinical practices, engineering progress, and improvements of physiological knowledges. The selection of the ECLS technique-and therefore the vascular access to implant the device-for a given nosological context trends to be defined according an evidence-based medicine.

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Extracorporeal membrane oxygenation with spontaneous breathing as a bridge to lung transplantation

Abstract: Extracorporeal membrane oxygenation in spontaneously breathing patients is a feasible, effective and safe bridge to lung transplantation.

Cited by 96 publications

References 21 publications

Economic Outcomes of Extracorporeal Membrane Oxygenation With and Without Ambulation as a Bridge to Lung Transplantation

Economic Outcomes of Extracorporeal Membrane Oxygenation With and Without Ambulation as a Bridge to Lung Transplantation

Ambulatory ECMO as a Bridge to Lung Transplant in a Previously Well Pediatric Patient With ARDS

Vascular access for extracorporeal life support: tips and tricks

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