High survival in adult patients with acute respiratory distress syndrome treated by extracorporeal membrane oxygenation, minimal sedation, and pressure supported ventilation

Lindén, Viveka; Palmér, Kenneth; Reinhard, Jarl; Westman, Reino; Ehrén, Henrik; Granholm, Tina; Frenckner, Björn

doi:10.1007/s001340000697

Cited by 154 publications

(103 citation statements)

References 21 publications

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“…With proper patient selection, the mortality among patients who have the most severely impaired gas exchange treated with ECMO can be lowered to approximate the mortality of those patients not requiring ECMO. [24][25][26][27][28] The Australia and New Zealand (ANZ) influenza investigators recently reported their experience with ECMO for respiratory failure secondary to H1N1-2009 infection in ANZ. 29 In this series, ECMO usage for H1N1-2009 infection was frequent (68/201, 33.8%), whereas it was infrequent in Canada (6/168, 3.6%).…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal lung support for patients who had severe respiratory failure secondary to influenza A (H1N1) 2009 infection in Canada

Freed

Henzler

White

et al. 2010

Can J Anesth/J Can Anesth

107

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Section: Discussionmentioning

confidence: 99%

Extracorporeal lung support for patients who had severe respiratory failure secondary to influenza A (H1N1) 2009 infection in Canada

Freed

Henzler

White

et al. 2010

Can J Anesth/J Can Anesth

107

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“…The use of regional oximetry is often used as well. During VV ECMO, it is important that mechanical ventilation be decreased to low tidal volumes, low inspiratory pressures and exposed to lower oxygen concentrations to limit iatrogenic trauma and to allow the lungs to begin the healing process [11]. FiO 2 on the ventilator should be weaned to 40% and PEEP should be maintained at 5 -10 cm H 2 O and not altered in response to hypoxia.…”

Section: Discussionmentioning

confidence: 99%

Veno-Venous Extracorporeal Membrane Oxygenation: Anesthetic Management for Massive Intracranial Hemorrhage in H1N1 Infection

Kraus¹,

Weis²,

Alwardt³

et al. 2015

OJAnes

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Background: Extracorporeal membrane oxygenator (ECMO) use is dramatically increasing in recent years. This case report describes a patient on veno-venous (VV) ECMO for H1N1 who underwent emergent craniotomy twice for intracranial hemorrhage. Case presentation: A 38-year-old male presented to a community hospital for worsening shortness of breath. He had experienced cough, malaise and fatigue for two weeks prior to presentation. On arrival, his arterial oxygen saturation was 64%. He was placed on oxygen via non-rebreather mask and started on Tamiflu plus antibiotics. He was intubated for worsening respiratory failure. Despite maximal ventilator settings, the arterial oxygen saturation was approximately 90%. He was placed in the prone position and nitric oxide was initiated. Severe acute respiratory distress syndrome (ARDS) secondary to influenza was diagnosed by viral PCR, clinical presentation, and diagnostic imaging. Within 24 hours of his intubation, a decision was made to initiate veno-venous (V-V) ECMO for respiratory support. Five days following the initiation of ECMO, asymmetric pupils and a nonreactive right pupil were noted. A massive right frontal intraparenchymal hemorrhage with midline shift and downward uncal herniation was found on computed tomography (CT). A decision was made to surgically intervene. He was taken to the operating room for immediate right frontal craniotomy and clot evacuation under general anesthesia. Conclusion: With the dramatic increase in ECMO use, anesthesiologists are encountering patients on ECMO in the operating room with more frequency. When the situation does arise, it is imperative that the anesthesiologist is knowledgeable about ECMO and how to appropriately administer anesthesia for these critically ill patients. Challenges M. Kraus et al. 252 confronting the anesthesiologist with ECMO patients include managing bleeding or coagulopathy, ventilation and oxygenation, volume status, transporting and positioning these patients, and altered pharmacokinetics of anesthetic drugs.

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“…The Karolinska group reported a very low mortality rate (24%) during their experience in 17 severe ARDS patients treated with extracorporeal support coupled with minimal sedation and pressure support ventilation (PSV) with low tidal volumes [15].…”

Section: Assisted Ventilation During Eclsmentioning

confidence: 99%

Ventilation during extracorporeal support

Pesenti

Carlesso

Länger

et al. 2017

Med Klin Intensivmed Notfmed

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High survival in adult patients with acute respiratory distress syndrome treated by extracorporeal membrane oxygenation, minimal sedation, and pressure supported ventilation

Cited by 154 publications

References 21 publications

Extracorporeal lung support for patients who had severe respiratory failure secondary to influenza A (H1N1) 2009 infection in Canada

Extracorporeal lung support for patients who had severe respiratory failure secondary to influenza A (H1N1) 2009 infection in Canada

Veno-Venous Extracorporeal Membrane Oxygenation: Anesthetic Management for Massive Intracranial Hemorrhage in H1N1 Infection

Ventilation during extracorporeal support

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