Monitoring during extracorporeal membrane oxygenation

Castro, Diana Morales; Morris, Idunn S; Teijeiro-Paradis, Ricardo; Fan, Eddy

doi:10.1097/mcc.0000000000000939

Cited by 7 publications

(3 citation statements)

References 72 publications

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“…It is important to have acceptable safety margins e.g., PEEP, FIO2, and power in the mechanical ventilatory (MV) settings to manage the patient off ECMO support. 11,15 Irrespective of the path chosen, it is important to discuss the need for repeated ECMO runs and reaffirm the goals with the patient, family, and care team to avoid confusion and discomfort.…”

Section: How Do You Wean and Discontinue The Support?mentioning

confidence: 99%

Finding the needle in haystack of questions: ECMO in hypoxemic respiratory failure

Guru

Sahoo

2023

J. Nep. Soc. Crit. Care Med.

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Extracorporeal membrane oxygenation (ECMO) has gained significant attraction as a supportive measure for severe cardio-respiratory failure over the past decade and a half. Despite advances in the management of acute respiratory distress syndrome (ARDS) and its associated respiratory failure, there remain challenges for researchers and clinicians. Lung-protective mechanical ventilation and fluid restriction are widely accepted strategies for ARDS care. However, the precise role of ECMO in managing ARDS patients remains to be clearly defined. ECMO offers a potential solution for the hypoxemia and hypercapnia that arise from respiratory failure through its extracorporeal principles. Recent technological advancements have contributed to the widespread use of ECMO in critical care medicine. Nevertheless, several questions regarding its optimal application persist, with patient-centered outcomes at the forefront of care delivery. The discussion regarding the details of physiological principle underlying ECMO, various cannulation strategies, and monitoring approaches is beyond the scope of this review. In this article, we aim to provide valuable insights and address relevant queries pertaining to the optimal use of ECMO in critical care medicine.

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Section: How Do You Wean and Discontinue The Support?mentioning

confidence: 99%

Finding the needle in haystack of questions: ECMO in hypoxemic respiratory failure

Guru

Sahoo

2023

J. Nep. Soc. Crit. Care Med.

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“…Pneumothorax during cannulation can become a life-threatening situation, as patients are already hypoxemic and receiving high-intensity mechanical ventilation. Echocardiographic guidance can identify guide wire misplacement, pneumothorax, and early right ventricular free-wall perforation (55). Inadvertent arterial cannulation is suspected in the event of acute limb ischemia in patients supported with V-V ECMO (54).…”

Section: Short-term Problemsmentioning

confidence: 99%

Complications Associated With Venovenous Extracorporeal Membrane Oxygenation—What Can Go Wrong?

Teijeiro-Paradis

Gannon

Fan

2022

Critical Care Medicine

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Despite increasing use and promising outcomes, venovenous extracorporeal membrane oxygenation (V-V ECMO) introduces the risk of a number of complications across the spectrum of ECMO care. This narrative review describes the variety of short-and long-term complications that can occur during treatment with ECMO and how patient selection and management decisions may influence the risk of these complications.DATA SOURCES: English language articles were identified in PubMed using phrases related to V-V ECMO, acute respiratory distress syndrome, severe respiratory failure, and complications. STUDY SELECTION:Original research, review articles, commentaries, and published guidelines from the Extracorporeal Life support Organization were considered.DATA EXTRACTION: Data from relevant literature were identified, reviewed, and integrated into a concise narrative review. DATA SYNTHESIS:Selecting patients for V-V ECMO exposes the patient to a number of complications. Adequate knowledge of these risks is needed to weigh them against the anticipated benefit of treatment. Timing of ECMO initiation and transfer to centers capable of providing ECMO affect patient outcomes. Choosing a configuration that insufficiently addresses the patient's physiologic deficit leads to consequences of inadequate physiologic support. Suboptimal mechanical ventilator management during ECMO may lead to worsening lung injury, delayed lung recovery, or ventilator-associated pneumonia. Premature decannulation from ECMO as lungs recover can lead to clinical worsening, and delayed decannulation can prolong exposure to complications unnecessarily. Short-term complications include bleeding, thrombosis, and hemolysis, renal and neurologic injury, concomitant infections, and technical and mechanical problems. Long-term complications reflect the physical, functional, and neurologic sequelae of critical illness. ECMO can introduce ethical and emotional challenges, particularly when bridging strategies fail. CONCLUSIONS:V-V ECMO is associated with a number of complications. ECMO selection, timing of initiation, and management decisions impact the presence and severity of these potential harms.

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“…Assessment of respiratory function according to Extracorporeal Life Support Organization (ELSO) guidelines is usually performed before trial-off and weaning, which includes a thorough evaluation of blood gases and ventilatory settings [10]. However, these assessments often include information from other investigations such as computed tomography (CT) [11]. Today, CT is often used to evaluate lung recruitability and lung pathology [12,13].…”

Section: Introductionmentioning

confidence: 99%

Severe Lung Dysfunction and Pulmonary Blood Flow during Extracorporeal Membrane Oxygenation

Falk,

Lidegran,

Diaz Ruiz

et al. 2024

JCM

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Background: Extracorporeal membrane oxygenation (ECMO) is indicated for patients with severe respiratory and/or circulatory failure. The standard technique to visualize the extent of pulmonary damage during ECMO is computed tomography (CT). Purpose: This single-center, retrospective study investigated whether pulmonary blood flow (PBF) measured with echocardiography can assist in assessing the extent of pulmonary damage and whether echocardiography and CT findings are associated with patient outcomes. Methods: All patients (>15 years) commenced on ECMO between 2011 and 2017 with septic shock of pulmonary origin and a treatment time >28 days were screened. Of 277 eligible patients, 9 were identified where both CT and echocardiography had been consecutively performed. Results: CT failed to indicate any differences in viable lung parenchyma within or between survivors and non-survivors at any time during ECMO treatment. Upon initiation of ECMO, the survivors (n = 5) and non-survivors (n = 4) had similar PBF. During a full course of ECMO support, survivors showed no change in PBF (3.8 ± 2.1 at ECMO start vs. 7.9 ± 4.3 L/min, p = 0.12), whereas non-survivors significantly deteriorated in PBF from 3.5 ± 1.0 to 1.0 ± 1.1 L/min (p = 0.029). Tidal volumes were significantly lower over time among the non-survivors, p = 0.047. Conclusions: In prolonged ECMO for pulmonary septic shock, CT was not found to be effective for the evaluation of pulmonary viability or recovery. This hypothesis-generating investigation supports echocardiography as a tool to predict pulmonary recovery via the assessment of PBF at the early to later stages of ECMO support.

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Monitoring during extracorporeal membrane oxygenation

Cited by 7 publications

References 72 publications

Finding the needle in haystack of questions: ECMO in hypoxemic respiratory failure

Finding the needle in haystack of questions: ECMO in hypoxemic respiratory failure

Complications Associated With Venovenous Extracorporeal Membrane Oxygenation—What Can Go Wrong?

Severe Lung Dysfunction and Pulmonary Blood Flow during Extracorporeal Membrane Oxygenation

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