Prone positioning during veno-venous or veno-arterial extracorporeal membrane oxygenation: feasibility and complications after cardiothoracic surgery

Genty, Thibaut; Cherel, Quentin; Thès, Jacques; Bouteau, Astrid; Roman, Calypso; Stéphan, François

doi:10.1186/s13054-022-03944-y

Cited by 4 publications

(6 citation statements)

References 6 publications

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“…At the same time, other studies have not reported about the LV function (just) before implanting VA ECMO. 5 , 6 Finally, we were able to wean the patient from ECPELLA in a total of 4 days, compared with an average of 8 days, as reported by Genty et al . 5 in VA ECMO patients.…”

Section: Discussionsupporting

confidence: 53%

“… 5 , 6 Finally, we were able to wean the patient from ECPELLA in a total of 4 days, compared with an average of 8 days, as reported by Genty et al . 5 in VA ECMO patients. It is worth mentioning that we started unloading the LV with relatively high P-levels after Impella was inserted.…”

Section: Discussionsupporting

confidence: 53%

“… 1–4 However, only a couple of case and observational studies demonstrate the effectiveness of the prone position in patients with a VA ECMO. 5 , 6 These studies showed that prone positioning could help avoid an additional venous cannula, which can potentially decrease arterial blood flow and cause mechanical complications. In experienced centres, there is increasing use of more advanced strategies by cannulation of three large vessels (‘triple’ cannulation), resulting in veno-veno-arterial or veno-arterio-venous (VAV) cannulation.…”

Section: Discussionmentioning

confidence: 99%

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Proning the extracorporeal membrane oxygenation plus Impella: a case report

de Jongh,

Bax,

Ayan

et al. 2024

European Heart Journal - Case Reports

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Background The prone position is recommended as supportive therapy in patients with moderate- to severe acute respiratory distress syndrome (ARDS). However, little is known about prone position ventilation in patients with cardiogenic shock supported by ECPELLA (ECMO plus Impella) developing ARDS. Case summary A 66-year-old man with severe left ventricle dysfunction was admitted to a non-academic ECMO centre for a high-risk coronary artery bypass grafting. He developed postcardiotomy shock needing ECMO support. To improve left ventricular unloading, an Impella was inserted two days later. One day later, he developed ARDS and needed prone position ventilation with ECPELLA in situ. After four weeks, he was discharged from the ICU. Discussion Previous studies demonstrated that prone positioning could help avoid an additional venous cannula in veno-arterial ECMO patients, which is associated with mechanical complications. In this case, there was a promising role for unloading the LV with Impella during veno-arterial ECMO and for proning the patient with cardiogenic shock developing ARDS during ECMO support without the need for an extra venous cannula.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

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Proning the extracorporeal membrane oxygenation plus Impella: a case report

de Jongh,

Bax,

Ayan

et al. 2024

European Heart Journal - Case Reports

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“…Regular monitoring of fibrinogen levels is crucial in patients undergoing ECMO to assess their coagulation status and optimize outcomes. Several studies emphasize the significance of monitoring fibrinogen levels in managing bleeding and thrombosis, as well as determining the need for circuit change-outs [3,5,6].…”

Section: Fibrinogen Levelsmentioning

confidence: 99%

“…Furthermore, tracking markers like D-dimers and fibrinogen aids in identifying thrombus formation within the circuit. This review underscores the importance of regular monitoring and highlights the need for further research to establish standardized protocols for optimal timing in ECMO oxygenators or circuit change-outs [3,4].…”

Section: Introductionmentioning

confidence: 99%

Improving ECMO therapy: Monitoring oxygenator functionality and identifying key indicators, factors, and considerations for changeout

Butt,

Razzaq,

Saleem

et al. 2024

J Extra Corpor Technol

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Introduction: The optimal timing for extracorporeal membrane oxygenation (ECMO) circuit change-out is crucial for the successful management of patients with severe cardiopulmonary failure. This comprehensive review examines the various factors that influence the timing of oxygenator replacement in the ECMO circuit. By considering these factors, clinicians can make informed decisions to ensure timely and effective change-out, enhancing patient outcomes and optimizing the delivery of ECMO therapy. Methodology: A thorough search of relevant studies on ECMO circuit and oxygenator change-out was conducted using multiple scholarly databases and relevant keywords. Studies published between 2017 and 2023 were included, resulting in 40 studies that met the inclusion criteria. Discussion: Thrombosis within the membrane oxygenator and its impact on dysfunction were identified as significant contributors, highlighting the importance of monitoring coagulation parameters and gas exchange. Several factors, including fibrinogen levels, pre and post-membrane blood gases, plasma free hemoglobin, D-dimers, platelet function, flows and pressures, and anticoagulation strategy, were found to be important considerations when determining the need for an oxygenator or circuit change-out. The involvement of a multidisciplinary team and thorough preparation were also highlighted as crucial aspects in this process. Conclusion: In conclusion, managing circuit change-outs in ECMO therapy requires considering factors such as fibrinogen levels, blood gases, plasma free hemoglobin, D-dimers, platelet function, flows, pressures, and anticoagulation strategy. Monitoring these parameters allows for early detection of issues, timely interventions, and optimized ECMO therapy. Standardized protocols, personalized anticoagulation approaches, and non-invasive monitoring techniques can improve safety and effectiveness of circuit change-outs. Further research and collaboration are needed to advance ECMO management and enhance patient outcomes.

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V-v Ecmo

Räpple¹

2022

Ecmo

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Prone positioning during veno-venous or veno-arterial extracorporeal membrane oxygenation: feasibility and complications after cardiothoracic surgery

Cited by 4 publications

References 6 publications

Proning the extracorporeal membrane oxygenation plus Impella: a case report

Proning the extracorporeal membrane oxygenation plus Impella: a case report

Improving ECMO therapy: Monitoring oxygenator functionality and identifying key indicators, factors, and considerations for changeout

V-v Ecmo

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