Review of ECMO (Extra Corporeal Membrane Oxygenation) Support in Critically Ill Adult Patients

Marasco, Silvana; Lukas, George; McDonald, Michael D.; McMillan, Julie; Ihle, Benno U.

doi:10.1016/j.hlc.2008.08.009

Cited by 344 publications

(285 citation statements)

References 21 publications

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“…An aim to keep platelets greater than 80 × 109/L is acceptable [6]. Lower degree of anticoagulation or even no anticoagulation for a period of time might be necessary if life-threatening hemorrhage exists [7]. ECMO support uniformly leads to thrombocytopenia, disseminated intravascular coagulopathy and renal dysfunction, which alter the function of the remaining platelets.…”

Section: Discussionmentioning

confidence: 99%

“…Fluid or blood products are generally indicated to remedy this situation. With the additional fluids, patients may require diuresis to maintain a favorable fluid balance while closely monitoring ECMO blood flow [7]. Blood flow can also be affected by cannula malposition, pneumothorax, and pericardial tamponade.…”

Section: Discussionmentioning

confidence: 99%

“…Great care is required to provide an optimal surgical approach while maintaining the integrity and efficiency of the ECMO circuit. Other complications that anesthesiologists need to be aware of include air embolism and thromboembolism [7]. Mechanical complications related to ECMO include oxygenator failure, tubing rupture, pump malfunction, and cannula related problems.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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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“…It is considered more invasive than v-v ECMO and is associated with a higher incidence of neurologic events (infarction, microemboli, hemorrhage) as well as peripheral vascular complications (dissection, limb ischemia, aneurysm). Moreover, femoro-femoral v-a ECMO sometimes fails to provide adequate central oxygenation, especially in patients with a high cardiac output (46).…”

Section: Veno-arterial (V-a) Ecmomentioning

confidence: 99%

Extracorporeal support in airway surgery

Höetzenecker¹,

Klepetko²,

Keshavjee³

et al. 2017

J. Thorac. Dis.

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Extracorporeal life support (ECLS) is increasingly used for major airway surgery. It facilitates complex reconstructions and maintains gas exchange during endoscopic procedures in patients with critical airway obstruction. ECLS offers the advantage of an uncluttered surgical field and eliminates the need for crossing ventilation tubes, thus, making precise surgical dissection easier. ECLS is currently used for hemodynamic and respiratory support in lung transplantation as well as extended tumor resections with an acceptable risk profile. This work reviews the published experience of ECLS in airway surgery both in adults and in pediatric patients. It highlights currently available devices and their indications.

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“…There have been clear demonstrations of its benefit in the general population of patients, with various indications. (1) Successful use of ECMO immediately postpartum has been reported in several case studies in obstetric patients with various indications. (2)(3)(4)(5)(6)(7)(8) In this report, we present a complex case of an obstetric patient with massive hemorrhage after a spontaneous abortion at 21 weeks of gestation.…”

Section: Introductionmentioning

confidence: 99%

Life saving use of ECMO in an obstetric patient with massive hemorrhage following uterine atony: a case report

Barbalić

Tokmadžić²,

Petrović³

et al. 2016

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The aim of this case report is to present the life saving use of extracorporeal membrane oxygenation (ECMO) in an obstetric patient with acute cardiorespiratory collapse following massive bleeding caused by an atonic uterus post partum. A 39-year-old patient, following a spontaneous abortion at 21 weeks of pregnancy, developed uterine atony and massive bleeding and was ultimately referred to the operating room for an emergent hysterectomy. Postoperatively, she was referred to the intensive care unit (ICU) where she developed severe acute respiratory distress syndrome (ARDS) that was successfully treated by employing ECMO. Following discontinuation of ECMO, her treatment was further complicated by a manifest hemolytic transfusion reaction. Although extensive testing was done to establish the cause of this reaction, we were unable to find it. The patient responded well to treatment with erythropoietin (EPO) and corticosteroids as well as a restrictive transfusion regime. This treatment pointed to a possible immune reaction to massive transfusions of blood products. This case demonstrated the importance of early aggressive treatment using ECMO in reversal of life threatening ARDS, as well as the need for a judicious approach when transfusing blood products.

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Review of ECMO (Extra Corporeal Membrane Oxygenation) Support in Critically Ill Adult Patients

Cited by 344 publications

References 21 publications

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

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

Extracorporeal support in airway surgery

Life saving use of ECMO in an obstetric patient with massive hemorrhage following uterine atony: a case report

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