Standardized Weaning from Temporary Extracorporeal Life Support in Cardiovascular Patients

Thomas, Marie; Kreibich, Maximilian; Beyersdorf, Friedhelm; Benk, Christoph; Maier, Sven; Trummer, Christian

doi:10.1055/s-0039-1692177

Cited by 5 publications

(10 citation statements)

References 21 publications

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“…Six studies have examined ECMO weaning directly, either by introducing new criteria for weaning or trialing new protocols and methods. [4][5][6][7][8][9] The remaining articles included examined ECMO outcomes and described the ECMO weaning protocol utilized in detail, but did not primarily study the weaning process itself. None of the studies reported complications attributed to their method of ECMO weaning.…”

Section: Resultsmentioning

confidence: 99%

“…2,6,7,13 Specific ventilator criteria have been proposed as well. Thomas et al 4 require that positive end expiratory pressure (PEEP) be less than 10 mm Hg before weaning. Slottosch et al 14 argued that a fraction of inspired oxygen (FiO 2 ) <70% should be achieved before ECMO weaning, and other authors have proposed even more stringent criteria, arguing that the FiO 2 from the ventilator should be as low as 50%.…”

Section: Respiratory Criteriamentioning

confidence: 99%

“…When evaluating patients for cardiopulmonary recovery, implementing a formalized weaning protocol can be useful in guiding clinical decisions, and has been shown to improve rates of recovery and patient survival. [1][2][3][4] The Extracorporeal Life Support Organization (ELSO) guidelines (2013) recommend that VA ECMO weaning can be attempted once there is evidence of aortic pulsatility and ventricular contraction on echocardiogram. It suggests that the flow should be reduced to 50% and 25% of cardiac output with subsequent clamping of the cannulas.…”

mentioning

confidence: 99%

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How to Turn It Down: The Evidence and Opinions Behind Adult Venoarterial Extracorporeal Membrane Oxygenation Weaning

Trahanas

Crowley

et al. 2021

ASAIO Journal

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Adequate and durable recovery in patients supported with venoarterial (VA) extracorporeal membrane oxygenation (ECMO) can be challenging to predict. Extracorporeal membrane oxygenation weaning is the process by which the ECMO flows are decreased to assess if a patient is ready for decannulation. The optimal strategies for deciding who to wean and how to wean VA ECMO remain undefined. A retrospective literature review was performed to understand the evidence supporting current practices in ECMO weaning and in particular patient selection and methods. Most published work and expert opinions agree that once the underlying process has resolved, the minimum required physiologic parameters for weaning from ECMO include: hemodynamic stability and cardiac pulsatility, adequate lung function to support oxygenation and ventilation, and evidence of recovered end organ function. Echocardiography is universally used to assess cardiac function during the weaning process. Currently, there is no consensus regarding who is eligible to wean or how to wean ECMO in adults. We have reviewed the literature to summarize the evidence and expert opinions behind VA ECMO weaning, and give an example of the protocol used at our center. We believe this protocol optimizes patient selection for weaning and helps to predict successful decannulation.

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Section: Resultsmentioning

confidence: 99%

Section: Respiratory Criteriamentioning

confidence: 99%

mentioning

confidence: 99%

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How to Turn It Down: The Evidence and Opinions Behind Adult Venoarterial Extracorporeal Membrane Oxygenation Weaning

Trahanas

Crowley

et al. 2021

ASAIO Journal

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“…For constrictive pericarditis caused by tuberculous bacteria, systematic antituberculosis drugs should be given. Surgery should be performed after body temperature, erythrocyte sedimentation rate, and general nutritional status are close to normal or relatively stable [Thomas 2020;Cavigelli-Brunner 2018;Rupprecht 2018;Mehta 2017]. Antituberculosis treatment should be continued for 6 to 12 months to avoid recurrence.…”

Section: Pathological Discussionmentioning

confidence: 99%

Preoperative Pericardial Effusion is Associated with Low Cardiac Output Syndrome After Pericardiectomy for Constrictive Pericarditis

Wen

et al. 2021

HSF

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Background: Low cardiac output syndrome is the main cause of death after pericardiectomy. Methods: Patients who underwent pericardiectomy for constrictive pericarditis from January 2009 to October 2020 at our hospital were included in the study. Histopathologic studies of pericardium tissue from every patient were performed. All survivors were followed up. Results: Ninety-two consecutive patients underdoing pericardiectomy were included in the study. The incidence of postoperative low cardiac output syndrome was 10.7% (10/92). There were five operative deaths. Mortality and incidence of LCOS in the group with pericardial effusion were significantly higher than those in the group without pericardial effusion. Tuberculosis of the pericardium (60/92, 65.2%) was the most common histopathologic finding in this study. Both univariate and multivariate analyses showed that preoperative pericardial effusion is associated with increased rate of low cardiac output syndrome. Eighty-five survivors were in NYHA class I (85/87, 97.7%), and two were in class II (2/87, 2.3%) at the latest follow up. Conclusions: Preoperative pericardial effusion is associated with low cardiac output syndrome after pericardiectomy. Tuberculosis of the pericardium was the most common histopathologic finding in this study. For constrictive pericarditis caused by tuberculous bacteria, systematic antituberculosis drugs should be given. Preoperative pericardial effusion is associated with increased rate of low cardiac output syndrome. Perfect preoperative preparation is very important to reduce the incidence of postoperative low cardiac output syndrome and mortality. It is very important to use a large dose of diuretics with cardiotonic or vasopressor in a short time after the operation.

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“…These factors also interact with one another pre-, peri-, and postoperatively. Figure 1 highlights the pathophysiological mechanisms resulting in development of AKI [Thomas 2020;Shen 2020;Nishimoto 2020;Sanaiha 2020;Murashima 2019;Ueno 2020].…”

Section: Pathophysiological Mechanisms Of Akimentioning

confidence: 99%

Acute Kidney Injury: Lessons from Pericardiectomy

Wen

et al. 2021

HSF

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Background: Acute kidney (renal) injury (AKI) is a severe and common complication that occurs in ~40% of patients undergoing cardiac surgery. AKI has been associated with increased mortality and worse prognosis. This prospective study was conducted to determine the risk factors for AKI after pericardiectomy and decrease the operative risk of mortality and morbidity. Methods: This was a prospective, observational cohort study of patients with constrictive pericarditis undergoing pericardiectomy. All patients underwent pericardiectomy via median sternotomy. Serum creatinine was used as the diagnostic standard of AKI according to Kidney Disease Improving Global Outcomes classification. All survivors were monitored to the end date of the study. Results: Consecutive patients (N = 92) undergoing pericardiectomy were divided into 2 groups: with AKI (n = 25) and without AKI (n = 67). The incidence of postoperative AKI was 27.2% (25/92). Hemodialysis was required for 10 patients (40%), and there were 5 operative deaths. Mortality, intubation time, time in intensive care unit, fresh-frozen plasma, and packed red cells of the group with AKI were significantly higher than those of the group without AKI. Both univariate and multivariate analyses showed that statistically significant independent predictors of AKI include intubation time, chest drainage, fresh-frozen plasma, and packed red cells. The latest follow-up data showed that 85 survivors were New York Heart Association class I (97.7%) and 2 were class II (2.3%). Conclusions: AKI after pericardiectomy is a serious complication and contributes to significantly increased morbidity and mortality. Prevention of AKI development after cardiac surgery and optimization of pre-, peri-, and postoperative factors that can reduce AKI, therefore, contribute to a better postoperative outcome and leads to lower rates of AKI, morbidity, and mortality.

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Standardized Weaning from Temporary Extracorporeal Life Support in Cardiovascular Patients

Cited by 5 publications

References 21 publications

How to Turn It Down: The Evidence and Opinions Behind Adult Venoarterial Extracorporeal Membrane Oxygenation Weaning

How to Turn It Down: The Evidence and Opinions Behind Adult Venoarterial Extracorporeal Membrane Oxygenation Weaning

Preoperative Pericardial Effusion is Associated with Low Cardiac Output Syndrome After Pericardiectomy for Constrictive Pericarditis

Acute Kidney Injury: Lessons from Pericardiectomy

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