The Early History of Extracorporeal Membrane Oxygenation

Featherstone, Peter J; Ball, Christine

doi:10.1177/0310057x1804600601

Cited by 16 publications

(18 citation statements)

References 18 publications

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“…Extracorporeal membrane oxygenation (ECMO) is a specialised, advanced life support modality for critically ill patients with refractory cardiac or respiratory failure. The first report of prolonged extracorporeal oxygenation and perfusion of a patient suffering from severe acute respiratory distress syndrome (ARDS) dates from 1971 [ 1 ] and is often seen as the beginning of ECMO support as we know it today [ 2 ]. Although extracorporeal membrane oxygenation is often referred to as a therapy, it is actually a temporary support for cardiorespiratory failure, bridging time for recovery or permanent assist.…”

Section: Introductionmentioning

confidence: 99%

ECMO Predictors of Mortality: A 10-Year Referral Centre Experience

Treml

Breitkopf

Bukumirić

et al. 2022

JCM

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Background: Extracorporeal membrane oxygenation (ECMO) is a specialised life support modality for patients with refractory cardiac or respiratory failure. Multiple studies strived to evaluate the benefits of ECMO support, but its efficacy remains controversial with still inconsistent and sparse information. Methods: This retrospective analysis included patients with ECMO support, admitted between January 2010 and December 2019 at a tertiary university ECMO referral centre in Austria. The primary endpoint of the study was overall all-cause three-month mortality with risk factors and predictors of mortality. Secondary endpoints covered the analysis of demographic and clinical characteristics of patients needing ECMO, including incidence and type of adverse events during support. Results: In total, 358 patients fulfilled inclusion criteria and received ECMO support due to cardiogenic shock (258, 72%), respiratory failure (88, 25%) or hypothermia (12, 3%). In total, 41% (145) of patients died within the first three months, with the median time to death of 9 (1–87) days. The multivariate analysis identified hypothermia (HR 3.8, p < 0.001), the Simplified Acute Physiology Score III (HR 1.0, p < 0.001), ECMO initiation on weekends (HR 1.6, p = 0.016) and haemorrhage during ECMO support (HR 1.7, p = 0.001) as factors with higher risk for mortality. Finally, the most frequent adverse event was haemorrhage (160, 45%) followed by thrombosis. Conclusions: ECMO is an invasive advanced support system with a high risk of complications. Nevertheless, well-selected patients can be successfully rescued from life-threatening conditions by prolonging the therapeutic window to either solve the underlying problem or install a long-term assist device. Hypothermia, disease severity, initiation on weekends and haemorrhage during ECMO support increase the risk for mortality. In the case of decision making in a setting of limited (ICU) resources, the reported risk factors for mortality may be contemplable, especially when judging a possible ECMO support termination.

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Section: Introductionmentioning

confidence: 99%

ECMO Predictors of Mortality: A 10-Year Referral Centre Experience

Treml

Breitkopf

Bukumirić

et al. 2022

JCM

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“…It provides augmented oxygenation (venovenous, VV-ECMO) and/or cardiac output (venoarterial, VA-ECMO) in patients of all ages who suffer the conditions associated with cardiopulmonary failure. The application of ECMO has also expanded to extracorporeal cardiopulmonary resuscitation, and bridging to lung transplantation, although it has been most successful in treatment of newborns with severe respiratory failure (5,13,14).…”

Section: History Of Thoracic Organ-oriented Extracorporeal Circulatio...mentioning

confidence: 99%

Inflammation and Oxidative Stress in the Context of Extracorporeal Cardiac and Pulmonary Support

2022

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Extracorporeal circulation (ECC) systems, including cardiopulmonary bypass, and extracorporeal membrane oxygenation have been an irreplaceable part of the cardiothoracic surgeries, and treatment of critically ill patients with respiratory and/or cardiac failure for more than half a century. During the recent decades, the concept of extracorporeal circulation has been extended to isolated machine perfusion of the donor organ including thoracic organs (ex-situ organ perfusion, ESOP) as a method for dynamic, semi-physiologic preservation, and potential improvement of the donor organs. The extracorporeal life support systems (ECLS) have been lifesaving and facilitating complex cardiothoracic surgeries, and the ESOP technology has the potential to increase the number of the transplantable donor organs, and to improve the outcomes of transplantation. However, these artificial circulation systems in general have been associated with activation of the inflammatory and oxidative stress responses in patients and/or in the exposed tissues and organs. The activation of these responses can negatively affect patient outcomes in ECLS, and may as well jeopardize the reliability of the organ viability assessment, and the outcomes of thoracic organ preservation and transplantation in ESOP. Both ECLS and ESOP consist of artificial circuit materials and components, which play a key role in the induction of these responses. However, while ECLS can lead to systemic inflammatory and oxidative stress responses negatively affecting various organs/systems of the body, in ESOP, the absence of the organs that play an important role in oxidant scavenging/antioxidative replenishment of the body, such as liver, may make the perfused organ more susceptible to inflammation and oxidative stress during extracorporeal circulation. In the present manuscript, we will review the activation of the inflammatory and oxidative stress responses during ECLP and ESOP, mechanisms involved, clinical implications, and the interventions for attenuating these responses in ECC.

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“…Furthermore, a significant risk of AKI was seen in the patients who have been on ECMO, which is common among critically ill patients with cardiorespiratory failure, it is used in the Cath labs. [ 12–14 ]…”

Section: Epidemiology and Risk Factorsmentioning

confidence: 99%

A review on extracorporeal membrane oxygenation and kidney injury

Mei

2020

J Biochem & Molecular Tox

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Extracorporeal membrane oxygenation (ECMO) is inevitable external life support in case of cardiac and respiratory failure since the 1970s. Acute kidney injury (AKI) and the requirement of renal replacement therapy (RRT) is a potential risk among these patients. This review aims to give an overview of the risk of AKI, RRT, and associated mortality among the patients who received ECMO for any of its indications. PubMed database was searched to find the relevant literature and the reference list of included studies was also searched for additional studies. The incidence of AKI ranged from 30% to 78% and RRT from 47% to 60% in ECMO patients. The pathophysiology of AKI in ECMO is multifactorial, and includes ischaemia, RBCs breakdown, comorbidity, conversion of zymogen form of pro‐inflammatory mediators, structural alteration of the kidney, coadministration of nephrotoxic drugs, coagulation abnormality, and oxidative stress. ECMO was associated with the higher incidence of renal abnormalities, AKI, requirement of RRT, and associated mortality. Patients who underwent RRT had improved renal function and reduced overall mortality compared to the non‐RRT group among the ECMO patients. Currently, there is no consensus evidence to support the superior use of the inline hemofilter system over continuous renal replacement therapy among patients who had AKI during ECMO.

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The Early History of Extracorporeal Membrane Oxygenation

Cited by 16 publications

References 18 publications

ECMO Predictors of Mortality: A 10-Year Referral Centre Experience

ECMO Predictors of Mortality: A 10-Year Referral Centre Experience

Inflammation and Oxidative Stress in the Context of Extracorporeal Cardiac and Pulmonary Support

A review on extracorporeal membrane oxygenation and kidney injury

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