The ProtekDuo in ECMO configuration for ARDS secondary to COVID-19: A systematic review

Maybauer, Marc O.; Capoccia, Massimo; Maybauer, Dirk M.; Lorusso, Roberto; Swol, Justyna; Brewer, Justin

doi:10.1177/03913988221142904

Cited by 18 publications

(12 citation statements)

References 14 publications

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“…Details on its use and configurations were described elsewhere in detail. 8 – 10 One patient was cannulated for venoarterial (V-A) ECMO under extracorporeal cardiopulmonary resuscitation (ECPR) after undergoing emergent cesarean section that was complicated by cardiac arrest. The cardiac arrest was secondary to bilateral main pulmonary artery embolism and the patient underwent catheter embolectomy on postoperative day 1.…”

Section: Resultsmentioning

confidence: 99%

Extracorporeal life support in pregnant and postpartum women with COVID-19-related acute respiratory distress syndrome

Banayosy

Smith³

et al. 2023

Int J Artif Organs

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Objective: Extracorporeal membrane oxygenation (ECMO) is an intervention used for patients with acute respiratory distress syndrome (ARDS) from COVID-19 who have failed conventional ventilatory strategies. Very few studies have given insight into the outcomes of pregnant and postpartum patients requiring ECMO support. Methods: Single center, retrospective, observational study of female pregnant and postpartum patients suffering COVID-19 ARDS and requiring ECMO. Results: Eight SARS-CoV-2 positive patients were identified. The average age was 31 ± 4 years, with Body Mass Indices (BMI) and SOFA scores ranging between 32–49 and 8–11, respectively. Two patients were pregnant at the time of ECMO initiation, two were peripartum, and four were postpartum. Five patients (63%) had bleeding, and one patient had a hysterectomy. Seven patients (88%) were supported by V-V ECMO and one with V-A ECMO. Patients had between one and three circuit exchanges due to oxygenator failure or clots in the circuit. All patients were in ICU between 7 and 74 days, with hospital length of stay between 8 and 81 days. All patients were weaned off ECMO and were successfully discharged from the hospital. All newborns were born via cesarean section, and all survived to discharge. Conclusion: Our study shows a 100% neonatal and maternal survival rate demonstrating that ECMO in this patient population is safe. These patients should be transferred to experienced high-volume ECMO centers with the ability to perform emergent cesarean sections. ECMO should be considered a life-saving therapy for pregnant women with severe COVID-19 with an overall excellent maternal and neonatal survival rate.

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Section: Resultsmentioning

confidence: 99%

Extracorporeal life support in pregnant and postpartum women with COVID-19-related acute respiratory distress syndrome

Banayosy

Smith³

et al. 2023

Int J Artif Organs

Self Cite

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“…The survival reported in patients with VPa ECMO is apparently better than that obtained with VV ECMO. 18 However, these reports are case series with few patients and a follow-up of less than 60 days. Badu et al 14 reported experience in the use of VPa ECMO with ProtekDuo cannula for the treatment of right ventricular failure in three subgroups of patients, one of these cohorts had associated respiratory failure.…”

Section: Discussionmentioning

confidence: 99%

Venopulmonary Artery Extracorporeal Life Support (VPa ECMO): A Novel Strategy for Refractory Hypoxemia Complicating VV ECMO

Salazar-Rojas,

García Gómez,

Pinzon Martinez

et al. 2024

ASAIO Journal

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Refractory hypoxemia (RH) during venovenous extracorporeal membrane oxygenation (VV ECMO) support is a complex problem that limits the benefit of this therapy. The need for sustained deep sedation and delays in active rehabilitation are considered as a direct consequence of RH. Changing from VV ECMO to a configuration that returns the flow to pulmonary artery, such as venopulmonary extracorporeal membrane oxygenation (VPa ECMO) may decrease recirculation and improve systemic oxygen delivery. We present a retrospective report that describes the impact of VPa ECMO on oxygenation during sedation withdrawal in 41 patients who received VV ECMO for coronavirus disease 2019 (COVID-19). We evidenced that arterial oxygen pressure (PaO2) increased from 68 to 112.3 mm Hg (p = 0.001) with a reduction of ECMO flow (5.7–4.8 L/m; p = 0.001). Other findings included lower rates of depth sedation (Richmond Agitation Sedation Scale [RASS] ≤3, 37–63%; p = 0.007) and lower requirement inotropic support assessed by LVIS score (4.7–1.1; p = 0.005). Discharge survival was 54% with a sustained benefit until day 79. This cannulation strategy improved effectively PaO2 in this cohort, it may be an alternative in patients with RH in VV ECMO.

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“…The versatility of the ProtekDuo® cannula allows for its use in various configurations, such as a drainage cannula for a VA ECMO mode [58,59]. Kumar et al described a patient with COVID-19 respiratory failure, initially on VV ECMO, who developed biventricular failure and cardiogenic shock.…”

Section: Application Of Protekduo® For Va Ecmo In (Dl)vp-a Configurationmentioning

confidence: 99%

“…Interestingly, the patient was originally supported Adaptive ECMO Therapeutics: The Integral Role of the ProtekDuo® Cannula DOI: http://dx.doi.org/10.5772/intechopen.1005327 with (dl)V-P ECMO and Impella CP, which had to be removed due to limb ischemia. However, the patient developed cardiogenic pulmonary edema and was converted to (dl)VP-Adt ECMO (Figure 10) until an Impella 5.5 could be placed [58].…”

Section: Application Of Protekduo® For Va Ecmo In (Dl)vp-a Configurationmentioning

confidence: 99%

Adaptive ECMO Therapeutics: The Integral Role of the ProtekDuo® Cannula

Brewer,

Dacey,

O. Maybauer

2024

Evolving Therapies and Technologies in Extracorporeal Membrane Oxygenation [Working Title]

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This chapter provides an in-depth analysis of the ProtekDuo® (LivaNova, London) dual-lumen cannula’s application in extracorporeal membrane oxygenation (ECMO), focusing on the procedural techniques of cannulation, weaning, and decannulation. The discussion will provide the step-by-step methodologies for inserting and removing the cannula, drawing from current clinical practices. Further, the chapter will explore the range of ECMO configurations that the ProtekDuo® cannula enables. It will examine how these configurations can be tailored to the evolving clinical requirements of patients, thereby enhancing the adaptability and effectiveness of ECMO therapy. This analysis will be anchored in the latest literature, providing a contemporary overview of patient outcomes and current practices. Lastly, the chapter will project into the future of the cannula technology for venopulmonary (VP) ECMO and other configurations. It will review ongoing research and development efforts, speculate on potential technological breakthroughs, and discuss the implication of these innovations for clinical practice. This forward-looking perspective will aim to inform and inspire continued advancement in ECMO therapy and technology.

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The ProtekDuo in ECMO configuration for ARDS secondary to COVID-19: A systematic review

Cited by 18 publications

References 14 publications

Extracorporeal life support in pregnant and postpartum women with COVID-19-related acute respiratory distress syndrome

Extracorporeal life support in pregnant and postpartum women with COVID-19-related acute respiratory distress syndrome

Venopulmonary Artery Extracorporeal Life Support (VPa ECMO): A Novel Strategy for Refractory Hypoxemia Complicating VV ECMO

Adaptive ECMO Therapeutics: The Integral Role of the ProtekDuo® Cannula

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