Timing of ECMO Initiation Impacts Survival in Influenza-Associated ARDS

Steimer, Desiree A.; Hernandez, Omar; Mason, David P.; Schwartz, Gary S.

doi:10.1055/s-0038-1642066

Cited by 14 publications

(12 citation statements)

References 4 publications

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“…Patients cannulated early experience less ventilator-induced lung injury as a secondary insult and therefore may have accelerated pulmonary recovery. 18 There was a tendency in both the institutional and transport ECMO groups to have early initiation of ECMO, with 57% and 47% of patients cannulated in the first 48 hours, respectively (Table 1). The transport cohort did have a higher proportion of patients cannulated in 2 to 7 days and >7 days, likely reflecting delay in referral, potentially from trials of alternative ventilation strategies such as prone positioning or high-frequency oscillatory ventilation.…”

Section: Discussionmentioning

confidence: 98%

Effect of extracorporeal membrane oxygenation transport on short- and long-term survival in patients with acute respiratory distress syndrome

Steimer

Hernandez

Ogola

et al. 2019

Baylor University Medical Center Proceedings

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Venovenous extracorporeal membrane oxygenation (ECMO) has emerged as an important tool in the treatment of acute respiratory distress syndrome (ARDS). The creation of portable ECMO circuits and pumps has supported the development of interfacility ECMO programs. Prior studies have demonstrated that ECMO transport is safe; however, long-term outcomes for these patients remain unknown. Retrospective analysis of our 5-year experience identified 58 patients transported on ECMO and 82 patients cannulated at our institution. When short-term (30 days) and long-term (1 year) outcomes were compared between these cohorts, there was no statistically significant difference in survival (P ¼ 0.44 and 0.49). There were no deaths related to transport, and the rate of ECMO-related complications was similar between the groups. With established patient safety and similar long-term survival, ECMO transport is a feasible solution to provide access to ECMO for all communities.

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Section: Discussionmentioning

confidence: 98%

Effect of extracorporeal membrane oxygenation transport on short- and long-term survival in patients with acute respiratory distress syndrome

Steimer

Hernandez

Ogola

et al. 2019

Baylor University Medical Center Proceedings

Self Cite

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“…ECMO provides time for the treatment of underlying reversible causes and thus acts as a bridge to therapy. However, survival depends on the timing of the reversal of these causes as well as the timing of the initiation of ECMO [14,15]. Therefore, survival will be better in cases in which underlying causes are quickly determined and treated.…”

Section: Discussionmentioning

confidence: 99%

Emergency department extracorporeal membrane oxygenation may also include noncardiac arrest patients

Özlüer¹,

Avcil²,

Ege³

et al. 2021

Turk J Med Sci

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Background/aim: The primary purpose of this study is to report the experience on the extracorporeal membrane oxygenation (ECMO) process for patients in the critical care unit (CCU) of an Emergency Department of a tertiary hospital in Turkey, from cannulation to decannulation, including follow-up procedures. Materials and Methods: This retrospective, observational study included eight patients who received Extracorporeal Membrane Oxygenation from Jan 2018-Jan 2020. We evaluated the demographics, indications for ECMO, laboratory values, Respiratory ECMO Survival Prediction, Survival After Veno-Arterial ECMO and ECMOnet scores, the management process, and patient outcomes. Blood gas analyses from after the first hour of ECMO initiation and the re-evaluation of the patients' Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores at the 24 th hour of ECMO were recorded. Results: The mean age was 52.7 ± 14.2 years. The median duration of the ECMO run was 81 (min-max: 4-267) hours, and the mean length of CCU stay was 10.2 ± 6.7 days. Of the 8 patients studied, 5 (62.5%) had veno-arterial and 3 (37.5%) had veno-venous ECMO. Three patients were successfully weaned (37.5%). The overall survival-to-discharge rate was 25%. Carbon dioxide levels were significantly decreased 1 hour after ECMO initiation (p=0.038) as well as the need for vasopressors. Lactate levels were lower in decannulated patients. Changes in the 2 APACHE II score were more consistent with the clinical deterioration in patients than were SOFA score changes. Conclusions: In the early phase of ECMO, vital signs improve, and the need for vasopressors and carbon dioxide levels decreases. Thus, CCUs in Emergency Departments with ECMO capabilities could potentially be designed, and emergency department ECMO algorithms could be tailored for critically ill in addition to outof-hospital cardiac arrest (OHCA) patients.

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“…The ideal timing of ECMO for pediatric patients remains unclear. Steimer et al 33 reported that adult patients with acute respiratory distress syndrome (ARDS) who were cannulated within 48 hours of admission had an 80% survival rate at 90 days. Liao et al 34 showed that early establishment of ECMO might improve the prognosis for patients with refractory cardiogenic shock.…”

Section: Discussionmentioning

confidence: 99%

Clinical and laboratory predictors of survival for pediatric patients on non-postcardiotomy extracorporeal membrane oxygenation (ECMO)

Şık¹,

Demirbuğa²,

Temur³

et al. 2020

Turk J Pediatr

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Extracorporeal membrane oxygenation (ECMO) is used in pediatric patients with severe cardiopulmonary failure who do not respond to conventional therapy; only a few studies have been conducted in Turkey. We present the experience of pediatric ECMO with the aim of showing factors affecting mortality. We retrospectively reviewed our ECMO database to identify patients who received ECMO from October 2015 to March 2018. Our population comprised 30 pediatric patients. The mean patient age was 41.31±53.35 months and 17 (56.7%) patients were male. The median duration of ECMO support was 8.9 (6.6-10.8) days. The rates of successful ECMO weaning and survival to discharge were 70.0% (n=21) and 66.7% (n=20), respectively. Indications for ECMO were respiratory failure (40.0%), cardiac failure (33.3%), and sepsis (26.7%). We found that pre-cannulation values of pH (p=0.034), leukocytes (p=0.029), C-reactive protein (p=0.045), creatinine (p=0.047), chloride (p=0.001) and post-cannulation pH (p=0.0001), bicarbonate (p=0.014), lactate (p=0.002), chloride (p=0.0001) were associated with mortality. The results showed that preexisting sepsis and renal conditions contributed to poor outcomes. Indications, ECMO onset time, and pre-and post-cannulation laboratory values such as leukocytes, CRP, creatinine, bicarbonate, lactate, and chloride are factors that affect outcomes.

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Timing of ECMO Initiation Impacts Survival in Influenza-Associated ARDS

Cited by 14 publications

References 4 publications

Effect of extracorporeal membrane oxygenation transport on short- and long-term survival in patients with acute respiratory distress syndrome

Effect of extracorporeal membrane oxygenation transport on short- and long-term survival in patients with acute respiratory distress syndrome

Emergency department extracorporeal membrane oxygenation may also include noncardiac arrest patients

Clinical and laboratory predictors of survival for pediatric patients on non-postcardiotomy extracorporeal membrane oxygenation (ECMO)

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