Understanding the long-term sequelae of ECMO survivors

Burns, Stacey; Constantin, Natalie; Robles, Priscila; Investigators, Recover

doi:10.1007/s00134-017-4714-3

Cited by 18 publications

(13 citation statements)

References 22 publications

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“…The overall balance between pro-and anti-inflammatory effects (i.e., whether end-organ protective strategies outweigh the injurious effects of ECLS) likely determine the impact on the immune response and the consequent risk of infection. Whether these alterations pose an increased risk of infection after decannulation from ECLS is an area that warrants further investigation [37].…”

Section: Risk Factors For the Development Of Infections During Eclsmentioning

confidence: 99%

ECLS-associated infections in adults: what we know and what we don’t yet know

et al. 2019

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Extracorporeal life support (ECLS) is increasingly used in the management of patients with severe cardiopulmonary disease. Infections are frequently the etiologies underlying the respiratory, and occasionally cardiac, failure that necessitates ECLS. Just as importantly, infections are among the most commonly reported adverse events during ECLS. Infections in this setting may be the sequelae of prolonged critical illness or of underlying immune dysregulation; they may be hospital-acquired infections, and they may or may not be attributable to the presence of ECLS itself, the latter being an aspect that can be difficult to determine. Current registry data and evidence from the literature offer some insights, but also leave open many questions regarding the nature and significance of infections reported both before and during ECLS, including the question of any causal link between ECLS and the development of infections. An ongoing lack of consistency in the identification, diagnosis, management, and prevention of infections during ECLS is limiting our ability to interpret literature data and thus highlighting the need for more rigorous investigation and standardization of definitions. This review aims to characterize the current understanding of infections associated with the use of ECLS, taking into account data from the updated Extracorporeal Life Support Organization Registry, which provides important context for understanding the epidemiology and outcomes of these patients.

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Section: Risk Factors For the Development Of Infections During Eclsmentioning

confidence: 99%

ECLS-associated infections in adults: what we know and what we don’t yet know

et al. 2019

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“…Whether these alterations pose an increased risk of infection after decannulation from ECMO is an area that warrants further investigation. 24…”

Section: Risk Factors For the Development Of Infections During Ecmomentioning

confidence: 99%

Sepsis Associated with Extracorporeal Membrane Oxygenation

Jain

Mehta

2022

Journal of Cardiac Critical Care TSS

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Sepsis in patients on extracorporeal membrane oxygenation (ECMO) remains a serious complication. Its presence is a poor prognostic marker and increases overall mortality. Adult patients with prolonged duration on ECMO are at high risk of developing sepsis. Ventilator-associated pneumonia and bloodstream infections are the main sources of infection these patients. A strong early suspicion, drawing adequate volume for blood cultures, and early and timely administration of empirical antibiotics can help control the infection and decrease the morbidity and mortality. The diagnostic and the treatment are both challenging. Cardiac patients have increased risk of nosocomial infection while on ECMO, which may be in part due to longer cannulation times, as well as increased likelihood of undergoing major procedures or having an open chest.

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“…Long duration of ECMO, usually called long runs, is probably the most important risk factor for developing healthcare-associated infections (such as respiratory, bloodstream and urinary tract infections). 11 In addition to local infection in the cannula site, vascular complications such as thrombosis, major bleeding and ischemia are frequent, mainly with VA-ECMO, as is described in studies in the adult population. 12 The main causes of morbidity and mortality in ECMO patients are thrombosis and bleeding.…”

Section: Complicationsmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation: The First 10 Years Experience of a Portuguese Pediatric Intensive Care Unit

Meireles¹,

Abecasis

Boto

et al. 2021

Acta Med Port

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Introduction: In Portugal, extracorporeal membrane oxygenation (ECMO) is used in pediatric patients since 2010. The aim of this study was to describe the clinical characteristics of patients, indications, complications and mortality associated with the use of ECMO during the first 10-years of experience in the Pediatric Intensive Care Unit located in Centro Hospitalar Universitário Lisboa Norte.Material and Methods: Retrospective observational cohort study of all patients supported with ECMO in a Pediatric Intensive Care Unit, from the 1st of May 2010 up to 31st December 2019.Results: Sixty-five patients were included: 37 neonatal (≤ 28 days of age) and 28 pediatric patients (> 28 days). In neonatal cases, congenital diaphragmatic hernia was the main reason for ECMO (40% of neonatal patients and 23% of total). Among pediatric patients, respiratory distress was the leading indication for ECMO (47% of total). The median length of ECMO support was 12 days. Clinical complications were more frequent than mechanical complications (65% vs 35%). Among clinical complications, access site bleeding was the most prevalent with 38% of cases. The overall patient survival was 68% at the time of discharge (65% for neonatal and 71% for pediatric cases), while the overall survival rate in Extracorporeal Life Support Organization registry was 61%. The number of ECMO runs has been increasing since 2011, even though in a non-linear way (three cases in 2010 to 11 cases in 2019).Discussion: In the first 10 years we received patients from all over the country. Despite continuous technological developments, circuitrelated complications have a significant impact. The overall survival rate in the Pediatric Intensive Care Unit was not inferior to the one reported by the Extracorporeal Life Support Organization.Conclusion: The overall survival of our Pediatric Intensive Care Unit is not inferior to one reported by other international centers. Our experience showed the efficacy of the ECMO technique in a Portuguese centre.

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Understanding the long-term sequelae of ECMO survivors

Cited by 18 publications

References 22 publications

ECLS-associated infections in adults: what we know and what we don’t yet know

ECLS-associated infections in adults: what we know and what we don’t yet know

Sepsis Associated with Extracorporeal Membrane Oxygenation

Extracorporeal Membrane Oxygenation: The First 10 Years Experience of a Portuguese Pediatric Intensive Care Unit

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