ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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Legionella-associated respiratory failure has a high mortality, despite modern ventilation modalities. Extracorporeal membrane oxygenation (ECMO) is used to achieve gas exchange independent of pulmonary function in patients with severe respiratory failure. This was a retrospective review of the management and outcome of patients with Legionella-associated respiratory failure treated with ECMO support in a large ECMO center over the past 10 years. ⋯ Median PaO2/FiO2 ratio was 66 and median pCO2 was 60 torr. Sixteen patients (84%) survived to hospital discharge. Extracorporeal membrane oxygenation should be considered in patients with Legionella-associated respiratory failure, who have failed conventional ventilation.
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In this article, summary data from the annual international Extracorporeal Life Support Organization (ELSO) Registry Reports through July 2012 are presented. Nearly 51,000 patients have received extracorporeal life support (ECLS). Of the patients, 50% (>25,000) were neonatal respiratory failure, with a 75% overall survival to discharge or transfer. ⋯ Previously stable at about 100 cases a year for a decade, adult respiratory failure ECLS cases increased dramatically in 2009 with the H1N1 influenza pandemic and publication of the Conventional ventilation or ECMO for Severe Adult Respiratory failure (CESAR) trial results and have remained at approximately 400 cases a year through 2011 (55% survival). Use of ECLS for cardiac support represents a large area of consistent growth. Approximately 13,000 patients have been treated with survival to discharge rates of 40%, 49%, and 39% for neonates, pediatric, and adults, respectively.
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Respiratory failure requiring intubation has traditionally been a relative contraindication to lung transplantation due to increased morbidity and mortality. Advances in extracorporeal membranous oxygenation (ECMO) have made it possible to extubate patients and provide physical therapy with minimal native lung function. ⋯ However, providing anesthesia for these cases requires an understanding of ECMO physiology and the pharmacology associated with ECMO. We describe the anesthetic for four patients who were bridged to lung transplant and the complexities of their perioperative management.
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The role of extracorporeal membrane oxygenation (ECMO) as part of cardiopulmonary resuscitation (ECPR) among the elderly is not clearly defined. We sought to query the international Extracorporeal Life Support Organization (ELSO) registry database to investigate the use of ECMO support among the elderly. The objective of this study was to investigate survival to hospital discharge among the elderly supported on ECMO. ⋯ Among listed comorbidities, only the presence of pre-ECMO acute renal failure was significantly more frequent in nonsurvivors compared with survivors (14 vs. 0; p = 0.04). Survival to hospital discharge among the elderly supported on ECMO is lower than that for younger adult patients (28.7% vs. 40.0%). However, it is higher than that after conventional CPR (17%), suggesting that age should not be a bar against consideration for the use of ECMO in older patients but should be considered on a case-by-case basis.