ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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The importance of microbial colonization during extracorporeal membrane oxygenation (ECMO) is unclear. We prospectively cultured ECMO oxygenators and retrospectively reviewed the culture results, clinical outcomes, and associated factors in 112 ECMO patients (122 oxygenators, 1,196 ECMO days). Of the oxygenators, 11.6% (n = 13) had positive cultures. ⋯ In multivariate analyses, age (per decade) (odds ratio [OR] = 1.95, 95% CI = 1.28-2.95; p = 0.002), oxygenator colonization (OR = 15.49, 95% CI = 3.31-72.46; p < 0.001), and renal replacement therapy (OR = 4.61, 95% CI = 1.69-12.58; p = 0.003) were significantly associated with mortality. Oxygenator colonization was associated with poor outcomes in ECMO patients. These results support the early exchange and culture of oxygenators in patients with persisting bacteremia.
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Discharging children on ventricular assist device (VAD) support offers advantages for quality of life. We sought to describe discharge and readmission frequency in children on VAD support. All VAD-implanted patients aged 10-21 years at Advanced Cardiac Therapies Improving Outcomes Network (ACTION) centers were identified from the Pediatric Health Information System database (2009-2018). ⋯ Discharge of children on VAD support has increased over time, although variability exists across centers. Readmissions are common with diverse indications; however, the risk of mortality is low. Further interventions, including collaboration in ACTION, are critical to increasing discharges and optimizing outpatient management.
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Venovenous extracorporeal membrane oxygenation (VV ECMO) can successfully support patients with refractory respiratory failure and is widely accepted as a bridge to recovery or bridge to transplantation. However, some problems hinder success. Recirculation, an innate complication of VV ECMO, hamper efficient oxygenation. ⋯ Compared to VV ECMO, it has advantages of hemodynamic support, elimination of recirculation, and facilitation of rehabilitation. In the present case, we overcame recirculation and impending RV failure by applying OxyRVAD to patient who was initially managed with VV ECMO. He underwent lung transplantation after about 6 months of OxyRVAD support with active rehabilitation, the longest maintenance period ever known.
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Review Multicenter Study
Multi-institutional Analysis of 100 Consecutive Patients with COVID-19 and Severe Pulmonary Compromise Treated with Extracorporeal Membrane Oxygenation: Outcomes and Trends Over Time.
The role of extracorporeal membrane oxygenation (ECMO) in the management of severely ill patients with coronavirus disease 2019 (COVID-19) continues to evolve. The purpose of this study is to review a multi-institutional clinical experience in 100 consecutive patients, at 20 hospitals, with confirmed COVID-19 supported with ECMO. This analysis includes our first 100 patients with complete data who had confirmed COVID-19 and were supported with ECMO. ⋯ Extracorporeal membrane oxygenation may facilitate salvage and survival of selected critically ill patients with COVID-19. Survivors tend to be younger. Substantial variation exists in the drug treatment of COVID-19, but ECMO offers a reasonable rescue strategy.
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We are developing a left atrial assist device (LAAD) to pump blood from the left atrium to the left ventricle for patients who have heart failure with preserved ejection fraction (HFpEF). This study aimed to assess the hemodynamics with the LAAD implanted at two different levels: the mitral valve (MV) level, after removing the MV; and the supravalvular level, preserving MV function conditions using an in vitro mock circulatory loop. ⋯ With high pump support after removing the MV, CO and AoP readings were comparable with those for preserved MV function (CO reached 3.9-4.1 L/min, AoP reached more than 110 mm Hg, and LAP dropped to 16-17 mm Hg under both conditions at high pump speeds). In the mock circulatory loop, our LAAD appeared to have sufficient ability to maintain the hemodynamic status at both positions.