Seminars in cardiothoracic and vascular anesthesia
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Semin Cardiothorac Vasc Anesth · Sep 2009
ReviewAnticoagulation and coagulation management for ECMO.
Advances in extracorporeal membrane oxygenation (ECMO) management have helped to reduce complications compared with its inception but they remain high. The principal causes of mortality and morbidity are bleeding and thrombosis. The nonbiologic surface of an extracorporeal circuit provokes a massive inflammatory response leading to consumption and activation of procoagulant and anticoagulant components. ⋯ Increased use of thrombelastogram will complement other methods currently being used to improved care. Methods to recognize the level of thrombin formation at the bedside could help reduce neurologic complications. ECMO requires a multidisciplinary team approach to achieve the best outcomes.
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Semin Cardiothorac Vasc Anesth · Sep 2009
ReviewUpdate on safety equipment for extracorporeal life support (ECLS) circuits.
Though much has been surveyed and written about the equipment aspects of extracorporeal life support (ECLS) in the past 10 years, there is value in reviewing the use and nonuse of multiple safety devices and techniques. Minimally equipped ECLS circuits for adult and pediatric bridge to decision during cardiac and respiratory failure are rapidly gaining popularity to maintain simplicity and portability. ⋯ The purpose of this review is to compare and contrast the spectrum of minimally equipped ECLS circuits to circuits with maximum flexibility and safety device protection. Due to the lack of high-level, well-controlled scientific studies regarding ECLS equipment and safety devices, this study reviews the basis for how we use ECLS circuits and devices in our institution to provide safe patient support.
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Semin Cardiothorac Vasc Anesth · Sep 2009
ReviewOptimal time for initiating extracorporeal membrane oxygenation.
The technical evolution of extracorporeal membrane oxygenation (ECMO) coincides with the vast improvement in intensive care medicine of the past 4 decades. Extracorporeal circulatory technology substitutes for acutely failed cardiac or pulmonary function until these organs regain sustainable function through goal-oriented intensive care practice. ⋯ Delaying the institution of ECMO may cause irreversible pulmonary and cardiac injuries in addition to other organs. Therefore, the optimal time of initiating ECMO support is crucial to the survival of a critically ill patient.
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Semin Cardiothorac Vasc Anesth · Sep 2009
Extracorporeal life support: utilization, cost, controversy, and ethics of trying to save lives.
Since the first successful application of extracorporeal membrane oxygenation (ECMO) in 1972, ECMO's role in the management of respiratory and circulatory collapse continues to be refined and debated. Randomized clinical trials aimed at establishing efficacy and patient selection criteria have been fraught with ethical challenges. Growing concerns over rising health care costs require that careful evaluations of cost, utilization, and ethical issues surrounding heroic life-saving interventions such as ECMO are undertaken. Continued analyses of ECMO's place in the medical management of respiratory and circulatory failure will help ensure that ECMO is used for not only prolonging life but also for providing a chance for "quality of life" following recovery from near-fatal illnesses.
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Semin Cardiothorac Vasc Anesth · Sep 2009
Extracorporeal membrane oxygenation for the treatment of neonatal respiratory failure.
This review discusses the use of extracorporeal membrane oxygenation (ECMO) for the treatment of respiratory failure in neonates. After briefly reviewing the early history of neonatal ECMO, the authors describe the respiratory diagnoses most often treated with ECMO and the manner in which affected neonates are deemed to have "failed" conventional therapies and thus require ECMO. After reviewing the most common indications for ECMO, factors that influence the timing of conversion to extracorporeal life support, as well as criteria that may exclude patients from receiving ECMO therapy, are described. At the conclusion of this article, the authors discuss the long-term outcomes of neonates whose respiratory disease was treated with ECMO and the costs associated with that care.