Crit Care Resusc
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Observational Study
Nosocomial infections acquired by patients treated with extracorporeal membrane oxygenation.
Infectious complications in patients treated with extracorporeal membrane oxygenation (ECMO) are a frequent contributor to morbidity and mortality in this group. Defining the characteristics of ECMO-related infections may inform treatment decisions, including antimicrobial therapy. ⋯ Infectious complications are common in ECMO patients and are associated with longer durations of hospital admission. Isolated pathogens were predominantly hospital-acquired Gram-negative bacteria and yeasts. Immunosuppression and treatment with VA ECMO were found to be specific risk factors for infection.
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Over the past decade, there has been growing interest in extracorporeal membrane oxygenation (ECMO) as a rescue therapy for patients with severe acute respiratory distress syndrome (ARDS) and cardiogenic shock. Although survival of ECMO-treated patients has improved recently, the incidence of ECMO-related complications such as bleeding and nosocomial infections remains unacceptably high. In addition, patients often experience long-term physiological and psychological sequelae. ⋯ Because the technique exposes patients to complications and is associated with high costs and resource utilisation, prediction models have been developed to assist clinicians in identifying patients that would most likely survive after ECMO treatment. In addition, these prediction models enable comparison of risk-adjusted outcomes, both over time and between centres. Our review explores the latest predictive survival models developed for ECMO-treated severe cardiogenic shock and ARDS patients.
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Multicenter Study Comparative Study
Management strategies in venovenous extracorporeal membrane oxygenation: a retrospective comparison from five European centres.
To investigate contemporary clinical practice in the management of venovenous (VV) extracorporeal membrane oxygenation (ECMO) in critically ill patients with bacterial pneumonia. ⋯ There is great diversity in management modalities for ventilator and ECMO settings for patients with bacterial pneumonia. Our study emphasises the lack of clinical consensus in VV ECMO management.
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Venovenous extracorporeal membrane oxygenation (VV ECMO) and extracorporeal CO2 removal (ECCO2R) are increasingly used in the management of severe respiratory failure. With bleeding complications being one of the major risks of these techniques, our aim in this systematic review was to assess the available literature on acquired von Willebrand syndrome (AvWS) and extracorporeal support. AvWS has previously been associated with bleeding and shear stress. ⋯ The prevalence of AvWF among patients on VV ECMO or ECCO2R is high, but only a limited number of studies are reported in the literature. AvWS testing should be performed, including vWF multimer analysis, vWF activity and vWF antigen concentration. The extent to which vWF contributes to bleeding during ECMO, or how much changes in ECMO management can influence high molecular weight vWF multimer levels, cannot be answered from the currently available evidence and there remains a need for future studies.
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Randomized Controlled Trial
A pilot, randomised controlled trial of a rotational thromboelastometry-based algorithm to treat bleeding episodes in extracorporeal life support: the TEM Protocol in ECLS Study (TEMPEST).
Minimal evidence to guide haemostatic therapy for bleeding in extracorporeal life support (ECLS) has resulted in wide variability in practice. We aimed to show that a goal-directed algorithm incorporating results from thromboelastometry (TEM) is feasible and safe for the timely management of bleeding episodes in adult patients receiving ECLS. ⋯ TEM allows assessment for coagulation status in a timely manner and its use for the treatment of bleeding episodes in adult patients receiving ECLS appears feasible and safe. Clinical benefit should be investigated in larger multicentre randomised trials.