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ECLS Update

Conrad SA, Broman LM, Taccone FS, Lorusso R, Malfertheiner MV, Pappalardo F, Nardo MD, Belliato M, Grazioli L, Barbaro RP, McMullan DM, Pellegrino V, Brodie D, Bembea MM, Fan E, Mendonca M, Diaz R, Bartlett RH. The Extracorporeal Life Support Organization Maastricht Treaty for Nomenclature in Extracorporeal Life Support. A Position Paper of the Extracorporeal Life Support Organization. Am J Respir Crit Care Med. 2018 Apr 3.

A month of ECMO/ECLS (research): an (incomplete) selection of noteworthy articles published in the last month of February, just follow the links... about one half free open access!

LA decompression and/or LV unload on veno-arterial support:

A retrospective review of patients treated for refractory cardiogenic shock, comparing outcome between VA ECMO & VA-ECMO + Impella #ECPELLA cohort:
Patel SM, Lipinski J, Al-Kindi SG, Patel T, Saric P et al. Simultaneous Venoarterial Extracorporeal Membrane Oxygenation and Percutaneous Left Ventricular Decompression Therapy with Impella Is Associated with Improved Outcomes in Refractory Cardiogenic Shock. ASAIO J. 2018 Feb 27.

Retrospective evaluation of Intra-Aortic Balloon Pump efficacy in preventing pulmonary edema in VA-ECMO-assisted patients:
Bréchot N, Demondion P, Santi F, Lebreton G, Pham T et al. Intra-aortic balloon pump protects against hydrostatic pulmonary oedema during peripheral venoarterial-extracorporeal membrane oxygenation. Eur Heart J Acute Cardiovasc Care. 2018 Feb;7(1):62-69. 

Retrospective evaluation of safety and efficacy of balloon atrio-septostomy strategy for left atrial discharging in adults and children:
Baruteau A, Barnetche T, Morin L, Jalal Z, Boscamp N et al. Percutaneous balloon atrial septostomy on top of venoarterial extracorporeal membrane oxygenation results in safe and effective left heart decompression. Eur Heart J Acute Cardiovasc Care. 2018 Feb;7(1):70-79.

...and a case rep of novel technique that combines peripheral VA-ECMO with direct ventricular decompression via a trans-apical left ventricular venting cannula and right ventricular decompression cannula:
Rao P, Mosier J, Malo J, Dotson V, Mogan C et al. Peripheral VA-ECMO with direct biventricular decompression for refractory cardiogenic shock. Perfusion. 2018 Feb 1.

Right heart failure??

Feasibility of long-term use of an ECMO-based percutaneous right ventricular assist system as bridge-to-recovery/to-transplant in the management of patients with severe right heart failure because of pulmonary hypertension, a case series:
Lepper PM, Hörsch SI, Seiler F, Kamp A, Becker SL et al. Percutaneous Mechanical Circulation Support Combined with Extracorporeal Membrane Oxygenation (oxyRVAD) in Secondary Right Heart Failure. ASAIO J. 2018 Feb 6. open access 

ECLS in pulmonary embolism and/or in pulmonary endarterectomy:

Retrospective revision of effectiveness/outcome of an aggressive, protocolized approach of VA-ECMO to triage, optimize, and treat patients with massive pulmonary embolism:
Pasrija C, Kronfli A, George P, Raithel M, Boulos F et al. Utilization of Veno-Arterial Extracorporeal Membrane Oxygenation for Massive Pulmonary Embolism. Ann Thorac Surg. 2018 Feb;105(2):498-504. open access 

Intraoperative switch from cardiopulmonary bypass to venoarterial ECMO support with full-dose protamine administration in patients with massive endobronchial bleeding after Pulmonary EndArterectomy as potentially life-saving treatment concept:
Guth S, Wiedenroth CB, Wollenschläger M, Richter MJ, Ghofrani HA et al. Short-term venoarterial extracorporeal membrane oxygenation for massive endobronchial hemorrhage after pulmonary endarterectomy. J Thorac Cardiovasc Surg. 2018 Feb;155(2):643-649.

Extracorporeal support to provide advanced life support in adult trauma patients:

Retrospective analysis of veno-venous ECMO support as rescue intervention in small cohort of patients with flame type burns and smoke inhalation injury:
Szentgyorgyi L, Shepherd C1 Dunn KW, Fawcett P, Barker JM et al. Extracorporeal membrane oxygenation in severe respiratory failure resulting from burns and smoke inhalation injury. Burns. 2018 Feb 27.

Review describing the historic underpinnings of ECMO, recent experience during combat operations and assessment of current status of the UD Department of Defense ECMO program and the way forward to establish long-range lung rescue therapy as a routine capability for combat casualty:
Cannon JW, Mason PE, Batchinsky AI. Past and present role of ECMO in combat casualty care: how far will we go? J Trauma Acute Care Surg. 2018 Feb 13. 

A retrospective study aimed at identifying the independent predictors of hospital mortality in adult trauma patients receiving ECMO for advanced cardiopulmonary dysfunctions.
Wu MY, Chou PL, Wu TI, Lin PJ. Predictors of hospital mortality in adult trauma patients receiving extracorporeal membrane oxygenation for advanced life support: a retrospective cohort study. Scand J Trauma Resusc Emerg Med. 2018 Feb 8;26(1):14. open access 

Veno-arterial support in cardiogenic shock

Position paper highlighting key aspects of extracorporeal support delivery in cardiac failure, advocating for a multidisciplinary team of experts to guide ECMO support, rigorous patient selection, attention to complications and concentration of the most complex care at high-volume centers with advanced cardiac capabilities:
Abrams D, Garan AR, Abdelbary A, Bacchetta M, Bartlett RH, et al; International ECMO Network (ECMONet) and The Extracorporeal Life Support Organization (ELSO). Position paper for the organization of ECMO programs for cardiac failure in adults. Intensive Care Med. 2018 Feb 15.

Review discussing indications, clinical management and complications of VA support in cardiogenic shock refractory to conventional treatment strategies:
Meuwese CL, Ramjankhan FZ, Braithwaite SA, de Jonge N, de Jong M, Buijsrogge MP2 et al. Extracorporeal life support in cardiogenic shock: indications and management in current practice. Neth Heart J. 2018 Feb;26(2):58-66. open access 

Extracorporeal membrane oxygenation as an ex utero intrapartum treatment procedure for placental support in a fetus with truncus arteriosus communis and hydrops with ventricular failure due to severe truncal valve stenosis at 34 weeks of gestation, a case rep:
Asai H, Tachibana T, Shingu Y, Matsui Y. Ex utero intrapartum treatment-to-extracorporeal membrane oxygenation followed by cardiac operation for truncus arteriosus communis. Interact Cardiovasc Thorac Surg. 2018 Feb 1;26(2):353-354. open access 

ECMO cannulae & cannulation procedure

Review (illustrated with many supplementary TTE, CXR, CT images) about the role of echocardiography to guide initial placement of the dual-lumen catheter and evaluate the cause of persistent hypoxemia during VV ECMO support:
Griffee MJ, Tonna JE, McKellar SH, Zimmerman JM. Echocardiographic Guidance and Troubleshooting for Venovenous Extracorporeal Membrane Oxygenation Using the Dual-Lumen Bicaval Cannula. J Cardiothorac Vasc Anesth. 2018 Feb;32(1):370-378.

Should additional steps be taken to reduce occurrence of cardiac perforation during dual lumen bicaval cannula placement? letter to the editor:
Charlesworth M, Ashworth AD. Reducing the Risk of Cardiac Perforation During Placement of Bicaval Veno-Venous Extracorporeal Membrane Oxygenation Cannulae. J Cardiothorac Vasc Anesth. 2018 Feb;32(1):e19-e20. open access 

Leg venous cannula to avoid distal leg congestion related to overperfusion in peripheral venoarterial ECMO with surgical cannulation of femoral artery, description of two pediatric cases:
Luo S, Foreman C, Sano M, Soto Agüero MJ, Guerguerian AM et al. Novel Leg Cannula for Venous Decompression in Peripheral Extracorporeal Membrane Oxygenation. Ann Thorac Surg. 2018 Feb;105(2):e95-e97. open access 

Finally, do not forget that cannulae are a potential source of infection on ECMO support: letter to the editor:
Messika J, Schmidt M, Aubry A, Combes A, Ricard JD. Extracorporeal Membrane Oxygenation-Associated Infections: Carefully Consider Cannula Infections! Crit Care Med. 2018 Feb;46(2):e171-e172.

Veno-venous support in respiratory failure

Evolving management of lung protection & ventilation during ECMO:
Pesenti A, Carlesso E, Langer T, Mauri T. Ventilation during extracorporeal support: Why and how. Med Klin Intensivmed Notfmed. 2018 Feb;113(Suppl 1):26-30. open access 

Evolving use of extracorporeal membrane oxygenation to support patients with respiratory failure, growing evidence base for its use, unanswered questions & ongoing research:
Brodie D. The Evolution of Extracorporeal Membrane Oxygenation for Adult Respiratory Failure. Ann Am Thorac Soc. 2018 Feb;15(Supplement_1):S57-S60. open access 

Retrospective cohort study evaluating survival rate in patients treated with ECMO for severe acute respiratory failure after implementing a multidisciplinary ECMO team:
Na SJ, Chung CR, Choi HJ, Cho YH, Sung K et al. The effect of multidisciplinary extracorporeal membrane oxygenation team on clinical outcomes in patients with severe acute respiratory failure. Ann Intensive Care. 2018 Feb 27;8(1):31. open access 

Referral of patient to an ECMO center and transport on extracorporeal support:

Evaluation of decision-making process leading to different outcomes in referrals to an ECMO center and identification of associated factors:
Gillon SA, Rowland K, Shankar-Hari M, Camporota L, Glover GW et al. Acceptance and transfer to a regional severe respiratory failure and veno-venous extracorporeal membrane oxygenation (ECMO) service: predictors and outcomes. Anaesthesia. 2018 Feb;73(2):177-186. open access 

Retrospective review of the outcome of patients transported while supported with ECMO:
Salna M, Chicotka S, Biscotti M III, Agerstrand C, Liou P et al. Management of Surge in Extracorporeal Membrane Oxygenation Transport. Ann Thorac Surg. 2018 Feb;105(2):528-534. open access 

Medication administration on ECMO

In vitro experimental study evaluating paracetamol, morphine, midazolam, fentanyl, and sufentanil
disposition in extracorporeal membrane oxygenation circuits.
Raffaeli G, Allegaert K, Koch B, Cavallaro G, Mosca F et al. In Vitro Adsorption of Analgosedative Drugs in New Extracorporeal Membrane Oxygenation Circuits. Pediatr Crit Care Med. 2018 Feb 6.

Complications of extracorporeal support

A review about dealing with bleeding and thrombosis in patients on ECMO:
Thomas J, Kostousov V, Teruya J. Bleeding and Thrombotic Complications in the Use of Extracorporeal Membrane Oxygenation. Semin Thromb Hemost. 2018 Feb;44(1):20-29. 

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