Figure 1 - available via license: Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
Content may be subject to copyright.
(A) The modality of VV-ECMO. The most frequently used modality of VV-ECMO is to drain the venous blood out from the femoral vein and then infuse it back through the internal jugular vein, which not only eases the burden on the lung but also improves blood supply to the heart. (B) The modality of VA-ECMO. The traditional modality of VA-ECMO is to drain venous blood out from the femoral vein and then infuse it back through the femoral artery, which reduces the pulmonary workload and cardiac preload.
Source publication
Traced back to December 2019, an unexpected outbreak of a highly contagious new coronavirus pneumonia (COVID-19) has rapidly swept around China and the globe. There have now been an estimated 2 580 000 infections and more than 170 000 fatal cases around the world. The World Health Organization (WHO) estimated that approximately 14% of infections de...
Contexts in source publication
Context 1
... the VV mode is operating, the oxygen supply is from the extracorporeal oxygenator and autologous pulmonary circulation, which not only eases the burden on the lungs but also improves blood supply to the heart. The oxygenated blood directly enters the pulmonary artery to participate in the circulation, reducing pulmonary circulation resistance and right ventricular afterload ( Figure 1A). Because of its unique cardiopulmonary-protective effect, VV-ECMO is considered as an assisting modality for reversible lung diseases with respiratory failure when traditional methods are not effective [45]. ...
Context 2
... 80% of the venous blood is drained out, oxygenated, and then reinfused through the femoral artery [44], which reduces the pulmonary workload and cardiac preload to the greatest extent. VA-ECMO achieves the conversion of venous to arterial blood and supplies a large amount of oxygen to meet the needs of the body while maintaining low cardiac output ( Figure 1B). At present, in the rescue of cardiogenic shocks due to conditions such as acute myocardial infarction and fulminant myocarditis, VA-ECMO provides prompt and efficacious support for gaining valuable time for recovery [47]. ...
Similar publications
Acute respiratory distress syndrome (ARDS) is characterized by massive inflammation, increased vascular permeability and pulmonary edema. Mortality due to ARDS remains very high and even in the case of survival, acute lung injury can lead to pulmonary fibrosis. The renin–angiotensin system (RAS) plays a significant role in these processes. The acti...
Extracorporeal membrane oxygenation (ECMO) is considered as a supportive treatment that provides circulatory and ventilatory support and can be thought off as a bridge to organ recovery. Since 2009, it has been applied as a rescue treatment for patients with severe adult respiratory distress syndrome (ARDS) mainly due to viral causes. In December 2...
The most severe clinical feature of COVID-19 is Acute Respiratory Distress Syndrome (ARDS) which requires intubation and mechanical ventilation and it occurs in approximately 2.3% of cases. About 94% of of these cases end in death. This case series report two confirmed COVID-19 patients who had met criteria of intubation and mechanical ventilation,...
Background and objectives: The coronavirus disease 2019 (COVID-19) pandemic is overwhelming Japan’s intensive care capacity. This study aimed to determine the number of patients with COVID-19 who required intensive care and to compare the numbers with Japan’s intensive care capacity. Materials and Methods: Publicly available datasets were used to o...
Case series
Patients: Male, 72-year-old • Male, 70-year-old
Final Diagnosis: Acute respiratory distress syndrome (ARDS) • COVID-19 • COVID-19 pneumonia
Symptoms: Cough • fever • malaise • nausea • respiratory distress • vomiting
Medication: —
Clinical Procedure: —
Specialty: Critical Care Medicine • Infectious Diseases • Radiology
Objective
Rare d...
Citations
... This approach minimizes the risk of barotrauma and allows a compromised lung to rest [4]. ECMO has demonstrated effectiveness as a bridge to recovery in conditions such as acute respiratory distress syndrome (ARDS) resulting from bacterial or viral infections like COVID-19 [5,6], as well as in providing support for lung transplant recipients [7]. While ECMO has been extensively utilized in various contexts, its application in treating ARDS associated with parasitic infections like echinococcosis remains limited, with only two documented cases in the literature thus far [8,9]. ...
Pulmonary echinococcosis is a parasitic infection that accounts for 20% of the infected cases with echinococcosis. Patients may present after a cyst rupture associated with a variety of complications, including acute respiratory distress syndrome (ARDS). Extracorporeal membrane oxygenation (ECMO) is known as supportive therapy for patients with respiratory and cardiac failure, including ARDS associated with multiple causes. Parasitic infection associated with ARDS due to cyst rupture managed with ECMO as bridging to definitive surgical intervention is documented in two previous case reports only. Here, we are presenting a 21-year-old female with a pulmonary hydatid cyst complicated by ARDS and managed with ECMO.
... Despite medical advancements, severe ARDS cases still exhibit a high mortality rate of up to 50% (5). VenoVenous ExtraCorporeal Membrane Oxygenation (VV-ECMO) is utilized as a salvage therapy when conventional approaches prove inadequate (6-9) However, certain patients on VV-ECMO may encounter insu cient arterial saturation (10). Several strategies have been explored to enhance oxygenation in such cases, (11)(12)(13). ...
Background
Acute Respiratory Distress Syndrome (ARDS) remains a significant challenge in critical care, with high mortality rates despite advancements in treatment. VenoVenous ExtraCorporeal Membrane Oxygenation (VV-ECMO) is utilized as salvage therapy in refractory cases. However, insufficient arterial saturation can occur in some patients on VV-ECMO, prompting the exploration of strategies to enhance oxygenation.
Methods
Using a porcine model of severe ARDS treated with VV-ECMO, this study investigated the efficacy of moderate hypothermia and landiolol in improving oxygenation within the first six hours after ECMO initiation. Primary endpoints included ECMO output to cardiac output ratio, arterial oxygen saturation (SaO2), and safety criteria encompassing heart rate, rhythm disorders, hemodynamics, tissue perfusion, and amine supply.
Results
Twenty-four male pigs underwent the study protocol, with animals randomized into hypothermia (n = 9), Landiolol (n = 7), and control (n = 6) groups. At baseline, all groups demonstrated similar hemodynamic and respiratory parameters. Both hypothermia and Landiolol groups exhibited a significant increase in ECMO to native cardiac output ratio at H3 compared to baseline, resulting in improved SaO2. Notably, static compliance remained comparable across groups, indicating consistent lung function. Safety criteria analysis revealed no significant rhythm disorders and lactate levels remained stable throughout the experiment.
Conclusions
In a porcine model of severe ARDS treated with VV-ECMO, both moderate hypothermia and landiolol demonstrated enhanced oxygenation, attributed to increased ECMO blood flow/cardiac output ratio. These interventions showed no adverse effects, suggesting their potential utility in improving oxygenation in refractory ARDS cases.
... Presently, ECMO technology has benefited patients suffering from acute respiratory distress syndrome, severe pneumonia, cardiogenic shock, heart failure, as well as those undergoing treatments for various acute and critical diseases (5)(6)(7)(8), and intraoperative and perioperative circulatory replacement in heart transplantation and lung transplantation (9)(10)(11). Additionally, for critically ill patients afflicted with severe respiratory infections such as H7N9, coronavirus disease 2019 (COVID- 19), and severe acute respiratory syndrome (SARS), ECMO is a vital auxiliary treatment technology (12)(13)(14). ...
Background
This study aims to visually assess the bibliometric status, current hotspots, and development trends in the field of extracorporeal membrane oxygenation (ECMO)-assisted support for respiratory failure through an examination of articles pertaining to ECMO-assisted support for respiratory failure.
Methods
A search was conducted on pertinent literature in the domain of ECMO-assisted support for respiratory failure published from 2003 to 2023, utilizing the Web of Science Core Collection (WOSCC) database. A bibliometric analysis was conducted using CiteSpace and VOSviewer visualization software to identify and assess associations between keywords, countries, institutions, authors, journals, and references.
Results
The present study incorporated a compilation of 1,901 pertinent articles. The United States published the maximum number of research articles in this field, and was closely followed by Germany and China. Furthermore, the University of Michigan was the leading institution in ECMO research. In this context, Daniel Brodie, an American expert, significantly contributed to this field and had published 107 related articles on the subject. Concurrently, active collaboration among ECMO researchers was also observed. Asaio Journal was the most prolific contributor, and Giles J. Peek, 2009, published in Lancet, comprised the most cited article in the field. Additionally, the analysis of keywords could be divided into three categories: (I) neonatal ECMO; (II) complications of ECMO; (III) ECMO application in coronavirus disease 2019 (COVID-19); (IV) application of point-of-care ultra sound in ECMO.
Conclusions
This study employed CiteSpace and VOSviewer to conduct a systematic literature review on ECMO-assisted support for respiratory failure from 2003 to 2023 in the Web of Science core database. The research outcomes in this domain were presented, offering researchers references for them to gain an accurate understanding of the current state of research and emerging trends in this field.
... Acute respiratory distress syndrome (ARDS) is an acute respiratory illness characterised by severe hypoxaemia and respiratory distress due to noncardiogenic pulmonary oedema [1][2][3][4][5]. Extracorporeal membrane oxygenation (ECMO) has been widely used due to the increase of severe ARDS patients, which can effectively improve the survival and blood oxygenation of ARDS patients compared with traditional mechanical ventilation [6][7][8][9][10]. Studies have shown that severe pneumonia, sepsis and other diseases that develop into ARDS are associated with uncontrolled cytokine storm [11][12][13]. ...
Background
Venovenous extracorporeal membrane oxygenation (VV ECMO) has been widely used for severe acute respiratory distress syndrome (ARDS) in recent years. However, the role of hemoadsorption in ARDS patients requiring VV ECMO is unclear.
Methods
Therefore, we conducted a systematic review to describe the effect of hemoadsorption on outcomes of ARDS patients requiring VV ECMO and elucidate the risk factors for adverse outcomes. We conducted and reported a systematic literature review based on the principles derived from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The systematic review searched Embase, CINHAL, and Pubmed databases for studies on ARDS patients receiving hemoadsorption and VV ECMO. The demographic data, clinical data and biological data of the patients were collected.
Results
We ultimately included a total of 8 articles including 189 patients. We characterized the population both clinically and biologically. Our review showed most studies described reductions in inflammatory markers and fluid resuscitation drug dosage in ARDS patients with Coronavirus disease 2019 (COVID-19) or sepsis after hemoadsorption.
Conclusion
Because most of the studies have the characteristics of high heterogeneity, we could only draw very cautious conclusions that hemoadsorption therapy may enhance hemodynamic stability in ARDS patients with COVID-19 or sepsis receiving VV ECMO support. However, our results do not allow us to draw conclusions that hemoadsorption could reduce inflammation and mortality. Prospective randomized controlled studies with a larger sample size are needed in the future to verify the role of hemoadsorption in ARDS patients requiring VV ECMO.
... Some patients with coronavirus disease 2019 (COVID-19) suffer from severe pneumonia and require intensive care, such as mechanical ventilation and extracorporeal membrane oxygenation (ECMO) [7]. Some of those patients experience PICS, similar to critically ill patients without COVID-19 [8]. ...
Returning to work can be a serious issue for patients who have undergone intensive care. Previous studies have reported a relatively low return-to-work prevalence among such patients. Some patients with coronavirus disease 2019 (COVID-19) experience severe pneumonia and require intensive care, including mechanical ventilation. However, little is known about the return-to-work prevalence among such patients. Therefore, we conducted a systematic review and meta-analysis of the literature describing the return-to-work prevalence among COVID-19 patients who received intensive care. The eligibility criteria were determined based on the medical condition, context, and population framework of each study, as follows: (1) full-text observational studies, (2) context: COVID-19 patients admitted to ICU, (3) condition: return-to-work prevalence after ICU discharge, and (4) population: critically ill patients who are 18 years and older. Eligible studies included randomized controlled trials (RCTs) and observational studies. Review articles, case reports, letters to the editor, and comments without data involving return-to-work prevalence were excluded.
We searched the Medical Literature Analysis and Retrieval System Online (MEDLINE, via PubMed), the Cumulated Index to Nursing and Allied Health Literature (CINAHL, via EBSCOhost), and the International Clinical Trials Registry Platform (ICTRP) databases from their inception till July 26, 2022, and updated the search on June 14, 2023. Specifically, we collected studies reporting data on the return-to-work prevalence among COVID-19 patients after receiving intensive care. Data extraction and quality assessment were performed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Prevalence Studies. Pre-developed standard forms were used for data collection, and pooled prevalence for return-to-work was calculated. Out of the 2221 available records, 42 full texts were reviewed, 20 of which were included in the qualitative synthesis. The number of return-to-work cases reported at 0-3 months, 4-6 months, and 7-12 months were three, 11, and nine, respectively. At 0-3 months, the pooled prevalence was 0.49 (three trials; n = 73; 95% CI: 0.15-0.84; I² = 82%). At 4-6 months, the pooled prevalence was 0.57 (11 trials; n = 900; 95% CI: 0.40-0.73; I² = 92%). Finally, at 7-12 months, the pooled prevalence was 0.64 (nine trials; n = 281; 95% CI: 0.50-0.77; I² = 80%). However, the overall quality of the included studies was low. Based on the results, approximately one-third of COVID-19 patients did not return to work 12 months after receiving intensive care. Given the quality and limitations of the studies, a more detailed and extensive cohort study is required; also, concerned authorities should implement adequate measures in terms of providing integrated job support for this patient population.
... Influenza virus infection can lead to acute pneumonia and acute respiratory distress syndrome (ARDS), which were clinically defined as acute respiratory failure, and multi-organ dysfunction (Ma et al., 2020;Fanelli et al., 2022). The example of lung-gut crosstalk in chronic respiratory diseases has been introduced above. ...
Both lung and gut belong to the common mucosal immune system (CMIS), with huge surface areas exposed to the external environment. They are the main defense organs against the invasion of pathogens and play a key role in innate and adaptive immunity. Recently, more and more evidence showed that stimulation of one organ can affect the other, as exemplified by intestinal complications during respiratory disease and vice versa, which is called lung-gut crosstalk. Intestinal microbiota plays an important role in respiratory and intestinal diseases. It is known that intestinal microbial imbalance is related to inflammatory bowel disease (IBD), this imbalance could impact the integrity of the intestinal epithelial barrier and leads to the persistence of inflammation, however, gut microbial disturbances have also been observed in respiratory diseases such as asthma, allergy, chronic obstructive pulmonary disease (COPD), and respiratory infection. It is not fully clarified how these disorders happened. In this review, we summarized the latest examples and possible mechanisms of lung-gut crosstalk in respiratory disease and IBD and discussed the strategy of shaping intestinal flora to treat respiratory diseases.
... Since it was introduced in 1970, Extracorporeal membrane oxygenation (ECMO) has been used as cardiopulmonary support for patients with respiratory failure. When COVID-19 was prevalent in China, it once played an indispensable role in saving the lives of many critically ill patients (115). ECMO may be considered to help patients with severe pneumonia who do not respond to mechanical ventilation. ...
In this review, we lay emphasis on the pathogenic mechanism, early recognition and treatment strategies of severe pediatric adenovirus pneumonia. The pathogenic mechanism of adenovirus is divided into three parts, direct damage to the target cells, inflammatory cytokines release and immune evasion of the virus. Indicators including age, clinical manifestations, imaging features and laboratory tests play an essential role in the early identification. Current treatment strategies are comprised of anti-viral drugs, respiratory support and bronchoscopy, continuous blood purification, immuno-regulation therapy and supportive care.
... The novel coronavirus disease 2019 (COVID-19), recognized as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is regarded as a critical public health issue. Severe pneumonia and acute respiratory distress syndrome are distinct features of COVID-19, causing a remarkably high rate of mortality (1). ...
Introduction: During the coronavirus disease 2019 (COVID-19) pandemic, physicians delivered a leading part and carried a high work volume, leading to burnout, which subsequently compromised patient safety, decreased the quality of care, and increased misdiagnosis. In the course of the COVID-19 pandemic, physicians should have been vigilant and informed about the potential conditions resulting in medical errors. Particularly, epidemics of infectious illnesses can cause serious challenges in lymphoma diagnosis. Case Presentation: This case report presents a patient with lymphoma presenting with cough, fever, shortness of breath, and a history of contact with her family members who tested positive for COVID-19, which caused delayed diagnosis and treatment, disease progression, and finally, the death of the patient. In the course of the COVID-19 pandemic, the center of attention was detracted from other possible diagnoses, thereby missing lymphoma as a potentially treatable disease. Conclusions: Although physicians are required to be watchful for COVID-19 amid the pandemic, it is also necessary not to neglect other diseases. A delay in the initiation of cancer therapy, even for one month, has been reported to increase the risk of mortality by approximately 10%.
... Another review emphasized that during the H1N1 influenza pandemic, when implemented early and maintained for an average of ten days, VV-ECMO yielded comparable one in three mortality rates (2). Prior to and during the H1N1 pandemic, researchers found no statistically significant improvement when VA-ECMO was added to standard care (3). ...
Context
After the COVID-19 pandemic, multiple reviews have documented the success of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Patients who experience hypoxemia but have normal contractility may be switched to veno-venous-ECMO (VV-ECMO).
Purpose
In this review, we present three protocols for anesthesiologists. Firstly, transesophageal echocardiography (TEE) aids in cannulation and weaning off inotropes and fluids. Our main objective is to assist in patient selection for the Avalon Elite single catheter, which is inserted into the right internal jugular vein and terminates in the right atrium. Secondly, we propose appropriate anticoagulant doses. We outline day-to-day monitoring protocols to prevent heparin-induced thrombocytopenia (HIT) or resistance. Once the effects of neuromuscular paralysis subside, sedation should be reduced. Therefore, we describe techniques that may prevent delirium from progressing into permanent cognitive decline.
Methods
We conducted a PubMed search using the keywords VV-ECMO, TEE, Avalon Elite (Maquet, Germany), and quetiapine. We combined these findings with interviews conducted with nurses and anesthesiologists from two academic ECMO centers, focusing on anticoagulation and sedation.
Results
Our qualitative evidence synthesis reveals how TEE confirms cannulation while avoiding right atrial rupture or low flows. Additionally, we discovered that typically, after initial heparinization, activated partial thromboplastin time (PTT) is drawn every 1 to 2 hours or every 6 to 8 hours once stable. Daily thromboelastograms, along with platelet counts and antithrombin III levels, may detect HIT or resistance, respectively. These side effects can be prevented by discontinuing heparin on day two and initiating argatroban at a dose of 1 μg/kg/min while maintaining PTT between 61 - 80 seconds. The argatroban dose is adjusted by 10 - 20% if PTT is between 40 - 60 or 80 - 90 seconds. Perfusionists assist in establishing protocols following manufacturer guidelines. Lastly, we describe the replacement of narcotics and benzodiazepines with dexmedetomidine at a dose of 0.5 to 1 μg/kg/hour, limited by bradycardia, and the use of quetiapine starting at 25 mg per day and gradually increasing up to 200 mg twice a day, limited by prolonged QT interval.
Conclusions
The limitation of this review is that it necessarily covers a broad range of ECMO decisions faced by an anesthesiologist. However, its main advantage lies in the identification of straightforward argatroban protocols through interviews, as well as the discovery, via PubMed, of the usefulness of TEE in determining cannula position and contractility estimates for transitioning from VA-ECMO to VV-ECMO. Additionally, we emphasize the benefits in terms of morbidity and mortality of a seldom-discussed sedation supplement, quetiapine, to dexmedetomidine.
... Severe organ dysfunction from COVID-19 infection is often debilitating or fatal and is associated with respiratory failure and multi-organ system failure [1]. In cases of severe COVID-19-related respiratory failure, extracorporeal membrane oxygenation (ECMO) is a useful and effective treatment modality that is often used as a last resort [2,3]. ECMO can be venovenous (VV-ECMO) or venoarterial (VA-ECMO). ...
In severe COVID-19-related respiratory failure, extracorporeal membrane oxygenation (ECMO) is a useful modality that is used to provide effective oxygenation and ventilation to the patient. This descriptive study aimed to investigate and compare the outcomes between COVID-19-infected patients and patients who were not infected and required ECMO support. A retrospective study was undertaken on a cohort of 82 adult patients ([Formula: see text]18-year-old) who required venoarterial (VA-ECMO) and venovenous (VV-ECMO) ECMO between January 2019 and December 2022 in a single academic center. Patients who were cannulated for COVID-19-related respiratory failure (C-group) were compared to patients who were cannulated for non-COVID etiologies (non-group). Patients were excluded if data were missing regarding cannulation, decannulation, presenting diagnosis, and survival status. Categorical data were reported as counts and percentages, and continuous data were reported as means with 95% confidence intervals. Out of the 82 included ECMO patients, 33 (40.2%) were cannulated for COVID-related reasons, and 49 (59.8%) were cannulated for reasons other than COVID-19 infection. Compared to the non-group, the C-group had a higher in-hospital (75.8% vs. 55.1%) and overall mortality rate (78.8% vs. 61.2%). The C-group also had an average hospital length of stay (LOS) of 46.6 ± 13.2 days and an average intensive care unit (ICU) LOS of 44.1 ± 13.3 days. The non-group had an average hospital LOS of 24.8 ± 6.6 days and an average ICU LOS of 20.8 ± 5.9 days. Subgroup analysis of patients only treated with VV-ECMO yielded a greater in-hospital mortality rate for the C-group compared to the non-group (75.0% vs. 42.1%). COVID-19-infected patients may experience different morbidity and mortality rates as well as clinical presentations compared to non-COVID-infected patients when requiring ECMO support.
