Figure 4 - uploaded by Renato Carneiro de Freitas Chaves
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-Diagram of a peripheral venoarterial extracorporeal membrane oxygenation circuit. The blood from the inferior vena cava is drained through a cannula in the right femoral vein. Then, the blood passes through the blood pump and the oxygenation membrane, returning to the arterial system of the patient through the left femoral artery.
Source publication
Extracorporeal membrane oxygenation is a modality of extracorporeal life support that allows for temporary support in pulmonary and/or cardiac failure refractory to conventional therapy. Since the first descriptions of extracorporeal membrane oxygenation, significant improvements have occurred in the device and the management of patients and, conse...
Contexts in source publication
Context 1
... ECMO circuit can be configured as VV-ECMO ( Figure 3) or as VA-ECMO (Figure 4). (10,18) In both ECMO modalities, an access route is required for drainage, as well as an access route for return of the blood to the patient (Figures 3 and 4). ...
Context 2
... VA-ECMO, the drainage cannula is inserted into a venous access and the return cannula into an arterial access, and VA-ECMO can be classified as central or peripheral, according to the cannulated vessels ( Figure 4). (15) In the central configuration, the drainage cannula can be inserted directly into the right atrium and the return cannula into the ascending segment of the aorta. ...
Context 3
... In the central configuration, the drainage cannula can be inserted directly into the right atrium and the return cannula into the ascending segment of the aorta. (15) In the peripheral configuration, blood can be drained through the femoral or jugular veins, and it returns to the patient through the carotid, axillary or femoral arteries (Figure 4). (15) Thus, a characteristic of VA-ECMO is the exclusion of pulmonary circulation. ...
Context 4
... is preferentially used in patients with preserved or moderately reduced cardiac function, being the modality of choice in patients with hypoxemic respiratory failure and hypercapnic respiratory failure ( Figure 3). (21,22) The main clinical trials that evaluated the use of VV-ECMO in patients with ARDS are summarized in table 2. (1)(2)(3)(4) The VA-ECMO configuration is indicated for patients with heart failure for whom pulmonary support might or might not be necessary (Figure 4). (22) The main clinical trials that evaluated the use of VA-ECMO are summarized in table 3. (5,7-9) ...
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Introduction:
Quality improvement in the administration of extracorporeal cardiopulmonary resuscitation (ECPR) over time and its association with low-flow duration (LFD) and outcomes of cardiac arrest (CA) have been insufficiently investigated. In this study, we hypothesized that quality improvement in efforts to shorten the duration of initiating...
Citations
... ECMO-kezelésre a kritikus állapotú betegek közül is a leginkább vulnerábilis betegek szorulnak. Az ECMO-kezelés "bridging" terápiaként alkalmazható akut respiratorikus distressz szindróma (ARDS) vagy pneumonia, kardiogén sokk esetén is [52]. A venovenosus ECMO (VV-ECMO) elsősorban a tüdő, míg a venoarterialis ECMO (VA-ECMO) a szív és a tüdő funkcióját helyettesítve tudja biztosítani a szöveti oxigenizációt. ...
A szepszis életet veszélyeztető, komplex klinikai állapot, melynek kezelése jelentős kihívást és számottevő költségráfordítást jelent a betegellátás számára. A szepszis által előidézett patofiziológiai változások jelentős mértékben megváltoztatják a gyógyszerek és a szervezet kölcsönhatását, megnehezítve az optimális gyógyszerelést. A kapillárisszivárgás jelensége, valamint az ellátás során alkalmazott folyadékterápia hatására megemelkedhet egyes antibiotikumok megoszlási térfogata. A hypalbuminaemia következtében megnövekedett szabad frakció a nagy fehérjekötődésű antibiotikumok gyorsabb eliminációját okozhatja. A megnövekedett perctérfogat és a vascularis ellenállás csökkenése a fiatalabb betegpopulációkban megnövekedett renalis clearance-t idézhet elő. A betegek nagyobb hányadában azonban a hipoperfúzió miatt szepszis indukálta akut veseelégtelenség jellemző, melynek hatására a renalis clearance csökken. A klinikai képet tovább árnyalja, ha vesepótló vagy extracorporalis membránoxigenizációs kezelést alkalmazunk. Az antibiotikumok fizikai-kémiai jellemzői meghatározzák, hogy a patofiziológiai változások milyen mértékben befolyásolják az egyes gyógyszermolekulák farmakokinetikai paramétereit. A várttól eltérő gyógyszer-expozíciót előidéző folyamatok ellensúlyozására a farmakokinetikai-farmakodinamikai indexek, valamint a fizikokémiai értékek ismeretében többféle klinikai stratégia áll rendelkezésre. A terápia racionális szempontok szerint történő személyre szabásával és a terápiás gyógyszerszint monitorozásával növelhető a hatékonyság, és csökkenthető az antibiotikumrezisztencia kialakulásának esélye. Orv Hetil. 2024; 165(11): 403–415.
... We instituted VV ECMO with the expectation that successful weaning from ECMO would be possible after DDLT. In our hospital, the most frequently used standard criterion for initiating ECMO is PaO 2 /FiO 2 < 100 mmHg with high PEEP (10-20 cmH 2 O) on FiO 2 > 90% [9]. The patient met this criterion, and considering her aggravating condition, VV ECMO was applied before DDLT. ...
... There are two types of ECMO: VV ECMO, which treats isolated respiratory failure, and veno-arterial ECMO, which supports both cardiac and respiratory failure [1,2,9]. Prior to initiating ECMO, echocardiography was performed to rule out cardiogenic pulmonary edema, and as a result, no structural or functional abnormalities of the heart were observed. ...
... One of the challenges in the perioperative management of our patient was a bleeding tendency. During ECMO support, anticoagulation with heparin administration is performed to maintain an ACT of 180 to 220 s or an activated partial thromboplastin time (aPTT) of 40 to 55 s [2,9]. However, in this case, the conventional anticoagulation method could not be employed due to the patient's severe bleeding tendency. ...
Background: Extracorporeal membrane oxygenation (ECMO) is an accommodation of the cardiopulmonary bypass technique that can support gas exchange and hemodynamic stability. It is used as a salvage maneuver in patients with life-threatening respiratory or cardiac failure that does not respond to conventional treatment. There are few case reports of successful perioperative use of ECMO, especially preoperatively, in liver transplantation (LT). Here, we report an experience of successful anesthetic management in deceased donor liver transplantation (DDLT) by applying perioperative veno-venous (VV) ECMO support in the setting of acute respiratory distress syndrome (ARDS) aggravated by hepatopulmonary syndrome (HPS). Case: A 25-year-old female (156.0 cm, 65.0 kg), without any underlying disease, was referred to our emergency department for decreased mentality. Based on imaging and laboratory tests, she was diagnosed with acute liver failure of unknown cause combined with severe ARDS aggravated by HPS. Since the patient faced life-threatening hypoxemia with a failure of conventional ventilation maneuvers, preoperative VV ECMO was initiated and maintained during the operation. The patient remained hemodynamically stable throughout DDLT, and ARDS showed gradual improvement after the administration of VV ECMO. As ARDS improved, the patient’s condition alleviated, and VV ECMO was weaned on postoperative day 6. Conclusions: This case demonstrates that VV ECMO may be a useful therapeutic option not only during the intraoperative and postoperative periods but also in the preoperative period for patients with liver failure combined with reversible respiratory failure.
... Последние реко мендации «Surviving sepsis campaign» от 2021 г. дают слабую рекомендацию к применению ВВЭКМО у паци ентов с сепсисиндуцированным ОРДС [15]. При этом, как уже говорилось выше, у пациентов, которым про водится ЭКМО, могут развиться инфекционные ослож нения, связанные с данной процедурой [10,16,17]. Частота инфекционных осложнений вовремя ЭКМО по данным регистра ELSO достигает 17,5%, по данным от дельных центров -от 10% до 65% [18,19,20]. ...
In modern medicine, the extracorporeal membrane oxygenation (ECMO) is becoming increasingly common in the treatment of severe respiratory failure. The development of infectious complications in patients receiving ECMO often leads to an increase in the duration of the procedure and significantly increases the risk of death. Dosing of antimicrobials during ECMO remains uncertain and requires further research. Diagnosis of infectious complications during ECMO is a difficult and requires the development of diagnostic protocols and the use of routine microbiological studies. The use of antimicrobials during ECMO could be complicated due to decrease in effective plasma concentration. The adsorption of antibacterial drugs in the ECMO circuit and oxygenator, the use of infusion therapy, the development of hypoalbuminemia, as well as the high incidence of acute renal and hepatic dysfunction in critically ill patients lead to an inevitable change in the volume of distribution and clearance of antibacterial drugs. These conditions require an individual approach to the choice of antimicrobials and optimization of dosing regimens in critically ill patients receiving ECMO.
... Extracorporeal membrane oxygenation (ECMO) is a lifesaving rescue tool for refractory respiratory and/or circulatory failure and is a major component of extracorporeal life support (ECLS) programs. (1) There are fundamental differences in pediatric ECMO patients compared to adults, including indications, circuit setup, sites of cannulation, and techniques. (2,3) The use of ECMO in pediatrics is increasing, and the Extracorporeal Life Support Organization (ELSO) reported that 23.2% of all ECMO runs performed in the last 5 years were in children and neonates. ...
Brazilian pediatrcis intensivists and knowlegde about ecmo
... Another non-pharmacological intervention is the use of Extracorporeal Membrane Oxygenation (ECMO). ECMO is an extracorporeal life support modality that enables temporary support in pulmonary and/or cardiac failure that is resistant to standard therapy [39]. The British Thoracic Society guidelines recommend using ECMO in certain patients with severe ARDS who are on lung protective ventilation with a Murray Score >3 or pH < 7.2 due to uncompensated hypercapnia [40]. ...
Acute respiratory distress syndrome (ARDS) is a rapidly progressive form of respiratory failure that accounts for 10% of admissions to the ICU and is associated with approximately 40% mortality in severe cases. Despite significant mortality and healthcare burden, the mainstay of management remains supportive care. The recent pandemic of SARS-CoV-2 has re-ignited a worldwide interest in exploring the pathophysiology of ARDS, looking for innovative ideas to treat this disease. Recently, many trials have been published utilizing different pharmacotherapy targets; however, the long-term benefits of these agents remain unknown. Metabolomics profiling and stem cell transplantation offer strong enthusiasm and may completely change the outlook of ARDS management in the near future.
... As this product promotes O 2 diffusion and supply by convection, HemoPure® increases gas transfer between red blood cells and tissues, and offers an alternative for local and systemic oxygenation -1 g of HemoPure® is equivalent to 3 g of human Hb [72]. HemoPure® has been used in the treatment of ischemic and hypoxic diseases, such as myocardial infarction, hemolysis, cardiopulmonary bypass, and organ transplantation [73][74][75][76]. However, its use may cause adverse effects, such as systemic vasoconstriction and arterial hypertension, in addition to decreased blood flow, increased pro-inflammatory mediators, and platelet inactivation due to the high affinity of HemoPure® for nitric oxide, thereby, decreasing its circulating levels. ...
Around 10-15% of COVID-19 patients affected by the Delta and the Omicron variants exhibit acute respiratory insufficiency and require intensive care unit admission to receive advanced respiratory support. However, the current ventilation methods display several limitations, including lung injury, dysphagia, respiratory muscle atrophy, and hemorrhage. Furthermore, most of the ventilatory techniques currently offered require highly trained professionals and oxygen cylinders, which may attain short supply owing to the high demand and misuse. Therefore, the search for new alternatives for oxygen therapeutics has become extremely important for maintaining gas exchange in patients affected by COVID-19. This review highlights and suggest new alternatives based on micro and nanostructures capable of supplying oxygen and/or enabling hematosis during moderate or acute COVID-19 cases.
... In Table 1 [3,6,[8][9][10][11][12][13][14][15][16][17][18][19][20], we summarize the different approaches to weaning of V-V ECMO reported in the literature. Most centres wean the sweep gas flow (SGF) to zero but variable practice regarding manipulation of extracorporeal blood flow (ECBF) or the fraction of oxygen of the SGF (FdO2) is apparent between centres. ...
Venovenous extracorporeal membrane oxygenation (VV-ECMO) has an established evidence base in acute respiratory distress syndrome (ARDS) and has seen exponential growth in its use over the past decades. However, there is a paucity of evidence regarding the approach to weaning, with variation of practice and outcomes between centers. Preconditions for weaning, management of patients’ sedation and mechanical ventilation during this phase, criteria defining success or failure, and the optimal duration of a trial prior to decannulation are all debated subjects. Moreover, there is no prospective evidence demonstrating the superiority of weaning the sweep gas flow (SGF), the extracorporeal blood flow (ECBF), or the fraction of oxygen of the SGF (FdO2); thus broad intercenter variability exists in this regard. Accordingly, the aim of this chapter is to discuss the required physiological basis to interpret different weaning approaches: first, we will outline the physiological changes in blood gases which should be expected from manipulations of ECBF, SGF, and FdO2. Subsequently, we will describe the resulting adaptation of patients’ control of breathing, with special reference to the effects of weaning on respiratory effort. Finally, we will discuss pertinent elements of the monitoring and mechanical ventilation of passively and spontaneously breathing patients during a weaning trial. Indeed, to avoid lung injury, invasive monitoring is often required in patients making spontaneous effort, as pressures measured at the airway may not reflect the degree of lung strain. In the absence of evidence, our approach to weaning is driven largely by an understanding of physiology.KeywordsExtracorporeal membrane oxygenation (ECMO)WeaningAcute respiratory distress syndrome (ARDS)Respiratory drivePatient self-inflicted lung injury (P-SILI)
... In Table 1 [3,6,[8][9][10][11][12][13][14][15][16][17][18][19][20], we summarize the different approaches to weaning of V-V ECMO reported in the literature. Most centres wean the sweep gas flow (SGF) to zero but variable practice regarding manipulation of extracorporeal blood flow (ECBF) or the fraction of oxygen of the SGF (FdO2) is apparent between centres. ...
Veno-venous extracorporeal membrane oxygenation (V-V ECMO) has an established evidence base in acute respiratory distress syndrome (ARDS) and has seen exponential growth in its use over the past decades. However, there is a paucity of evidence regarding the approach to weaning, with variation of practice and outcomes between centres. Preconditions for weaning, management of patients' sedation and mechanical ventilation during this phase, criteria defining success or failure, and the optimal duration of a trial prior to decannulation are all debated subjects. Moreover, there is no prospective evidence demonstrating the superiority of weaning the sweep gas flow (SGF), the extracorporeal blood flow (ECBF) or the fraction of oxygen of the SGF (FdO2), thereby a broad inter-centre variability exists in this regard. Accordingly, the aim of this review is to discuss the required physiological basis to interpret different weaning approaches: first, we will outline the physiological changes in blood gases which should be expected from manipulations of ECBF, SGF and FdO2. Subsequently, we will describe the resulting adaptation of patients' control of breathing, with special reference to the effects of weaning on respiratory effort. Finally, we will discuss pertinent elements of the monitoring and mechanical ventilation of passive and spontaneously breathing patients during a weaning trial. Indeed, to avoid lung injury, invasive monitoring is often required in patients making spontaneous effort, as pressures measured at the airway may not reflect the degree of lung strain. In the absence of evidence, our approach to weaning is driven largely by an understanding of physiology.
... [14] ECMO is a technique that supports cardiopulmonary function and can be used as an adjunct to lung transplantation to maintain oxygenation and provide supportive treatment for respiratory and circulatory failure. [15] Gastric lavage, activated carbon adsorption, and blood purification can be used in the early stages to reduce paraquat concentrations in the body and prevent further absorption of the poison. [16] Unlike previously reported cases of paraquat poisoning, the presence of paraquat in the urine was only detected in this case on the 13th day after poisoning; thus, the critical window for poison removal was lost. ...
Rationale:
Paraquat is an extremely toxic herbicide with a high mortality rate on poisoning. It can damage vital organs, such as the lungs, liver, heart, and kidneys. In this study, we report a case of pulmonary fibrosis after paraquat poisoning in a patient who underwent a lung transplant procedure after preoperative administration of corticosteroids and immunosuppressive agents and continuous noninvasive ventilation support therapy.
Patient concerns:
An 18-year-old student was hospitalized owing to diarrhea, chest pain, and gradually evolving dyspnea.
Diagnoses:
Owing to the inability to estimate the intake concentration and dose, paraquat was only detected in the urine on the 13th day, resulting in rapid progression of the disease and severe pulmonary fibrosis.
Interventions:
Extensive media coverage has attracted the attention of all sectors of society. The patient received financial assistance; thus, she could receive a double-lung transplant with extracorporeal membrane oxygenation (ECMO) support on the 34th day after the poisoning.
Outcomes:
Postoperatively, the girl was actively rehabilitated, adhered to anti-rejection medication, followed up regularly, and had a good prognosis.
Lessons:
Lung transplantation is currently the most effective treatment for pulmonary fibrosis, and mass media campaigns can provide economic support, influence potential organ donation, and provide such patients more chances to survive.
... [3] In recent years, conventional treatment methods have been insufficient in cardiothoracic surgery; consequently, mechanical circulation support systems are used to reduce morbidity and mortality in difficult cases. [4] Extracorporeal membrane oxygenation (ECMO) is a mechanical circulatory support system used in cases where tissue perfusion is impaired, such as with cardiogenic shock and dependence on the cardiopulmonary bypass after cardiac surgery. [5] Indications for the use of ECMO, survival after application, and discharge rates are gradually increasing. ...
Aneurysms are one of the most complex conditions in open heart surgery. In this case, the nursing care of a 39-year-old female patient who was operated due to pulmonary artery aneurysm and left main coronary artery stenosis and who underwent extracorporeal membrane oxygenation was discussed. It is thought that qualified and comprehensive nursing care is important in increasing the success of the treatment and reducing the mortality and morbidity rates in the patient who underwent extracorporeal membrane oxygenation after pulmonary artery aneurysm and coronary artery bypass surgery with high mortality.
