☆ 4.6 Review

Complications Associated With Venovenous Extracorporeal Membrane Oxygenation-What Can Go Wrong?

CRITICAL CARE MEDICINE (2022)

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Major Bleeding and Thrombosis Events in COVID-19 Versus Influenza Patients Requiring Extracorporeal Membrane Oxygenation

Kalynn A. Northam et al.

Summary: There is no difference in the incidence of major bleeding and major thrombosis between COVID-19 and influenza patients requiring ECMO. However, COVID-19 patients experience fewer major bleeding events per day of ECMO treatment compared with influenza patients.

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Longitudinal Trends in Bleeding Complications on Extracorporeal Life Support Over the Past Two Decades-Extracorporeal Life Support Organization Registry Analysis

Anne Willers et al.

Summary: Data on hospital outcomes in bleeding complications during extracorporeal life support (ECLS) have been lacking. This retrospective study analyzed data from 53,644 adult patients and found a steady decrease in bleeding complications over the past 20 years, mostly attributed to surgical and cannula-site-related bleeding. However, more data is needed to determine the exact reasons for the decrease in bleeding trends.

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Intracranial Hemorrhages on Extracorporeal Membrane Oxygenation: Differences Between COVID-19 and Other Viral Acute Respiratory Distress Syndrome

Benjamin Seeliger et al.

Summary: This multicenter retrospective analysis investigates the risk of intracranial hemorrhage in COVID-19 patients receiving ECMO support. The results show a higher incidence and severity of intracranial hemorrhage in COVID-19 patients compared to viral non-COVID-19 patients on ECMO, with a higher ICU mortality rate.

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Veno-venous extracorporeal membrane oxygenation (vv-ECMO) for severe respiratory failure in adult cancer patients: a retrospective multicenter analysis

Matthias Kochanek et al.

Summary: The overall survival of cancer patients requiring vv-ECMO is poor, and the value of vv-ECMO in cancer patients with respiratory failure remains unclear. Further research is needed to determine the benefits of vv-ECMO in this population. The risk factors identified in this study may help in better selection of patients who may benefit from vv-ECMO.

INTENSIVE CARE MEDICINE (2022)

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Review Critical Care Medicine

Effect of prone positioning on survival in adult patients receiving venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis

Laurent Papazian et al.

Summary: This systematic review and meta-analysis examined the effect of prone positioning on survival in ARDS patients receiving vvECMO. The results showed a significant improvement in 28-day survival with prone positioning.

INTENSIVE CARE MEDICINE (2022)

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Bleeding and thrombotic events in adults supported with venovenous extracorporeal membrane oxygenation: an ELSO registry analysis

Jose Nunez et al.

Summary: This study aimed to analyze the prevalence, mortality association, and risk factors for bleeding and thrombosis events among adults supported with venovenous extracorporeal membrane oxygenation. Bleeding and thrombotic events are common during VV-ECMO and have a strong, cumulative association with in-hospital mortality. While thrombotic events are more frequent, bleeding carries a higher risk of inpatient mortality. Differential risk factors for bleeding and thrombotic complications exist, suggesting the possibility of a tailored approach to VV-ECMO management.

INTENSIVE CARE MEDICINE (2022)

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Duration of invasive mechanical ventilation prior to extracorporeal membrane oxygenation is not associated with survival in acute respiratory distress syndrome caused by coronavirus disease 2019

Martina Hermann et al.

Summary: This study aimed to investigate the influence of duration of invasive mechanical ventilation (IMV) prior to extracorporeal membrane oxygenation (ECMO) on ICU mortality in coronavirus disease 2019 (COVID-19) related acute respiratory distress syndrome (ARDS) patients. The results showed that the duration of IMV prior to ECMO cannulation did not affect survival. Therefore, the suitability of ECMO treatment should be assessed for COVID-19 related ARDS patients.

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Acute Kidney Injury in Patients with Severe ARDS Requiring Extracorporeal Membrane Oxygenation: Incidence, Prognostic Impact and Risk Factors

Kevin Pilarczyk et al.

Summary: AKI is a common complication in adult patients receiving ECMO support, with two-thirds of patients experiencing moderate to severe AKI and increased morbidity and long-term mortality.

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Kai Man Chan et al.

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Extracorporeal Membrane Oxygenation Circuits in Parallel for Refractory Hypoxemia in COVID-19: A Case Series

Yatrik J. Patel et al.

Summary: Despite the use of ECMO for COVID-19-related ARDS, refractory hypoxemia remains a challenging problem. Adding a second ECMO circuit in parallel can improve oxygenation and facilitate recovery.

ASAIO JOURNAL (2022)

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Diana Morales Castro et al.

Summary: This review focuses on the cardiorespiratory monitoring tools that can be used to assess and titrate adequacy of ECMO therapy, as well as methods to assess readiness to wean and/or discontinue ECMO support. Recent findings suggest that echocardiography, respiratory monitoring, and surrogate measurements of ECMO-derived parameters are invaluable in the optimal management of ECMO patients.

CURRENT OPINION IN CRITICAL CARE (2022)

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Venovenous extracorporeal membrane oxygenation in patients with acute covid-19 associated respiratory failure: comparative effectiveness study

Martin Urner et al.

Summary: An observational study found that extracorporeal membrane oxygenation (ECMO) is associated with a reduced risk of mortality in adults with COVID-19 associated respiratory failure. Age, severity of hypoxaemia, and duration and intensity of mechanical ventilation were identified as modifiers of treatment effectiveness, and should be taken into consideration when deciding to initiate ECMO in patients with COVID-19.

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Early Mobilization during Extracorporeal Membrane Oxygenation for Cardiopulmonary Failure in Adults Factors Associated with Intensity of Treatment

Darryl Abrams et al.

Summary: This study aimed to identify factors associated with achieving out-of-bed physical therapy in ECMO-supported patients and assess the safety and feasibility of early mobilization with femoral cannulation. The results showed that pre-transplantation, venovenous ECMO, later cannulation year, and higher Charlson comorbidity index were associated with increased odds of achieving out-of-bed physical therapy, while invasive mechanical ventilation and femoral cannulation were associated with decreased odds. Physical therapy with femoral cannulation was safe, feasible, and had low complication rates.

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Prone positioning during venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a pooled individual patient data analysis

Marco Giani et al.

Summary: This study evaluated the association between prone positioning during extracorporeal support and ICU mortality in patients with severe ARDS using pooled individual patient data analysis of European cohort studies. The findings suggest that the use of prone positioning during ECMO was not significantly associated with reduced ICU mortality in a large population of ARDS patients.

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Thrombosis and Bleeding in Extracorporeal Membrane Oxygenation (ECMO) Without Anticoagulation: A Systematic Review

Sven R. Olson et al.

Summary: The study reviewed thrombosis and bleeding outcomes in ECMO patients without continuous systemic anticoagulation. Results showed that while the incidence of bleeding and thrombosis was higher, the risk of circuity and patient thrombosis in anticoagulant-free ECMO patients was comparable to those receiving continuous systemic anticoagulation during ECMO.

ASAIO JOURNAL (2021)

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Limb ischemia and bleeding in patients requiring venoarterial extracorporeal membrane oxygenation

Andre Y. Son et al.

Summary: ALI and significant bleeding are common occurrences after peripheral VA-ECMO cannulation. Cannulation in the operating room is associated with a decreased risk of ALI but an increased risk of bleeding, while ultrasound-guided cannulation decreases the risk of bleeding. DPC placement does not significantly affect the risk of ALI or bleeding.

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Oliver Hunsicker et al.

Summary: Intracranial hemorrhage is a serious complication in patients receiving venovenous extracorporeal membrane oxygenation during treatment of the acute respiratory distress syndrome. The study found that early occurrence of intracranial hemorrhage is associated with higher 60-day mortality, and adjusting modifiable risk factors may lower the prevalence of this complication.

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Vincent Prinz et al.

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Extracorporeal Membrane Oxygenation for COVID-19-associated Severe Acute Respiratory Distress Syndrome in Chile A Nationwide Incidence and Cohort Study

Rodrigo A. Diaz et al.

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AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE (2021)

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Management of Adult Patients Supported with Venovenous Extracorporeal Membrane Oxygenation (VV ECMO): Guideline from the Extracorporeal Life Support Organization (ELSO)

Joseph E. Tonna et al.

Summary: The use of venovenous extracorporeal membrane oxygenation (VV ECMO) in adults is increasing worldwide. This updated ELSO guideline aims to provide practical guidance to clinicians on patient selection, initiation, cannulation, management, and weaning of VV ECMO for adult respiratory failure.

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Article Critical Care Medicine

A Comparison of Thrombosis and Hemorrhage Rates in Patients With Severe Respiratory Failure Due to Coronavirus Disease 2019 and Influenza Requiring Extracorporeal Membrane Oxygenation

Andrew J. Doyle et al.

Summary: This study revealed that patients with coronavirus disease 2019 receiving extracorporeal membrane oxygenation had higher rates of venous thromboembolism and hemorrhage compared to patients with influenza.

CRITICAL CARE MEDICINE (2021)

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Extracorporeal membrane oxygenation network organisation and clinical outcomes during the COVID-19 pandemic in Greater Paris, France: a multicentre cohort study

Guillaume Lebreton et al.

Summary: This study analyzed adult patients admitted to intensive care units in Greater Paris for ECMO treatment during the early stages of the COVID-19 pandemic. Most patients were male and prone positioned before ECMO. The 90-day survival rate after ECMO treatment was 46%, with the main causes of death being multiorgan failure and septic shock.

LANCET RESPIRATORY MEDICINE (2021)

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Effect of positive end-expiratory pressure on lung injury and haemodynamics during experimental acute respiratory distress syndrome treated with extracorporeal membrane oxygenation and near-apnoeic ventilation

Joaquin Araos et al.

Summary: In experimental severe ARDS with near-apnoeic ventilation and ECMO, a PEEP of 10 cm H2O minimised lung injury and improved gas exchange without compromising haemodynamic stability.

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Whitney D. Gannon et al.

Summary: The protocol for daily assessment of readiness to liberate from ECMO is safe and feasible, and may help identify patients for decannulation earlier than gradual weaning approaches.

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Standardized liberation trials in patients with COVID-19 ARDS treated with venovenous extracorporeal membrane oxygenation: when ready, let them breathe!

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