Veno‐arteriovenous extracorporeal membrane oxygenation—A single center experience
Background Patients with combined circulatory shock and respiratory failure may benefit from veno‐arteriovenous (V‐AV) extracorporeal membrane oxygenation support (ECMO). We report our center’s experience with V‐AV ECMO and propose an algorithm to help identify patients that may benefit from early V...
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| Veröffentlicht in: | Artificial organs 2021-12, Vol.45 (12), p.1554-1561 |
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| creator | Mihu, Mircea R. Mageka, Dennis Swant, Laura V. El Banayosy, Ahmed Maybauer, Marc O. Harper, Michael D. Koerner, Michael M. El Banayosy, Aly |
| description | Background
Patients with combined circulatory shock and respiratory failure may benefit from veno‐arteriovenous (V‐AV) extracorporeal membrane oxygenation support (ECMO). We report our center’s experience with V‐AV ECMO and propose an algorithm to help identify patients that may benefit from early V‐AV ECMO support.
Methods
Clinical data were extracted from electronic medical records between November 1, 2016 and November 1, 2019.
Results
Out of a total of 369 patients placed on extracorporeal life support (ECLS), we identified a total of 26 patients who underwent hybrid ECMO placement. Three patients were excluded from our analysis due to veno‐venoarterial extracorporeal membrane oxygenation (V‐VA ECMO) configuration, therefore 23 patients were included in our analysis. The median age was 53 (range 25–73) years. Hybrid ECMO support was instituted most commonly for differential hypoxemia in patients on venoarterial (V‐A) ECMO support, and cardiogenic shock in patients who were initially started on venovenous (V‐V) ECMO. The initial ECMO cannulation was V‐A in 12 patients, V‐V in 8 patients, and directly V‐AV in 3 patients. Nine out of 23 patients were successfully decannulated (39.1%) and survived until hospital discharge. The main ECMO‐related complications included bleeding (n = 10), circuit exchange either due to hemolysis or oxygenator failure (n = 4), ECMO cannula site infection (n = 2), deep venous thrombosis (n = 2), and death during ECMO cannula exchange (n = 1).
Conclusions
V‐AV ECMO represents a rescue strategy in critically ill patients with combined respiratory failure and cardio‐circulatory shock.
Out of 369 patients placed on extracorporeal life support between November 1, 2016 and November 1, 2019, we identified a total of 23 patients who underwent V‐AV ECMO placement. The initial ECMO cannulation was V‐A in 12 patients, V‐V in 8 patients and V‐AV in 3 patients. Nine out of 23 patients were successfully decannulated (39.1%) and survived to hospital discharge. In conclusion, V‐AV ECMO represents a rescue strategy in critically ill patients with combined respiratory failure and cardio‐circulatory shock. ECMO, extracorporeal membrane oxygenation; V‐A, venoarterial; V‐AV, veno‐arteriovenous; V‐V, venovenous; V‐VA, veno‐venoarterial. |
| doi_str_mv | 10.1111/aor.14070 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2572526206</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2596859443</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3530-c362e84db109f995554a055ef7ad26225d39f43ee3ad511ed1594c24ca1d46923</originalsourceid><addsrcrecordid>eNp1kM9Kw0AQhxdRbK0efAEJeNFD2t3N7qY5luI_KBTEirewTSYlJcnG3VTbWx_Bg0_YJ3FqqwfBOeyw8M3HzI-Qc0a7DKunje0yQUN6QNpMcukzGYlD0qZMUV8q8dIiJ87NKaWhoOqYtAIhWURV2CaTZ6jMZv2hbQM2N2_4WzgPlo3VibG1saALr4RyanUFnlmuZlDpJjfVZv058FxezQrwEqhwGqdqdECVwCk5ynTh4GzfO2Rye_M0vPdH47uH4WDkJ4EMKL6KQ1-kU0ajLIqklEJTKSELdcoV5zINokwEAIFOJWOQbu9KuEg0S4WKeNAhVztvbc3rAlwTl7lLoChwWbwj5jLkEk1UIXr5B52bha1wO6Qi1UezCJC63lGJNc5ZyOLa5qW2q5jReJt1jFnH31kje7E3LqYlpL_kT7gI9HbAe17A6n9TPBg_7pRfL6WKdg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2596859443</pqid></control><display><type>article</type><title>Veno‐arteriovenous extracorporeal membrane oxygenation—A single center experience</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Mihu, Mircea R. ; Mageka, Dennis ; Swant, Laura V. ; El Banayosy, Ahmed ; Maybauer, Marc O. ; Harper, Michael D. ; Koerner, Michael M. ; El Banayosy, Aly</creator><creatorcontrib>Mihu, Mircea R. ; Mageka, Dennis ; Swant, Laura V. ; El Banayosy, Ahmed ; Maybauer, Marc O. ; Harper, Michael D. ; Koerner, Michael M. ; El Banayosy, Aly</creatorcontrib><description>Background
Patients with combined circulatory shock and respiratory failure may benefit from veno‐arteriovenous (V‐AV) extracorporeal membrane oxygenation support (ECMO). We report our center’s experience with V‐AV ECMO and propose an algorithm to help identify patients that may benefit from early V‐AV ECMO support.
Methods
Clinical data were extracted from electronic medical records between November 1, 2016 and November 1, 2019.
Results
Out of a total of 369 patients placed on extracorporeal life support (ECLS), we identified a total of 26 patients who underwent hybrid ECMO placement. Three patients were excluded from our analysis due to veno‐venoarterial extracorporeal membrane oxygenation (V‐VA ECMO) configuration, therefore 23 patients were included in our analysis. The median age was 53 (range 25–73) years. Hybrid ECMO support was instituted most commonly for differential hypoxemia in patients on venoarterial (V‐A) ECMO support, and cardiogenic shock in patients who were initially started on venovenous (V‐V) ECMO. The initial ECMO cannulation was V‐A in 12 patients, V‐V in 8 patients, and directly V‐AV in 3 patients. Nine out of 23 patients were successfully decannulated (39.1%) and survived until hospital discharge. The main ECMO‐related complications included bleeding (n = 10), circuit exchange either due to hemolysis or oxygenator failure (n = 4), ECMO cannula site infection (n = 2), deep venous thrombosis (n = 2), and death during ECMO cannula exchange (n = 1).
Conclusions
V‐AV ECMO represents a rescue strategy in critically ill patients with combined respiratory failure and cardio‐circulatory shock.
Out of 369 patients placed on extracorporeal life support between November 1, 2016 and November 1, 2019, we identified a total of 23 patients who underwent V‐AV ECMO placement. The initial ECMO cannulation was V‐A in 12 patients, V‐V in 8 patients and V‐AV in 3 patients. Nine out of 23 patients were successfully decannulated (39.1%) and survived to hospital discharge. In conclusion, V‐AV ECMO represents a rescue strategy in critically ill patients with combined respiratory failure and cardio‐circulatory shock. ECMO, extracorporeal membrane oxygenation; V‐A, venoarterial; V‐AV, veno‐arteriovenous; V‐V, venovenous; V‐VA, veno‐venoarterial.</description><identifier>ISSN: 0160-564X</identifier><identifier>EISSN: 1525-1594</identifier><identifier>DOI: 10.1111/aor.14070</identifier><identifier>PMID: 34519067</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>acute respiratory distress syndrome ; Adult ; Aged ; Algorithms ; Cannulae ; Cannulation ; cardiogenic shock ; Catheterization - adverse effects ; Catheterization - methods ; Circuits ; Complications ; Critical Illness ; differential hypoxemia ; Electronic health records ; Electronic medical records ; Extracorporeal membrane oxygenation ; Extracorporeal Membrane Oxygenation - adverse effects ; Extracorporeal Membrane Oxygenation - methods ; Failure ; Female ; Humans ; hybrid ECMO ; Hypoxemia ; Male ; Membranes ; Middle Aged ; Oxygenation ; Patients ; Respiratory failure ; Respiratory Insufficiency - therapy ; Retrospective Studies ; Shock (Circulatory) ; Shock, Cardiogenic - therapy ; Thromboembolism ; Thrombosis ; Treatment Outcome ; veno‐arteriovenous (V‐AV) ECMO</subject><ispartof>Artificial organs, 2021-12, Vol.45 (12), p.1554-1561</ispartof><rights>2021 International Center for Artificial Organs and Transplantation and Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3530-c362e84db109f995554a055ef7ad26225d39f43ee3ad511ed1594c24ca1d46923</citedby><cites>FETCH-LOGICAL-c3530-c362e84db109f995554a055ef7ad26225d39f43ee3ad511ed1594c24ca1d46923</cites><orcidid>0000-0002-7334-2891</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Faor.14070$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Faor.14070$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,777,781,1412,27905,27906,45555,45556</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34519067$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mihu, Mircea R.</creatorcontrib><creatorcontrib>Mageka, Dennis</creatorcontrib><creatorcontrib>Swant, Laura V.</creatorcontrib><creatorcontrib>El Banayosy, Ahmed</creatorcontrib><creatorcontrib>Maybauer, Marc O.</creatorcontrib><creatorcontrib>Harper, Michael D.</creatorcontrib><creatorcontrib>Koerner, Michael M.</creatorcontrib><creatorcontrib>El Banayosy, Aly</creatorcontrib><title>Veno‐arteriovenous extracorporeal membrane oxygenation—A single center experience</title><title>Artificial organs</title><addtitle>Artif Organs</addtitle><description>Background
Patients with combined circulatory shock and respiratory failure may benefit from veno‐arteriovenous (V‐AV) extracorporeal membrane oxygenation support (ECMO). We report our center’s experience with V‐AV ECMO and propose an algorithm to help identify patients that may benefit from early V‐AV ECMO support.
Methods
Clinical data were extracted from electronic medical records between November 1, 2016 and November 1, 2019.
Results
Out of a total of 369 patients placed on extracorporeal life support (ECLS), we identified a total of 26 patients who underwent hybrid ECMO placement. Three patients were excluded from our analysis due to veno‐venoarterial extracorporeal membrane oxygenation (V‐VA ECMO) configuration, therefore 23 patients were included in our analysis. The median age was 53 (range 25–73) years. Hybrid ECMO support was instituted most commonly for differential hypoxemia in patients on venoarterial (V‐A) ECMO support, and cardiogenic shock in patients who were initially started on venovenous (V‐V) ECMO. The initial ECMO cannulation was V‐A in 12 patients, V‐V in 8 patients, and directly V‐AV in 3 patients. Nine out of 23 patients were successfully decannulated (39.1%) and survived until hospital discharge. The main ECMO‐related complications included bleeding (n = 10), circuit exchange either due to hemolysis or oxygenator failure (n = 4), ECMO cannula site infection (n = 2), deep venous thrombosis (n = 2), and death during ECMO cannula exchange (n = 1).
Conclusions
V‐AV ECMO represents a rescue strategy in critically ill patients with combined respiratory failure and cardio‐circulatory shock.
Out of 369 patients placed on extracorporeal life support between November 1, 2016 and November 1, 2019, we identified a total of 23 patients who underwent V‐AV ECMO placement. The initial ECMO cannulation was V‐A in 12 patients, V‐V in 8 patients and V‐AV in 3 patients. Nine out of 23 patients were successfully decannulated (39.1%) and survived to hospital discharge. In conclusion, V‐AV ECMO represents a rescue strategy in critically ill patients with combined respiratory failure and cardio‐circulatory shock. ECMO, extracorporeal membrane oxygenation; V‐A, venoarterial; V‐AV, veno‐arteriovenous; V‐V, venovenous; V‐VA, veno‐venoarterial.</description><subject>acute respiratory distress syndrome</subject><subject>Adult</subject><subject>Aged</subject><subject>Algorithms</subject><subject>Cannulae</subject><subject>Cannulation</subject><subject>cardiogenic shock</subject><subject>Catheterization - adverse effects</subject><subject>Catheterization - methods</subject><subject>Circuits</subject><subject>Complications</subject><subject>Critical Illness</subject><subject>differential hypoxemia</subject><subject>Electronic health records</subject><subject>Electronic medical records</subject><subject>Extracorporeal membrane oxygenation</subject><subject>Extracorporeal Membrane Oxygenation - adverse effects</subject><subject>Extracorporeal Membrane Oxygenation - methods</subject><subject>Failure</subject><subject>Female</subject><subject>Humans</subject><subject>hybrid ECMO</subject><subject>Hypoxemia</subject><subject>Male</subject><subject>Membranes</subject><subject>Middle Aged</subject><subject>Oxygenation</subject><subject>Patients</subject><subject>Respiratory failure</subject><subject>Respiratory Insufficiency - therapy</subject><subject>Retrospective Studies</subject><subject>Shock (Circulatory)</subject><subject>Shock, Cardiogenic - therapy</subject><subject>Thromboembolism</subject><subject>Thrombosis</subject><subject>Treatment Outcome</subject><subject>veno‐arteriovenous (V‐AV) ECMO</subject><issn>0160-564X</issn><issn>1525-1594</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kM9Kw0AQhxdRbK0efAEJeNFD2t3N7qY5luI_KBTEirewTSYlJcnG3VTbWx_Bg0_YJ3FqqwfBOeyw8M3HzI-Qc0a7DKunje0yQUN6QNpMcukzGYlD0qZMUV8q8dIiJ87NKaWhoOqYtAIhWURV2CaTZ6jMZv2hbQM2N2_4WzgPlo3VibG1saALr4RyanUFnlmuZlDpJjfVZv058FxezQrwEqhwGqdqdECVwCk5ynTh4GzfO2Rye_M0vPdH47uH4WDkJ4EMKL6KQ1-kU0ajLIqklEJTKSELdcoV5zINokwEAIFOJWOQbu9KuEg0S4WKeNAhVztvbc3rAlwTl7lLoChwWbwj5jLkEk1UIXr5B52bha1wO6Qi1UezCJC63lGJNc5ZyOLa5qW2q5jReJt1jFnH31kje7E3LqYlpL_kT7gI9HbAe17A6n9TPBg_7pRfL6WKdg</recordid><startdate>202112</startdate><enddate>202112</enddate><creator>Mihu, Mircea R.</creator><creator>Mageka, Dennis</creator><creator>Swant, Laura V.</creator><creator>El Banayosy, Ahmed</creator><creator>Maybauer, Marc O.</creator><creator>Harper, Michael D.</creator><creator>Koerner, Michael M.</creator><creator>El Banayosy, Aly</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7334-2891</orcidid></search><sort><creationdate>202112</creationdate><title>Veno‐arteriovenous extracorporeal membrane oxygenation—A single center experience</title><author>Mihu, Mircea R. ; Mageka, Dennis ; Swant, Laura V. ; El Banayosy, Ahmed ; Maybauer, Marc O. ; Harper, Michael D. ; Koerner, Michael M. ; El Banayosy, Aly</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3530-c362e84db109f995554a055ef7ad26225d39f43ee3ad511ed1594c24ca1d46923</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>acute respiratory distress syndrome</topic><topic>Adult</topic><topic>Aged</topic><topic>Algorithms</topic><topic>Cannulae</topic><topic>Cannulation</topic><topic>cardiogenic shock</topic><topic>Catheterization - adverse effects</topic><topic>Catheterization - methods</topic><topic>Circuits</topic><topic>Complications</topic><topic>Critical Illness</topic><topic>differential hypoxemia</topic><topic>Electronic health records</topic><topic>Electronic medical records</topic><topic>Extracorporeal membrane oxygenation</topic><topic>Extracorporeal Membrane Oxygenation - adverse effects</topic><topic>Extracorporeal Membrane Oxygenation - methods</topic><topic>Failure</topic><topic>Female</topic><topic>Humans</topic><topic>hybrid ECMO</topic><topic>Hypoxemia</topic><topic>Male</topic><topic>Membranes</topic><topic>Middle Aged</topic><topic>Oxygenation</topic><topic>Patients</topic><topic>Respiratory failure</topic><topic>Respiratory Insufficiency - therapy</topic><topic>Retrospective Studies</topic><topic>Shock (Circulatory)</topic><topic>Shock, Cardiogenic - therapy</topic><topic>Thromboembolism</topic><topic>Thrombosis</topic><topic>Treatment Outcome</topic><topic>veno‐arteriovenous (V‐AV) ECMO</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mihu, Mircea R.</creatorcontrib><creatorcontrib>Mageka, Dennis</creatorcontrib><creatorcontrib>Swant, Laura V.</creatorcontrib><creatorcontrib>El Banayosy, Ahmed</creatorcontrib><creatorcontrib>Maybauer, Marc O.</creatorcontrib><creatorcontrib>Harper, Michael D.</creatorcontrib><creatorcontrib>Koerner, Michael M.</creatorcontrib><creatorcontrib>El Banayosy, Aly</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Artificial organs</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mihu, Mircea R.</au><au>Mageka, Dennis</au><au>Swant, Laura V.</au><au>El Banayosy, Ahmed</au><au>Maybauer, Marc O.</au><au>Harper, Michael D.</au><au>Koerner, Michael M.</au><au>El Banayosy, Aly</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Veno‐arteriovenous extracorporeal membrane oxygenation—A single center experience</atitle><jtitle>Artificial organs</jtitle><addtitle>Artif Organs</addtitle><date>2021-12</date><risdate>2021</risdate><volume>45</volume><issue>12</issue><spage>1554</spage><epage>1561</epage><pages>1554-1561</pages><issn>0160-564X</issn><eissn>1525-1594</eissn><abstract>Background
Patients with combined circulatory shock and respiratory failure may benefit from veno‐arteriovenous (V‐AV) extracorporeal membrane oxygenation support (ECMO). We report our center’s experience with V‐AV ECMO and propose an algorithm to help identify patients that may benefit from early V‐AV ECMO support.
Methods
Clinical data were extracted from electronic medical records between November 1, 2016 and November 1, 2019.
Results
Out of a total of 369 patients placed on extracorporeal life support (ECLS), we identified a total of 26 patients who underwent hybrid ECMO placement. Three patients were excluded from our analysis due to veno‐venoarterial extracorporeal membrane oxygenation (V‐VA ECMO) configuration, therefore 23 patients were included in our analysis. The median age was 53 (range 25–73) years. Hybrid ECMO support was instituted most commonly for differential hypoxemia in patients on venoarterial (V‐A) ECMO support, and cardiogenic shock in patients who were initially started on venovenous (V‐V) ECMO. The initial ECMO cannulation was V‐A in 12 patients, V‐V in 8 patients, and directly V‐AV in 3 patients. Nine out of 23 patients were successfully decannulated (39.1%) and survived until hospital discharge. The main ECMO‐related complications included bleeding (n = 10), circuit exchange either due to hemolysis or oxygenator failure (n = 4), ECMO cannula site infection (n = 2), deep venous thrombosis (n = 2), and death during ECMO cannula exchange (n = 1).
Conclusions
V‐AV ECMO represents a rescue strategy in critically ill patients with combined respiratory failure and cardio‐circulatory shock.
Out of 369 patients placed on extracorporeal life support between November 1, 2016 and November 1, 2019, we identified a total of 23 patients who underwent V‐AV ECMO placement. The initial ECMO cannulation was V‐A in 12 patients, V‐V in 8 patients and V‐AV in 3 patients. Nine out of 23 patients were successfully decannulated (39.1%) and survived to hospital discharge. In conclusion, V‐AV ECMO represents a rescue strategy in critically ill patients with combined respiratory failure and cardio‐circulatory shock. ECMO, extracorporeal membrane oxygenation; V‐A, venoarterial; V‐AV, veno‐arteriovenous; V‐V, venovenous; V‐VA, veno‐venoarterial.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>34519067</pmid><doi>10.1111/aor.14070</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-7334-2891</orcidid></addata></record> |
| fulltext | fulltext |
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| ispartof | Artificial organs, 2021-12, Vol.45 (12), p.1554-1561 |
| issn | 0160-564X 1525-1594 |
| language | eng |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | acute respiratory distress syndrome Adult Aged Algorithms Cannulae Cannulation cardiogenic shock Catheterization - adverse effects Catheterization - methods Circuits Complications Critical Illness differential hypoxemia Electronic health records Electronic medical records Extracorporeal membrane oxygenation Extracorporeal Membrane Oxygenation - adverse effects Extracorporeal Membrane Oxygenation - methods Failure Female Humans hybrid ECMO Hypoxemia Male Membranes Middle Aged Oxygenation Patients Respiratory failure Respiratory Insufficiency - therapy Retrospective Studies Shock (Circulatory) Shock, Cardiogenic - therapy Thromboembolism Thrombosis Treatment Outcome veno‐arteriovenous (V‐AV) ECMO |
| title | Veno‐arteriovenous extracorporeal membrane oxygenation—A single center experience |
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