Jo-anne Fowles

Direct complications of the Avalon bicaval dual-lumen cannula in respiratory extracorporeal membrane oxygenation (ECMO): Single-center experience.

Purpose Cannulation for veno-venous extracorporeal membrane oxygenation (VVECMO) may involve a single site when using a dual-lumen cannula. Benefits include a decrease in blood recirculation, easier patient mobilization, and lower risk of dislodgment. We aimed to review all complications related to the cannula. Methods The study included all adult patients admitted to a single intensive care unit (ICU), between November 2009 and September 2013, requiring VVECMO in whom an Avalon Cannula was inserted. The list of patients, complications, and patient data were retrieved from the local ECMO database and the intensive care Clinical Information System (CIS). Results Seventy two patients were cannulated with an Avalon cannula between November 1, 2009 and September 31, 2013. Forty-four patients had no cannula-related complications. A total of 35 complications were recorded in 28 patients, 6 of whom required further intervention. Conclusions Successful cannulation was possible in all patients with the majority of complications graded as minor.

Extracorporeal membrane oxygenation for the treatment of adult sickle cell acute chest syndrome

Sickle cell disease (SCD) is a hereditary haemoglobinopathy that results in polymerization of haemoglobin molecules and subsequent vaso-occlusion. A common cause of death in adults is acute chest syndrome (AChS) with resulting hypoxemic respiratory failure. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been used successfully in acutely reversible respiratory failure when conventional mechanical ventilation has been unable to adequately oxygenate and ventilate in a lung-protective fashion. We present an adult SCD patient with severe respiratory failure due to AChS, successfully treated with VV-ECMO. We also discuss some of the technical challenges and considerations when using ECMO in the SCD patient.

Bleeding Complications Associated With Percutaneous Tracheostomy Insertion in Patients Supported With Venovenous Extracorporeal Membrane Oxygen Support: A 10-Year Institutional Experience

OBJECTIVES To evaluate the bleeding complications associated with percutaneous tracheostomy while a patient is receiving venovenous extracorporeal membrane oxygen (VV ECMO) support. DESIGN Retrospective, observational analysis. SETTING Single-center, tertiary, academic institution. PARTICIPANTS All consecutive patients on VV ECMO over a 10 year-period undergoing percutaneous tracheostomy. INTERVENTIONS Percutaneous tracheostomy. MEASUREMENTS AND MAIN RESULTS Fifty percutaneous tracheostomies were performed in patients requiring VV ECMO support over the 10-year period. The authors observed a 40% incidence of bleeding, with 32% of these incidences characterized as minor (self-limiting, localized stomal ooze) and 8% characterized as significant (necessitating surgical control and frequent packing or accompanied by a decrease in hemoglobin >20%). CONCLUSIONS Bleeding is associated with percutaneous tracheostomy and is self-limiting in the majority of patients.

Central Veno-Arterial Extracorporeal Membrane Oxygenation (C-VA-ECMO) After Cardiothoracic Surgery: A Single Centre Experience

OBJECTIVES Central veno-arterial extracorporeal membrane oxygenation (C-VA-ECMO) provides temporary cardiorespiratory support for patients in heart failure who cannot be weaned from cardiopulmonary bypass successfully. Outcomes are influenced by the reversibility of the initial insult and complications of the technique. METHODS The authors reviewed their single-center experience over the last 8 years to inform future practice. The study included all patients supported with C-VA-ECMO after cardiothoracic surgery between January 2008 and July 2016. The authors identified mortality risk factors using logistic regression analysis and chi-square tests. RESULTS One hundred and one patients were supported with C-VA-ECMO during the studied period. Weaning from ECMO was successful in 57.4% of patients, whereas 7.9% were bridged to veno-venous ECMO, 2% to peripheral veno-arterial ECMO, and 2% to biventricular ventricular assist devices. In-hospital and 1-year survival for all patients was 33.7% and 27.7%, respectively. Survival was considerably higher in transplantation patients (n = 11), at 63.6% and 54.5%, respectively. Risk factors linked to in-hospital mortality were age older than 70 years, lactate level greater than 4 mmol/L after 48 hours, and hepatic and kidney failure during ECMO support. CONCLUSIONS Overall one-third of patients in the cohort who the authors believe would otherwise have died from postcardiotomy cardiogenic shock survived because C-VA-ECMO was commenced after cardiac surgery. Survival is greater in transplantation patients necessitating this form of support during or immediately after surgery.

Extracorporeal membrane oxygenation: look out for a retrieval team coming to a hospital near you!

In 2011 the Department of Health commissioned five hospitals in England to provide extracorporeal membrane oxygenation (ECMO) to adults with severe respiratory failure. This review will explain the principles underlying ECMO, describe the circuitry used and discuss the care of a patient receiving support. We hope that it will be of use should a patient at your hospital be considered a candidate for ECMO.