RESUMO
BACKGROUND: Mechanical power (MP) refers to the energy delivered by a ventilator to the respiratory system per unit of time. MP referenced to predicted body weight (PBW) or respiratory system compliance have better predictive value for mortality than MP alone in acute respiratory distress syndrome (ARDS). Our objective was to assess the potential impact of consecutive changes of MP on hospital mortality among ARDS patients receiving extracorporeal membrane oxygenation (ECMO). METHODS: We performed a retrospective analysis of patients with severe ARDS receiving ECMO in a tertiary care referral center in Taiwan between May 2006 and October 2015. Serial changes of MP during ECMO were recorded. RESULTS: A total of 152 patients with severe ARDS rescued with ECMO were analyzed. Overall hospital mortality was 53.3%. There were no significant differences between survivors and nonsurvivors in terms of baseline values of MP or other ventilator settings. Cox regression models demonstrated that mean MP alone, MP referenced to PBW, and MP referenced to compliance during the first 3 days of ECMO were all independently associated with hospital mortality. Higher MP referenced to compliance (HR 2.289 [95% CI 1.214-4.314], p = 0.010) was associated with a higher risk of death than MP itself (HR 1.060 [95% CI 1.018-1.104], p = 0.005) or MP referenced to PBW (HR 1.004 [95% CI 1.002-1.007], p < 0.001). The 90-day hospital mortality of patients with high MP (> 14.4 J/min) during the first 3 days of ECMO was significantly higher than that of patients with low MP (⦠14.4 J/min) (70.7% vs. 46.8%, p = 0.004), and the 90-day hospital mortality of patients with high MP referenced to compliance (> 0.53 J/min/ml/cm H2O) during the first 3 days of ECMO was significantly higher than that of patients with low MP referenced to compliance (⦠0.53 J/min/ml/cm H2O) (63.6% vs. 29.7%, p < 0.001). CONCLUSIONS: MP during the first 3 days of ECMO was the only ventilatory variable independently associated with 90-day hospital mortality, and MP referenced to compliance during ECMO was more predictive for mortality than was MP alone.
Assuntos
Oxigenação por Membrana Extracorpórea/classificação , Mortalidade Hospitalar/tendências , Fenômenos Mecânicos , Síndrome do Desconforto Respiratório/mortalidade , Adulto , Idoso , Oxigenação por Membrana Extracorpórea/métodos , Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome do Desconforto Respiratório/epidemiologia , Síndrome do Desconforto Respiratório/terapia , Estudos Retrospectivos , Estatísticas não Paramétricas , Taiwan/epidemiologiaRESUMO
BACKGROUND: The Extracorporeal Life Support Organization (ELSO) Maastricht Treaty for Nomenclature in Extracorporeal Life Support (ECLS) established consensus nomenclature and abbreviations for ECLS to ensure accurate, concise communication. METHODS: We build on this consensus nomenclature by layering a framework of precise and efficient abbreviations for cannula configuration that describe flow direction, number of cannulae used, any additional ECLS-related catheters, and cannulation sites. This work is a consensus of international representatives of the ELSO, including those from the North American, Latin American, European, South and West Asian, and Asian-Pacific chapters of ELSO. RESULTS: The classification increases in descriptive capability by introducing a third (cannula tip position) and fourth (cannula dimension) level to those provided in the previous consensus on ECLS cannulation configuration nomenclature. This expansion offers the simplest level needed to convey cannulation information yet allows for more details when required. CONCLUSIONS: A complete nomenclature for ECLS cannulation configurations accommodating future revisions was developed to facilitate ability to compare practices and results, to promote efficient communication, and to improve quality of registry data.
Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Oxigenação por Membrana Extracorpórea/tendências , Sociedades/tendências , Cateterismo/métodos , Cateterismo/tendências , Oxigenação por Membrana Extracorpórea/classificação , Humanos , Terminologia como AssuntoRESUMO
The presence of renal dysfunction is not unusual in patients with pulmonary or cardiac dysfunction who require rescue with extracorporeal membrane oxygenation (ECMO). The complexity, implicit in the implementation of both techniques, can be overwhelming. This review aims to explain the most important aspects of continuous renal replacement therapy in a patient with extracorporeal support.
Assuntos
Injúria Renal Aguda/terapia , Terapia Combinada/métodos , Oxigenação por Membrana Extracorpórea/métodos , Terapia de Substituição Renal/instrumentação , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/mortalidade , Chile/epidemiologia , Oxigenação por Membrana Extracorpórea/classificação , Humanos , Terapia de Substituição Renal/métodos , Fatores de Risco , Taxa de SobrevidaRESUMO
Extracorporeal life support (ECLS) was developed more than 50 years ago, initially with venoarterial and subsequently with venovenous configurations. As the technique of ECLS significantly improved and newer skills developed, complexity in terminology and advances in cannula design led to some misunderstanding of and inconsistency in definitions, both in clinical practice and in scientific research. This document is a consensus of multispecialty international representatives of the Extracorporeal Life Support Organization, including the North America, Latin America, EuroELSO, South West Asia and Africa, and Asia-Pacific chapters, imparting a global perspective on ECLS. The goal is to provide a consistent and unambiguous nomenclature for ECLS and to overcome the inconsistent use of abbreviations for ECLS cannulation. Secondary benefits are ease of multicenter collaboration in research, improved registry data quality, and clear communication among practitioners and researchers in the field.
Assuntos
Oxigenação por Membrana Extracorpórea/classificação , Oxigenação por Membrana Extracorpórea/métodos , Terminologia como Assunto , Consenso , HumanosRESUMO
The presence of renal dysfunction is not unusual in patients with pulmonary or cardiac dysfunction who require rescue with extracorporeal membrane oxygenation (ECMO). The complexity, implicit in the implementation of both techniques, can be overwhelming. This review aims to explain the most important aspects of continuous renal replacement therapy in a patient with extracorporeal support.
Assuntos
Humanos , Oxigenação por Membrana Extracorpórea/métodos , Terapia de Substituição Renal/instrumentação , Terapia Combinada/métodos , Injúria Renal Aguda/terapia , Oxigenação por Membrana Extracorpórea/classificação , Chile/epidemiologia , Taxa de Sobrevida , Fatores de Risco , Terapia de Substituição Renal/métodos , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/mortalidadeRESUMO
BACKGROUND: Although many risk models have been tested in patients who undergo extracorporeal membrane oxygenation, few have been assessed for patients who received veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support in the emergency department (ED). This study aimed to successfully predict outcomes of patients with cardiac or noncardiac failure who received VA-ECMO in the ED within 24 hours of arrival at the ED. METHOD: This retrospective, observational cohort study included 154 patients, who were classified as cardiac (n = 127) and noncardiac (n = 27) patients and received VA-ECMO within 24 hours after arrival at the China Medical University Hospital ED in Taiwan between January 2009 and September 2014. We recorded mechanical ventilation settings, arterial blood gases, laboratory parameters including plasma lactate level, requirement of catecholamines, and risk scores at time of ECMO initiation. ECMO and mechanical ventilation support duration, length of stay in the hospital, and 90-day mortality data were also examined. RESULTS: The overall mortality rate was 64.9 %. We used "survival after veno-arterial ECMO (SAVE)" scores to assess survival prediction in survival and nonsurvival groups, which was statistically different (-3.2 vs. -8.3, p <0.001). According to multivariate Cox proportional regression of survival, lactate (hazard ratio [HR] = 1.01, 95 % confidence interval [CI], 1.01-1.01, p <0.001) and SAVE score (HR = 0.92, [95 % CI, 0.88-0.96], p = 0.001) were independent predictors of outcome. Excellent discrimination (area under curve (AUC) = 0.843) was observed when lactate and SAVE score were combined, which we referred to as "the modified SAVE score." CONCLUSIONS: Modified SAVE scores improved outcome prediction for patients who underwent urgent VA-ECMO in the ED.
Assuntos
Oxigenação por Membrana Extracorpórea/classificação , Oxigenação por Membrana Extracorpórea/métodos , Medição de Risco/normas , Índice de Gravidade de Doença , Adulto , Idoso , Gasometria , Distribuição de Qui-Quadrado , Estudos de Coortes , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Análise de Regressão , Síndrome do Desconforto Respiratório/mortalidade , Síndrome do Desconforto Respiratório/terapia , Estudos Retrospectivos , Medição de Risco/métodos , Estatísticas não Paramétricas , Análise de Sobrevida , Taiwan , Resultado do TratamentoRESUMO
Recently, several prognostic scoring systems for patients with severe acute respiratory distress syndrome (ARDS) requiring extracorporeal membrane oxygenation (ECMO) have been published. The aim of this study was to validate the established scoring systems for outcome prediction in Korean patients. We retrospectively reviewed the data of 50 patients on ECMO therapy in our center from 2012 to 2014. A calculation of outcome prediction scoring tools was performed and the comparison across various models was conducted. In our study, the overall hospital survival was 46% and successful weaning rate was 58%. The Predicting Death for Severe ARDS on V-V ECMO (PRESERVE) score showed good discrimination of mortality prediction for patients on ECMO with AUC of 0.80 (95% CI 0.66-0.90). The respiratory extracorporeal membrane oxygenation survival prediction (RESP) score and simplified acute physiology score (SAPS) II score also showed fair prediction ability with AUC of 0.79 (95% CI 0.65-0.89) and AUC of 0.78 (95% CI 0.64-0.88), respectively. However, the ECMOnet score failed to predict mortality with AUC of 0.51 (95% CI 0.37-0.66). When evaluating the predictive accuracy according to optimal cut-off point of each scoring system, RESP score had a best specificity of 91.3% and 66.7% of sensitivity, respectively. This study supports the clinical usefulness of the prognostic scoring tools for severe ARDS with ECMO therapy when applying to the Korean patients receiving ECMO.
Assuntos
Oxigenação por Membrana Extracorpórea , Projetos de Pesquisa/normas , Síndrome do Desconforto Respiratório/terapia , Adulto , Idoso , Área Sob a Curva , Oxigenação por Membrana Extracorpórea/classificação , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , República da Coreia , Síndrome do Desconforto Respiratório/mortalidade , Síndrome do Desconforto Respiratório/patologia , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/classificação , Oxigenação por Membrana Extracorpórea/história , Veia Femoral/lesões , Veia Femoral/cirurgia , Conversão para Cirurgia Aberta/instrumentação , Conversão para Cirurgia Aberta/métodos , Conversão para Cirurgia Aberta , Análise Multivariada , Metanálise como Assunto , Espanha/epidemiologiaRESUMO
The Food and Drug Administration (FDA) is issuing a final order to redesignate membrane lung devices for long-term pulmonary support, a preamendments class III device, as extracorporeal circuit and accessories for long-term respiratory/cardiopulmonary failure, and to reclassify the device to class II (special controls) in patients with acute respiratory failure or acute cardiopulmonary failure where other available treatment options have failed, and continued clinical deterioration is expected or the risk of death is imminent. A membrane lung device for long-term pulmonary support (>6 hours) refers to the oxygenator in an extracorporeal circuit used during long-term procedures, commonly referred to as extracorporeal membrane oxygenation (ECMO). Because a number of other devices and accessories are used with the oxygenator in the circuit, the title and identification of the regulation are revised to include extracorporeal circuit and accessories for long-term respiratory/cardiopulmonary failure. Although an individual device or accessory used in an ECMO circuit may already have its own classification regulation when the device or accessory is intended for short-term use (<=6 hours), such device or accessory will be subject to the same regulatory controls applied to the oxygenator (i.e., class II, special controls) when evaluated as part of the ECMO circuit for long-term use (>6 hours). On its own initiative, based on new information, FDA is revising the classification of the membrane lung device for long-term pulmonary support.
Assuntos
Aprovação de Equipamentos/legislação & jurisprudência , Oxigenação por Membrana Extracorpórea/classificação , Oxigenação por Membrana Extracorpórea/instrumentação , Humanos , Insuficiência Respiratória/terapia , Estados Unidos , United States Food and Drug AdministrationRESUMO
Recently, several prognostic scoring systems for patients with severe acute respiratory distress syndrome (ARDS) requiring extracorporeal membrane oxygenation (ECMO) have been published. The aim of this study was to validate the established scoring systems for outcome prediction in Korean patients. We retrospectively reviewed the data of 50 patients on ECMO therapy in our center from 2012 to 2014. A calculation of outcome prediction scoring tools was performed and the comparison across various models was conducted. In our study, the overall hospital survival was 46% and successful weaning rate was 58%. The Predicting Death for Severe ARDS on V-V ECMO (PRESERVE) score showed good discrimination of mortality prediction for patients on ECMO with AUC of 0.80 (95% CI 0.66-0.90). The respiratory extracorporeal membrane oxygenation survival prediction (RESP) score and simplified acute physiology score (SAPS) II score also showed fair prediction ability with AUC of 0.79 (95% CI 0.65-0.89) and AUC of 0.78 (95% CI 0.64-0.88), respectively. However, the ECMOnet score failed to predict mortality with AUC of 0.51 (95% CI 0.37-0.66). When evaluating the predictive accuracy according to optimal cut-off point of each scoring system, RESP score had a best specificity of 91.3% and 66.7% of sensitivity, respectively. This study supports the clinical usefulness of the prognostic scoring tools for severe ARDS with ECMO therapy when applying to the Korean patients receiving ECMO.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Área Sob a Curva , Oxigenação por Membrana Extracorpórea/classificação , Estimativa de Kaplan-Meier , Prognóstico , Curva ROC , República da Coreia , Projetos de Pesquisa/normas , Síndrome do Desconforto Respiratório/mortalidade , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
This pictorial review provides the principles of extracorporeal membrane oxygenation (ECMO) support and associated CT imaging features with emphasis on the hemodynamic changes and possible imaging pitfalls encountered. It is important that radiologists in ECMO centers apply well-designed imaging protocols and familiarize themselves with post-contrast CT imaging findings in patients on ECMO.
Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Hemodinâmica/fisiologia , Tomografia Computadorizada Multidetectores , Adulto , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Meios de Contraste/administração & dosagem , Meios de Contraste/farmacocinética , Oxigenação por Membrana Extracorpórea/classificação , Feminino , Coração Auxiliar , Humanos , Balão Intra-Aórtico/instrumentação , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional/fisiologia , Estudos Retrospectivos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
This pictorial review provides the principles of extracorporeal membrane oxygenation (ECMO) support and associated CT imaging features with emphasis on the hemodynamic changes and possible imaging pitfalls encountered. It is important that radiologists in ECMO centers apply well-designed imaging protocols and familiarize themselves with post-contrast CT imaging findings in patients on ECMO.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aorta Torácica/fisiopatologia , Meios de Contraste/administração & dosagem , Oxigenação por Membrana Extracorpórea/classificação , Coração Auxiliar , Hemodinâmica/fisiologia , Balão Intra-Aórtico/instrumentação , Tomografia Computadorizada Multidetectores , Fluxo Sanguíneo Regional/fisiologia , Estudos Retrospectivos , Disfunção Ventricular Esquerda/fisiopatologiaAssuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Oxigenação por Membrana Extracorpórea/métodos , Assistência Perioperatória/métodos , Adulto , Cateterismo , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/classificação , Oxigenação por Membrana Extracorpórea/instrumentação , Humanos , Cuidados Intraoperatórios , Movimentação e Reposicionamento de Pacientes , Cuidados Pré-Operatórios , Resultado do TratamentoRESUMO
We compared the morbidity of patients with meconium aspiration syndrome (MAS) with that in patients with all other respiratory conditions treated with extracorporeal membrane oxygenation (ECMO) (no MAS). If ECMO for MAS was associated with a lower complication rate, then relaxed ECMO entry criteria could be considered. A retrospective review was performed of all patients in the national extracorporeal life support (ELSO) registry from 1989 to 2004. Complications were divided into mechanical, hematologic, neurologic, renal, pulmonary, cardiovascular, infectious, and metabolic categories. MAS and no-MAS patients were divided into veno-venous (VV) or veno-arterial (VA) ECMO categories, based on mode of ECMO used, and number of complications per patient in each category was determined. Statistical significance was determined by Chi-square test. A total of 1587 patients (700 MAS, 887 no MAS) on VV ECMO and 2723 (572 MAS, 2151 no MAS) on VA ECMO were identified with a total of 2415 complications in MAS and 9550 in no-MAS patients. Overall, MAS patients had a significantly lower number of complications per patient in each category versus no-MAS patients. These results indicate that regardless of type of ECMO, there are fewer complications on ECMO in MAS versus no-MAS patients. These data support the consideration of relaxed ECMO entry criteria for MAS.