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Deaths Following Cardiac Surgery and Invasive Interventions
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
There has been also an increase in use of intra-aortic balloon pump (IABP) insertion (Fig. 9.6) as well as left and right ventricular assist devices (LVAD and RVAD) (Fig. 9.7). Extracorporeal membrane oxygenator (ECMO) has also been increasingly used for both cardiac and respiratory support.
Complications of open thoracoabdominal aortic aneurysm repair
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Conversely, full cardiopulmonary bypass employs a membrane oxygenator and can therefore draw blood directly from the systemic venous circulation. This is most commonly accomplished by directing a long venous cannula through the femoral vein and up into the inferior vena cava near the atrio-caval junction. After passing through the membrane oxygenator, the blood is again returned to the distal circulation through the femoral artery.
Current Epidemiological and Clinical Features of COVID-19; a Global Perspective From China
Published in William C. Cockerham, Geoffrey B. Cockerham, The COVID-19 Reader, 2020
Huilan Tu, Sheng Tu, Shiqi Gao, Anwen Shao, Jifang Sheng
At present, there is no specific antiviral treatment recommended for COVID-19, and no vaccine is available. For mildly to moderately ill patients, active symptomatic support remains key for treatment, such as maintaining hydration and nutrition and controlling fever and cough. For patients with severe infection or those with respiratory failure, oxygen inhalation through a mask, high nasal oxygen flow inhalation, non-invasive ventilation, or mechanical ventilation is needed. Extracorporeal membrane oxygenation (ECMO) can be implemented if the other methods do not work.66 Additionally, hemo-dynamic support is essential for managing septic shock,54 and antibiotics and antifungals may also be required. As corticosteroid therapy is commonly used among critically ill MERS patients,67 short courses of corticosteroids at low-to-moderate doses can be used with caution.68,69 As anxiety and fear are common among COVID-19 patients, dynamic assessment strategies should be established to monitor their mental health.70
Mesenchymal stromal cells for acute respiratory distress syndrome (ARDS), sepsis, and COVID-19 infection: optimizing the therapeutic potential
Published in Expert Review of Respiratory Medicine, 2021
Ellen Gorman, Jonathan Millar, Danny McAuley, Cecilia O’Kane
MSC administration during extracorporeal membrane oxygenation (ECMO) has been investigated in large animal models of ARDS. Millar et al, 2020, demonstrated that endobronchial MSC administration in an ovine model of ARDS during ECMO improved indices of shock (vasopressor requirements, arterial pressure, lactate) and histological lung injury, although interestingly did not improve oxygenation or pulmonary mechanics [97]. An earlier study by Kocyildirim et al, 2017, had investigated MSC administration during ECMO in a swine LPS model [98]. Similarly, they demonstrated a trend toward reduced histological lung injury in a small study group (n = 3); however, no effects on oxygenation or hemodynamics were reported during a 4-hour period of follow up [98]. Of concern, the study by Millar et al, 2020, demonstrated the function of the membrane oxygenator was significantly impaired following MSC administration, with an increase in trans-oxygenator pressure gradient from 4 hours post-MSC delivery [97]. MSCs by definition are plastic adherent and cells consistent with MSCs were found to be adherent to membrane oxygenator fibers following their administration during ECMO in this model [97]. This supported previous findings in an ex-vivo ECMO model, which similarly demonstrated that MSC avidity for binding to plastic surfaces impaired the function of a membrane oxygenator [99]. The authors concluded that MSC administration could not be recommended during ECMO. In an ongoing trial of MSC therapy in patients with COVID-19 ARDS, patients receiving ECMO are excluded [100].
Postoperative delirium after coronary artery bypass graft surgery: Dexmedetomidine infusion alone or with the addition of oral melatonin
Published in Egyptian Journal of Anaesthesia, 2021
Ramy Mahrose, Heba ElSerwi, Alfred Maurice, Mayar Elsersi
Midazolam was used before surgery with a maximum of 0.03 mg/kg. Induction of anesthesia was with incremental doses of fentanyl up to 10–12 ug/kg and incremental doses of propofol 0.5–2 mg/kg. Muscle relaxation was achieved by 0.6 mg/kg rocuronium followed by top-up doses during the surgery guided by the nerve stimulator. Maintenance of anesthesia was done using isoflurane 0.5–2%. Blood pressure and heart rate were maintained at around 20% of baseline values. Heparin was used for anticoagulation and maintenance of activated clotting time more than 480 s. The cardiopulmonary bypass circuit was primed with 1 L of Ringer’s Lactate and 250 ml of 20% mannitol. Membrane oxygenator (Medtronic Affinity NT) was used. During CPB temperature was lowered to 30–32°C and maintained at the same level, the pump flow rate 2.4–2.8 l/min/m2, and mean perfusion pressure was targeted between 60 and 80 mmHg. Increments of morphine and propofol were used to maintain anesthesia during CPB. Hematocrit was maintained within 25–35%, fractional concentration of inspired oxygen adjusted to keep oxygen partial pressure within 150–250 mmHg, and gas flow was adjusted to maintain arterial carbon dioxide tension within 35–40 mmHg. Intermittent antegrade and occasionally retrograde blood cardioplegia was given for myocardial protection. Rewarming to 36º-37°C was done before separation from CPB. Protamine sulfate 1 mg/100 U heparin was given after separation from CPB to reach activated clotting time within 10% of baseline. After surgery all patients were transferred to ICU.
Extracorporeal membrane oxygenation support in adult patients with acute respiratory distress syndrome
Published in Expert Review of Respiratory Medicine, 2020
Mechanical ventilation is an important lifesaving therapy for providing respiratory support to maintain adequate gas exchange in patients with acute respiratory distress syndrome (ARDS) until the function of the damaged lung is restored. However, some patients fail to achieve adequate oxygenation or carbon dioxide removal to sustain life despite positive-pressure ventilation. Extracorporeal membrane oxygenation (ECMO) was introduced as salvage therapy in such patients. Unlike the expectation that ECMO could reduce the risk of death by improving refractory hypoxemia or hypercapnic respiratory acidosis in patients with severe respiratory failure, earlier studies showed only an improvement of gas exchange without survival benefit from ECMO, and these disappointing results discouraged wider application [1,2]. However, since then, the Conventional Ventilator Support Versus ECMO for Severe Acute Respiratory Failure (CESAR) trial and several studies during the H1N1 influenza pandemic in 2009 reported the successful use of ECMO, again highlighting the technique in the management of severe acute respiratory failure [3–7]. These studies suggested that advances in patient selection, timing of ECMO initiation, and bedside management during ECMO support are key influencing factors in achieving positive results in parallel with improvements in circuit technology. In this review, therefore, we discuss the indications for ECMO in patients with ARDS and contemporary management of adult patients receiving ECMO for respiratory support.