Perfusion
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Renal failure is a common occurrence in patients with refractory cardiogenic shock including those supported with veno-arterial extracorporeal membrane oxygenation. Prevalence and outcome of acute and chronic kidney failure in extracorporeal membrane oxygenation patients have not been well documented. In this study, we investigated the occurrence of acute and chronic kidney failure in veno-arterial extracorporeal membrane oxygenation patients as well as predictors for survival. ⋯ A total of 196 veno-arterial extracorporeal membrane oxygenation patients were investigated. In total, 41.8% (82/196) patients had acute renal failure requiring continuous renal replacement therapy during extracorporeal membrane oxygenation. The 30- and 90-day survival was 55.1% (108/196) and 48.5% (95/196), respectively; 21.3% (23/108) and 11.6% (11/95) patients needed renal replacement therapy after 30 and 90 days, respectively. Predictors for KDIGO Stage 3 renal failure during extracorporeal membrane oxygenation were lactate (p = 0.026) and the number of blood units transfused during extracorporeal membrane oxygenation support (p = 0.000). A predictor for renal replacement therapy after 30 and 90 days was an elevated plasma-free hemoglobin level. The in-hospital survival was 54.6% (107/196). Serum lactate of less than 4.3 mmol/L, lower age, plasma-free hemoglobin of ⩽62 mg/dL, low number of blood units transfused during extracorporeal membrane oxygenation, and the use of an intra-aortic balloon pump were predictors for in-hospital and 90-day survival.
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Veno-venous extracorporeal carbon dioxide removal allows clearance of CO2 from the blood and is becoming popular to enhance protective mechanical ventilation and assist in the management of acute exacerbations of chronic obstructive pulmonary disease, including the prevention of intubation. The main factor determining CO2 transfer across a membrane lung for any given blood flow rate and venous CO2 content is the sweep gas flow rate. The in vivo characteristics of CO2 clearance using ultra-low blood flow devices in patients with acute exacerbations of chronic obstructive pulmonary disease has not been previously described. ⋯ The extracorporeal carbon dioxide removal device used in the study provides efficient clearance of CO2 at low sweep flow rates which then plateaus. This has implications for how the device may be used in clinical practice, particularly during the weaning phase where the final discontinuation of the device may take longer than anticipated. (ClinicalTrials.gov: NCT02086084, registered 13 March 2014, https://clinicaltrials.gov/ct2/show/NCT02086084 ).
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The criteria and process for liberation from extracorporeal membrane oxygenation in patients with severe acute respiratory distress syndrome are not standardized. The predictive accuracy of the oxygen challenge test as a diagnostic test in determining weaning and decannulation from venovenous extracorporeal membrane oxygenation was tested. ⋯ In severe acute respiratory distress syndrome requiring venovenous extracorporeal membrane oxygenation, the PaO2-OCT is a poor predictor of readiness to decannulate from extracorporeal membrane oxygenation. Additional factors involved in the control of respiratory drive and carbon dioxide clearance, particularly native lung dead space and total minute ventilation, should be assessed.
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Cerebral complications in veno-arterial extracorporeal membrane oxygenation are known to have a strong impact on mortality and morbidity. Aim of this study is to investigate the early incidence, risk factors and in-hospital mortality of intra-cranial ischaemia and haemorrhage in adults undergoing veno-arterial extracorporeal membrane oxygenation treatment. ⋯ Cerebral complications are frequent in patients on veno-arterial extracorporeal membrane oxygenation and may be clinically silent events. Careful monitoring with routine neuroimaging seems to be the most appropriate diagnostic approach at present. Intra-cranial ischaemia occurs more frequent than haemorrhage and is associated with cannulation of the aorta ascendens.
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The Harlequin syndrome is a complication observed in patients receiving peripheral venoarterial extracorporeal membrane oxygenation. This condition is defined as a critical variation in the oxygen saturation between the upper and the lower part of the body deriving from a poor lung function. ⋯ The use of a secondary centrifugal pump to manage the blood flow directed to the internal jugular vein, in the veno-arteriovenous extracorporeal membrane oxygenation setup, allows the reduction in the risk of blood clot formation, clotting factor consumption, and pulmonary embolism when compared to the use of an external clamp.