Extracorporeal Membrane Oxygenation (ECMO) as Bridge to Transplant in Pulmonary Vascular Diseases: Analysis of United Network for Organ Sharing (UNOS) Database

2019 ◽  
Author(s):  
J. Sethi ◽  
G.A. Garrido Rosa ◽  
K. Patel ◽  
N.S. Sharma
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Vascular Diseases ◽  
Bridge To Transplant ◽  
Membrane Oxygenation ◽  
Pulmonary Vascular Diseases ◽  
United Network

Extracorporeal Membrane Oxygenation

2019 ◽  
pp. 152-158
Author(s):  
J. Kyle Bohman ◽  
Gregory J. Schears
Keyword(s):  
Pulmonary Embolism ◽  
Extracorporeal Membrane Oxygenation ◽  
Massive Pulmonary Embolism ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Bridge To Transplant ◽  
Membrane Oxygenation ◽  
Cardiopulmonary Support ◽  
Improved Outcomes ◽  
Resource Requirements ◽  
Substantial Resource

This chapter examines the indications, applications, and complications of modern extracorporeal membrane oxygenation (ECMO). The safety profile of ECMO has improved through advancements in devices, components, and routine management, resulting in improved outcomes and an expanded range of applications. Currently, ECMO can provide cardiopulmonary support in reversible conditions, such as post-cardiotomy shock, acute respiratory failure, extracorporeal cardiopulmonary resuscitation, bridge to transplant, complex airway repairs, and massive pulmonary embolism, among others. The chapter focuses on the primary factors involved in using ECMO successfully: appropriate patient selection, optimal cannulation strategy, and availability of comprehensive medical resources (or a referral agreement with a comprehensive ECMO center) to handle emergent ECMO complications and to absorb the substantial resource requirements of treating patients with ECMO.

scholarly journals Lessons learned from extracorporeal membrane oxygenation as a bridge to lung transplantation

2014 ◽  
Author(s):  
Vladimir Shumaster ◽  
Oliver Jawitz ◽  
David Yuh ◽  
Pramod Bonde
Keyword(s):  
Postoperative Complications ◽  
Extracorporeal Membrane Oxygenation ◽  
Lung Transplantation ◽  
Survival Rates ◽  
Length Of Hospital Stay ◽  
Lessons Learned ◽  
Control Group ◽  
Membrane Oxygenation ◽  
Lung Transplants ◽  
United Network

Extracorporeal membrane oxygenation (ECMO) has been used infrequently as a bridge to lung transplantation due to lack of consensus and data regarding the benefits of such a strategy. We present data from the United Network of Organ Sharing (UNOS) database on the outcomes of patients bridged to lung transplantation with ECMO. We used the UNOS database to analyze data between January 1, 2000 and December 31, 2011. During this time 14,263 lung transplants were performed, of which 143 (1.0%) were bridged using ECMO. Patients on ECMO as a bridge to lung transplantation were compared to those transplanted without prior ECMO support. Demographics, survival rates, complications, and rejection episodes were compared between the two groups. The 30-day, 6-month, 1-year, 3-year, and 5-year survival rates were 69%, 56%, 48%, 26%, and 11%, respectively, for the ECMO bridge group and 95%, 88%, 81%, 58%, and 38% respectively, for the control group (p ≤ 0.01). The ECMO group incurred higher rate of postoperative complications, including airway dehiscence (4% vs. 1%, p ≤ 0.01), stroke (3% vs. 2%, p ≤ 0.01), infection (56% vs. 42%, p ≤ 0.01), and pulmonary embolism (10% vs. 0.6%, p ≤ 0.01). The length of hospital stay was longer for the ECMO group (41 vs. 25 days, p ≤ 0.01), and they were treated for rejection more often (49% vs. 36%, p = 0.02). The use of ECMO as a bridge to lung transplantation is associated with significantly worse survival and more frequent postoperative complications. Therefore, we advocate very careful patient selection and cautious use of ECMO.

scholarly journals A Review of Pulmonary Arterial Hypertension Treatment in Extracorporeal Membrane Oxygenation: A Case Series of Adult Patients

2022 ◽  
Vol 27 ◽  
pp. 107424842110690
Author(s):  
Heather Torbic ◽  
Benjamin Hohlfelder ◽  
Sudhir Krishnan ◽  
Adriano R. Tonelli
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Extracorporeal Membrane Oxygenation ◽  
Arterial Hypertension ◽  
Case Series ◽  
Retrospective Case ◽  
Bridge To Transplant ◽  
Membrane Oxygenation ◽  
Drug Concentrations ◽  
Pulmonary Arterial ◽  
Va Ecmo

Background: Little data is published describing the use of medications prescribed for pulmonary arterial hypertension (PAH) in patients receiving extracorporeal membrane oxygenation (ECMO). Even though many patients with PAH may require ECMO as a bridge to transplant or recovery, little is reported regarding the use of PAH medications in this setting. Methods: This retrospective case series summarizes the clinical experience of 8 patients with PAH receiving ECMO and reviews medication management in the setting of ECMO. Results: Eight PAH patients, 5 of whom were female, ranging in age from 21 to 61 years old, were initiated on ECMO. Veno-arterial (VA) ECMO was used in 4 patients, veno-venous (VV) ECMO and hybrid ECMO configurations in 2 patients respectively. Common indications for ECMO included cardiogenic shock, bridge to transplant, and cardiac arrest. All patients were on intravenous (IV) prostacyclin therapy at baseline. Refractory hypotension was noted in 7 patients of whom 5 patients required downtitration or discontinuation of baseline PAH therapies. Three patients had continuous inhaled epoprostenol added during their time on ECMO. In patients who were decannulated from ECMO, PAH therapies were typically resumed or titrated back to baseline dosages. One patient required no adjustment in PAH therapy while on ECMO. Two patients were not able to be decannulated from ECMO. Conclusion: The treatment of critically ill PAH patients is challenging given a variety of factors that could affect PAH drug concentrations. In particular, PAH patients on prostacyclin analogues placed on VA ECMO appear to have pronounced systemic vasodilation requiring vasopressors which is alleviated by temporarily reducing the intravenous prostacyclin dose. Patients should be closely monitored for potential need for rapid titrations in prostacyclin therapy to maintain hemodynamic stability.

scholarly journals MitraClip® procedure as bridge to left ventricular assist device: Enable extracorporeal membrane oxygenation weaning and reduce perioperative risk

Perfusion ◽  
2022 ◽  
pp. 026765912110652
Author(s):  
Martin O. Schmiady ◽  
Stephan Winnik ◽  
Dominique Bettex ◽  
Raed Aser
Keyword(s):  
Mitral Valve ◽  
Extracorporeal Membrane Oxygenation ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
Assist Device ◽  
Ventricular Assist ◽  
Bridge To Transplant ◽  
Membrane Oxygenation ◽  
Left Ventricular Assist

Secondary mitral valve regurgitation is a frequent consequence of left ventricular dysfunction in patients with severe heart failure. The management of this disease can be challenging since it often culminates in refractory pulmonary edema and multi-organ failure. We present the case of a 50-year-old male who was admitted in cardiogenic shock following myocardial infarction. After successful revascularization, percutaneous mitral valve repair using the MitraClip® device enabled weaning from extracorporeal membrane oxygenation followed by the implantation of a left ventricular assist device as bridge to transplant.

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