Feasibility of using the ProtekDuo cannula in V-P ECMO and PROpella configurations during ground and air transport.

INTRODUCTION: Use of the ProtekDuo cannula has been described for right ventricular assist devices (RVADs) and extracorporeal membrane oxygenation (ECMO) systems. CASE REPORT: We describe remote cannulation and transport of two patients with ProtekDuo cannula. One patient had isolated acute right ventricular failure (aRVF), was cannulated with ProtekDuo cannula in venopulmonary (V-P) configuration and transported by ambulance. Another patient had biventricular failure after myocardial infarction, was supported with ProtekDuo and Impella CP in PROpella configuration, and transported by helicopter. DISCUSSION: We appear to be the first group to report remote cannulation using the ProtekDuo cannula followed by ambulance and helicopter transport, which were performed without complication. We describe the pros and cons of these configurations in comparison to the gold standard of shock management with venoarterial ECMO, as well as important considerations for transport. CONCLUSION: Use of the ProtekDuo cannula for remote cannulations and transport is feasible and appears safe.

Extracorporeal membrane oxygenation in diabetic ketoacidosis-related cardiac and respiratory failure.

INTRODUCTION: Diabetic ketoacidosis (DKA) is a common clinical problem. When patients develop severe shock and/or respiratory failure, extracorporeal membrane oxygenation (ECMO) may be considered. This case series describes the clinical presentation and outcomes of patients with DKA supported with ECMO. METHODS: We conducted a retrospective and anonymized review of 15 patients with DKA who required ECMO at our institution. Demographic and ECMO-specific data were collected. Additional variables include ICU length of stay (LOS), acute kidney injury and use of continuous renal replacement therapy, disposition, and mortality. RESULTS: All ECMO cannulations were performed by an intensivist using peripheral vascular access. The majority of patients were female (73%) with a median age of 27 (IQR = 21.5-45) years. A diagnosis of diabetes mellitus (DM) prior to ECMO was present in 11 (73%) patients. Venoarterial ECMO was the initial mode used in 11 (73%) patients. The median duration of ECMO support was 7 (IQR = 6-14) days. The median ICU LOS was 12 (IQR = 8.5-20.5) days, and the median hospital LOS was 21 (IQR = 11-36.5) days. Eight patients had cardiac arrest and underwent extracorporeal cardiopulmonary resuscitation (ECPR) of which 4 (50%) patients survived to discharge. Overall, 10 (66.7%) patients were successfully weaned from ECMO and survived to discharge. CONCLUSION: This is the largest case series regarding the use of ECMO for patients with refractory shock, cardiac arrest, or respiratory failure related to DKA. The findings suggest that ECMO is a viable support option for managing these patients and has excellent outcomes, including patients with cardiac arrest.