Outcomes of Venoarterial Extracorporeal Membrane Oxygenation Patients Requiring Multiple Episodes of Support.

OBJECTIVES: This study describes the largest North American single-institution experience with adult patients requiring multiple extracorporeal membrane oxygenation (ECMO) runs in the same admission and aims to describe outcomes of survival and complication rates in this patient population. DESIGN: A retrospective chart review-based study in a single quaternary care center of venoarterial (VA) ECMO patients cannulated multiple times on ECMO support to assess for outcomes and survival (both of ECMO therapy and survival to discharge). SETTING: Single quaternary academic center for ECMO. PARTICIPANTS: All patients undergoing VA ECMO who were at least 18 years of age from 2011 to 2019, composed of a total of 14 patients requiring multiple cannulations. INTERVENTIONS: None, this was a retrospective chart review. MEASUREMENTS AND MAIN RESULTS: Of the 326 patients reviewed, 14 patients (4.3% of all patients in the database) had multiple ECMO therapies. The average patient age was 55.2 ± 10.99 years of age, and 57% were female; 4 of the 14 (28.6%) patients survived to hospital discharge. The top 2 indications for initial VA ECMO therapy were cardiogenic shock after myocardial infarction (35.7%) and after cardiotomy shock (35.7%). For repeated cannulation, the most common cause was hypoxia (64%, 9 patients), with 6 of these patients requiring a right ventricular assist device plus oxygenator. Other causes for repeated cannulation included post-cardiotomy shock (14%), recurrent ventricular tachycardia (14%), and cardiogenic shock (7%). All patients who required continuous venovenous hemofiltration during their first run of ECMO did not survive to discharge. CONCLUSIONS: Fourteen of 326 patients in the authors' VA ECMO database required additional ECMO therapy after decannulation; this represents at least 1 to 2 cases per year at higher-volume centers. Despite the small number of patients in this retrospective review, it seems that certain patients are reasonable candidates for additional ECMO therapy should their cardiopulmonary function again decline. The findings of renal replacement therapy and infection being more common during a second ECMO run are logical, but larger cohorts (ideally multicenter or from within the Extracorporeal Life Support Organization registry) are required to validate these preliminary findings.

Extracorporeal Membrane Oxygenation Is a Team Sport: Institutional Survival Benefits of a Formalized ECMO Team.

OBJECTIVES: At the authors' institution, prior to 2014, patients requiring care in the peri-extracorporeal membrane oxygenation (ECMO) period were treated by intensivists with specific training in ECMO but worked independently. This isolated form of care was addressed in late 2013 with the formal initiation of an ECMO team. The authors wanted to assess the difference in overall mortality for ECMO patients cared for prior to the initiation of a multidisciplinary team compared to after its establishment. DESIGN: This was a retrospective chart review-based study. SETTING: This was a single-center university-based hospital setting. PARTICIPANTS: The study included all adult patients at the authors' institution who required ECMO support between the years 2009 and 2017. INTERVENTIONS: The new multidisciplinary ECMO team established a set of protocols and guidelines to care for ECMO patients. The formal ECMO team consisted of cardiac surgery, cardiac anesthesia, intensivists, cardiology heart failure specialist, intensive care unit nursing (NP/RN), perfusion services, respiratory therapy, nutrition, physical and occupational therapy, and an ethics committee member. MEASUREMENTS AND MAIN RESULTS: Manual chart review was conducted and survival to discharge was collected and separated into 2 groups, 2009 to 2013 (pre-ECMO team) and 2014 to 2017 (post-ECMO team). In a total of 279 charts reviewed, patients required ECMO support. Survival to discharge for patients between 2009 and 2013 was 37.7% compared to a survival to discharge of 52.3% between 2014 and 2017 (p value = 0.02). CONCLUSIONS: Patients cared for after the initiation of an ECMO team showed improved survival compared to patients cared for prior to the creation of the ECMO team.

Irrigación de las glándulas suprarrenales en el período fetal / Irrigation of the adrenal glands in the fetal period

Se hace un estudio anatómico de la revascularización de las glándulas suprarrenales en el feto