Qatar Medical Journal - 1 - Extracorporeal Life Support Organisation of the South and West Asia Chapter 2017 Conference Proceedings, February 2017

Extracorporeal Life Support (ECLS) is saving an increasing number of lives worldwide,1 so it is a great pleasure to welcome for the first time in Qatar the South and West Asia Chapter (SWAC) of the Extracorporeal Life Support Organisation (ELSO). The conference organizing and scientific committees have worked tirelessly under the leadership of Dr Ibrahim Fawzy Hassan (2017 Conference Chair) to make ELSO SWAC 2017 an enriching event tha Read More

Introduction: The aim of the program was to establish a severe respiratory failure (SRF) service with mobile extracorporeal membrane oxygenation (ECMO) retrieval capability throughout Qatar. This was achieved through the collaboration of various Hamad Medical Corporation (HMC) entities (critical care, cardiothoracic surgery, vascular surgery, and ambulance services). The service was commissioned by the Ministry of Public Health in O Read More

Introduction: The H1N1 epidemic in 2009 caused a significant increase in the utilization of respiratory extracorporeal membrane oxygenation (ECMO) therapy for severe respiratory failure (SRF) patients who failed to improve following conventional ventilation therapy. Its use was linked to a high patient survival rate (more than 70%) reported from Australian and New Zealand1 as well as Canadian ECMO2 registries. It eventually led to the CES Read More

Introduction: Extracorporeal membrane oxygenation (ECMO) is an adaptation of conventional cardiopulmonary bypass techniques used for long-term support of respiratory and/or cardiac function. It provides physiologic cardiopulmonary support for patients with acute, reversible cardiac or respiratory failure. The term “extracorporeal life support” (ECLS) was proposed to describe prolonged but temporary (1–30 days) support of heart or lun Read More

Introduction: The provision of an effective extracorporeal membrane oxygenation (ECMO) service requires a dedicated unit with sufficient caseload and access to specialised resources.1 Moving unstable patients, with refractory respiratory failure on conventional mechanical ventilation, to the specialised centre for ECMO poses great risk to the patient.1,2 Therefore, there is a need to have mobile ECMO capabilities with specialised retrieval tea Read More

In the USA, trauma represents the leading cause of death between the ages of 1 and 46 years and contributed to 192,000 deaths in 2014.1 Major trauma is also responsible for significant disabilities and increased hospital length of stay (LOS), and represents a huge financial burden. Acute respiratory failure (ARF) is multifactorial in trauma patients with diverse underlying pathophysiological mechanisms. In a blunt thoracic injury, Read More

“Bringing ECMO simulation to life”: The main theme of the 4th Annual Conference of the Extracorporeal Life Support Organisation – South and West Asia Chapter (ELSO-SWAC), “Bringing ECMO Simulation to Life”, is meant to emphasise the growing role of simulation in healthcare and medical education at large and in the highly specialised and complex field of extracorporeal life support (ECLS), and in particular for extracorporeal membrane ox Read More

Extracorporeal life support (ECLS) is the prototype example of translational research. It began in laboratory studies to design, test, and characterize devices for prolonged extracorporeal circulation in the 1960s. The first clinical cases of ECLS for heart and lung failure were in the 1970s. These cases were met with skepticism, but the results in neonatal respiratory failure were encouraging. In the early 1980s, two centers conducted rando Read More

The South and West Asia Chapter of Extracorporeal Life Support Organisation (SWAC ELSO) was established in the year 2013 with the combined efforts of senior members from the ELSO and the ECMO society of India.1 It was established with the idea of improving the awareness and practice of ECMO in this part of the world. I am pleased to see the growth of the organisation in the next couple of years. This region is representative of the me Read More

The clarion call for setting up a Qatar adult extracorporeal membrane oxygenation (ECMO) program came during the MERS-CoV outbreak in the Arabian Peninsula region.1 This carried a high mortality rate in those presenting with severe respiratory failure, and recent data from the “CESAR Trial” showed that treatment in a severe respiratory failure center with ECMO capabilities improved severe respiratory failure (SRF) patient survival.2 Owin Read More

Rationale: Transport of critically ill patients on extracorporeal membrane oxygenation (ECMO) can be challenging; however, this has been demonstrated to be safe and feasible if undertaken by adequately trained teams,1–3 with appropriate equipment and a platform that can accommodate the team and allows full access to the patient. The ECMO retrieval service is a key component of the severe respiratory failure (SRF-ECMO) program. The H Read More

Quality and patient safety are core elements of a successful extracorporeal membrane oxygenation (ECMO) program. Patient survival, patient safety, and quality of life were the main considerations when establishing an ECMO service in Qatar, with the alternatives being death from refractory hypoxemia or permanent lung fibrosis and reduced quality of life as a result of harmful ventilation. The program strives to achieve these goal Read More

Introduction: Acute severe respiratory failure poses a major treatment challenge which stubbornly carries high mortality and morbidity rates. Here, we review PaO2/FiO2 (PF) ratio and disease severity, and discuss protective lung ventilation and the rescue therapies, and when to use what? PF ratio alone is not sufficient to determine disease severity: A recent study by Villar and colleagues demonstrated that only 38% of patients who were class Read More

The extracorporeal membrane oxygenation (ECMO) cannulae can be safely inserted into the jugular and femoral regions using a percutaneous dilation technique or by open surgical cannulation. Percutaneous dilation that avoids skin cutting can achieve a tight seal between skin, vessels and cannulae. This avoids bleeding associated with surgical dissection and limits tissue damage. Surgical dissection is also associated with additional risks of Read More

Temporary mechanical cardiopulmonary support may be used intraoperatively to facilitate cardiac surgery. Over the past decade, this intervention has been extended for prolonged use in the intensive care unit (ICU) as extracorporeal membrane oxygenation (ECMO).1 Two types of ECMO exist in clinical practice: veno-arterial (VA) and veno-venous (VV). VV ECMO provides support to the pulmonary system by extracting blood from the right atr Read More

The use of venovenous extracorporeal membrane oxygenation (VV-ECMO) for severe acute respiratory failure (ARF) has considerably increased worldwide. Therefore, extracorporeal membrane oxygenation (ECMO) teams called for practical guidelines with clear objectives on how to manage ECMO on daily basis.1 All classical topics of intensive care management have been put in perspective with the use of ECMO, opening multiple Read More

Introduction: Echocardiography (ECHO) plays a fundamental role in the management of patients supported with extracorporeal membrane oxygenation (ECMO).1 It is particularly useful for the detection of cardiac complications that may arise during ECMO. It helps in many ways during the ECMO run, as presented in Table 1.Table 1Indications for ECMO therapy.3 ECHO helps to identify or exclude new reversible pathology, which could be the ac Read More

Extracorporeal membrane oxygenation (ECMO) is used to support patients with hypoxemia due to severe respiratory failure. Hypoxemia can persist during ECMO as a result of reduction in mechanical ventilatory support as part of a lung protective strategy, following which gas exchange provided by the native lungs is reduced or absent. If tissue oxygen delivery is maintained, mild to moderate hypoxemia will be well tolerated, but if tissue Read More

The prone position has been used successfully for many years to improve oxygenation in patients who require mechanical ventilatory support for management of acute respiratory distress syndrome (ARDS). Proning improves oxygenation by optimizing lung recruitment and ventilation–perfusion matching. The following improved outcomes have been shown: when the prone position is used for moderate to severe ARDS; when used in Read More

Introduction: Extracorporeal circulation has been around for more than half a century, but many questions remain regarding how to best achieve anticoagulation in a patient on extracorporeal membrane oxygenation (ECMO). Although unfractionated heparin is the predominant agent used for cardiopulmonary bypass, the amount required and how best to monitor its effects are still unresolved. Extracorporeal circulation is associate Read More