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

Bleeding is a common complication in patients undergoing extracorporeal membrane oxygenation (ECMO) management.1 It requires immediate management to achieve hemostasis, replace blood, and compensate volume loss. Refractory hemorrhage can be lethal and can lead to massive transfusions with all their known complications. Refractory bleeding and massive transfusions in ECMO patients are associated with high mort Read More

The application of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is becoming an increasingly frequent procedure in emergency medicine.1 Correct appraisal of clinical conditions and patient selection are critical not only in terms of expected outcome, but also in terms of adequate temporary support configuration, optimization of resources, and organization of daily hospital activities, since inappropriate implant may rem Read More

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly applied for the treatment of cardiogenic shock despite its high complication rate.1 The lack of left ventricular unloading is one of the serious problems associated with the poor outcome of VA-ECMO. Therefore, hemodynamic management during VA-ECMO should address the higher afterload caused by the retrograde blood flow and the consequent le Read More

The use of mechanical circulatory assistance remains controversial during refractory septic shock in adults.1 However, a profound myocardial dysfunction can occur during bacterial septic shock.2–4 In this context, extracorporeal membrane oxygenation (ECMO) is highly effective as salvage therapy for children with refractory septic shock.5,6 We reported the largest cohort of adults who received VA-ECMO for refractory cardiovas Read More

Background: Mortality of patients on extracorporeal membrane oxygenation (ECMO) remains high. Diagnosis of infection during extracorporeal life support (ECLS) is still challenging, and prevention strategies vary widely from center to center.1–3 These facts led us to analyze the occurrence rate, site, and organism in our ECLS patients in order to implement infection control measures to reduce the incidence of infections during ECLS.4 Read More

Veno-arterial extracorporeal membrane oxygenation (ECMO) has been used successfully for several years in refractory cardiogenic shock. Of note, the survival rate is markedly affected by the underlying patient condition, and especially their capacity to recover. Combes et al.1 demonstrated a short- and a long-term survival rate (11 months of median follow-up time) of, respectively, 42 and 36% in a large series of patients with cardiogenic sho Read More

Aim: Refractory cardiogenic shock (CS) complicates 5–7% of cases with ST-elevation myocardial infarction (STEMI), and is a leading cause of hospital death after myocardial infarction.1 CS complicating acute myocardial infarction (AMI) continues to have a high mortality of 40–50% despite early revascularization and adjunctive therapies.2 Extracorporeal membrane oxygenation (ECMO) technology has advanced significantly and is rea Read More

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) is the rapid deployment of extracorporeal membrane oxygenation (ECMO) – or cardiopulmonary bypass – to provide immediate cardiovascular support for patients who have cardiac arrest unresponsive to conventional cardiopulmonary resuscitation (CPR) measures. There is improved survival with isolated cardiac lesions.1 Cardiac disease (adjusted for confo Read More

Acute myocardial infarction is a common cause of cardiogenic shock (approximately 75% of all patients) and out-of-hospital cardiac arrest (approximately 70% of survivors).1 Mechanical hemodynamic support is employed prior to coronary revascularization (pre-percutaneous coronary intervention (PCI)), during or after PCI.2 Revascularization procedure is characterized by a transient interruption of coronary blood flow (due t Read More

The rapid institution of veno-arterial extracorporeal membrane oxygenation (VA ECMO) support for patients with prolonged, recurrent cardiac arrest (CA) complicated by severe shock and cases of refractory arrhythmia without return of spontaneous circulation (ROSC) is now termed ECMO-CPR (E-CPR). The use of E-CPR is increasing and there are reported benefits for both out-of-hospital and in-hospital patient populations. Recently, this Read More

Cardiac arrest is a common problem, both in the in-hospital environment and in the out-of-hospital environment with an estimated incidence of over 300,000–400,000 cases of out-of-hospital cardiac arrests every year in the USA. Globally, the outcome of cardiac arrest remains poor, particularly with respect to neurological outcomes.1 It is estimated that approximately 10–11% of patients with cardiac arrest survive to hospital discharge. A Read More

Since its development in the early 1990s, extracorporeal membrane oxygenation (ECMO) has become a standard therapy for a wide variety of respiratory and cardiac problems in neonates. Traditionally, the preferred method of access and support has been using a venous inflow, with arterial outflow methodology (venoarterial or VA ECMO), bypassing the cardiac circulation.1 Ongoing improvements in catheter configuration have m Read More

Introduction: Strategy during extracorporeal membrane oxygenation (ECMO) support is guided by available outcome data. Boundaries limiting selection of cases are shifting with advances in ECMO technology, conventional support, and destination therapies. Evolution: Neonatal respiratory ECMO numbers continue to decline due to improved conventional therapies, whereas infants historically excluded from ECMO (for example, ex-premature inf Read More

For neonates, veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) support is still commonly used for respiratory as well as for cardiac or combined failure. However, in the pediatric population, veno-venous (VV) ECMO is establishing itself as the standard mode of support for respiratory failure.1 The need for ECMO in neonatal respiratory support has declined over the past years following introduction of alternative options. Co Read More

VA support remains common in neonates and children placed on extracorporeal membrane oxygenation (ECMO) for respiratory, cardiac or combined dysfunction.1 Providing adequate ECMO flow to reverse tissue oxygen debt is imperative in the first few hours of ECMO. Several studies outline the poor outcome which results if lactic acidosis and pH do not improve after institution of ECMO. Following serial lactate, urine output, and other signs Read More

Extracorporeal membrane oxygenation (ECMO) is a commonly used form of mechanical circulatory support in children with congenital or acquired heart disease, and cardiac failure refractory to conventional medical treatments.1 The cardiac output is partially or completely provided by the ECMO machine. To assess how much support is needed at any given time, a constant balance of oxygen delivery and oxygen consumption is require Read More

Background: Extracorporeal membrane oxygenation (ECMO) is a rapidly expanding, life-supporting therapy for critically ill patients with severe respiratory and/or cardiovascular failure. Cerebrovascular impairment can result in hemorrhagic and ischemic complications commonly seen in the patients supported on ECMO. The healthy brain is protected by cerebral autoregulation, which maintains an adequate cerebral blood flow in f Read More

Survival of patients with malignancy over the last 30 years has continually improved due to advancements in aggressive chemotherapeutic regimens as well as supportive measures toward treatment and prevention of infection.1,2 Even though cancer remains a significant cause of mortality in children, 5-year survival for childhood cancers, including hematologic malignancies and solid tumors, is greater than 80%. In these children, critical illn Read More

Background: Harlequin syndrome is a rare autonomic disorder, characterized by unilateral diminished sweating and flushing of the face in response to heat or exercise.1 Harlequin syndrome is described in patients receiving peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO), where differential oxygen saturation is observed between the upper and lower parts of the body. It is a phenomenon related to cannulation, Read More

Extracorporeal membrane oxygenation (ECMO) is a form of mechanical circulatory support that can be lifesaving in people with potentially reversible heart or lung injuries. ECMO is nearly always used urgently, when all other treatment options for cardiopulmonary injury have failed and high mortality is otherwise expected. Standard ECMO treatment involves venous drainage from the femoral vein or left atrium with artificial extra-circulatory Read More