ライフサイエンスコーパス: ECMO

1 ECMO also resulted in survival of patients with uncommon

2 ECMO can potentially eliminate mortality for meconium as

3 ECMO is a lifesaving option for patients with interstiti

4 ECMO is not able to reverse the poor prognosis in patien

5 ECMO support after heart (3), lung (2), heart-lung (1),

6 ECMO support in patients who are awake and nonintubated

7 ECMO used to support CPR rescued one third of patients i

8 ECMO utilization increased from 13 patients in 8 hospita

9 ECMO was used on 514 consecutive patients under age 19 y

10 Of 26,242 ECMO uses reported, 695 (2.6%) were for E-CPR (n=682 pat

11 MO support for >48 hours for a total of 2942 ECMO days, 142 (64%) developed NIs.

12 Interestingly, the 51 ECMO patients who could not be matched were younger, had

13 al ECMO mortality rates varied widely across ECMO centers: the interquartile range was 18-50% for neo

14 95% CI, 1.4-36), and arterial pH <7.00 after ECMO deployment (OR, 6.0; 95% CI, 2.1-17.4).

15 Extreme mortality after ECMO in elderly patients and patients requiring cardiopu

16 nd predictors of in-hospital mortality after ECMO used to support CPR (E-CPR).

17 erminants of early and 1-year survival after ECMO in adult patients, we conducted a retrospective coh

18 Although ECMO is effective for short-term circulatory support, it

19 be suitable for lung transplantation from an ECMO bridge.

20 conventional management, to a centre with an ECMO-based management protocol to significantly improve

21 In multivariable analysis, ECMO + iMV and iMV alone were independently associated w

22 Catheterization and ECMO records and echocardiograms were reviewed, as were

23 Demographic, CPR, and ECMO details associated with mortality were evaluated us

24 of cerebral NIRS monitoring during LVAD and ECMO implantation may reduce the perioperative neurologi

25 t of utilizing cerebral NIRS during LVAD and ECMO implantation.

26 proaches to using cerebral NIRS for LVAD and ECMO implantation.

27 mediate postoperative period in the LVAD and ECMO patient population.

28 o monitor patients while undergoing LVAD and ECMO placement and their resultant care has expanded.

29 asive mechanical ventilation (iMV) only, and ECMO + iMV.

30 Annual ECMO mortality rates varied widely across ECMO centers:

31 at hospitals with more than 30 adult annual ECMO cases had significantly lower odds of mortality (ad

32 a bridge to transplantation was intended at ECMO initiation.

33 tively, was comparable in both groups (awake ECMO: median, 9 d; range, 1-45.

34 y or cardiopulmonary failure receiving awake ECMO support.

35 Six (23%) of 26 patients in the awake ECMO group and 10 (29%) of 34 patients in the MV group d

36 yr; range, 23-62) were included in the awake ECMO group and 34 patients (59% female; median age, 36 y

37 Patients in the awake ECMO group required shorter postoperative MV (P = 0.04)

38 at 6 months after LuTx was 80% in the awake ECMO group versus 50% in the MV group (P = 0.02).

39 Because ECMO is a complex, high-risk, and costly modality, at pr

40 absence of severe metabolic acidosis before ECMO support, and uncomplicated ECMO course were associa

41 higher rate when repair was performed before ECMO.

42 cedure, cardiopulmonary resuscitation before ECMO placement, and age >65 years were independent predi

43 isease, cardiopulmonary resuscitation before ECMO, and renal dysfunction.

44 er duration of mechanical ventilation before ECMO, and development of renal or hepatic dysfunction wh

45 s, duration of mechanical ventilation before ECMO, diagnosis, central nervous system dysfunction, acu

46 was continued for a minimum of 5 days (BLTx-ECMO group).

47 severe acute respiratory failure treated by ECMO from 2000 to 2012 were extracted from the Extracorp

48 allocated to consideration for treatment by ECMO (n=90 patients) or to receive conventional manageme

49 Referral to consideration for treatment by ECMO led to a gain of 0.03 quality-adjusted life-years (

50 allocated to consideration for treatment by ECMO survived to 6 months without disability compared wi

51 r referral to consideration for treatment by ECMO.

52 ntrast, in historically high-volume centers, ECMO had no adverse influence on post-transplant surviva

53 nd that, in historically low-volume centers, ECMO was associated with increased post-transplant morta

54 ransplantation was attempted under continued ECMO.

55 Compared with conventional ECMO, TCS durations are longer, and more importantly, pa

56 or reported survival rates of short duration ECMO.

57 During ECMO, renal dysfunction (OR 1.89, 95% CI 1.17 to 3.03),

58 Catheterization during ECMO enables the diagnosis of residual lesions and can f

59 y (OR 2.79, 95% CI 1.55 to 5.02), CPR during ECMO (OR 3.06, 95% CI 1.42 to 6.58), and arterial blood

60 s of bleeding and thrombosis are high during ECMO support.

61 d impact on outcomes of NIs occurring during ECMO support were analyzed.

62 tracranial hemorrhage) and thrombosis during ECMO support; (2) to identify factors associated with th

63 is a major contributor to transfusion during ECMO.

64 congenital heart disease, renal dysfunction, ECMO duration of >14 days, and initial ECMO indication a

65 tion, and extracorporeal life support (ECLS, ECMO).

66 on strategies, indications, and evidence for ECMO in respiratory and cardiac failure in adults as wel

67 Objective performance goals for ECMO were developed.

68 ECMO, lower hospital volume, indication for ECMO after a cardiac procedure, cardiopulmonary resuscit

69 Cardiac physiology and indication for ECMO were not associated with mortality rate.

70 The indications for ECMO in these patients remain controversial.

71 There is expansion in the indications for ECMO including a bridge to lung transplantation, the use

72 l ischemic time was significantly longer for ECMO-rescued recipients compared with our overall transp

73 own CDH had significantly increased need for ECMO if repaired in the first 48 hours, whereas patients

74 Reason for ECMO discontinuation included native lung recovery (54%)

75 uppression and myocarditis as the reason for ECMO support were associated with better outcomes.

76 The indication for transplantation, for ECMO support, and the timing of cannulation had no impac

77 target patients most likely to benefit from ECMO.

78 The median time from ECMO cannulation to left atrial decompression was 11 hrs

79 Patients transplanted from ECMO at age <1 year had the worst survival.

80 was worse in patients who underwent Tx from ECMO (3 years: 64%) versus on ventricular assist device

81 undred three (5%) patients underwent Tx from ECMO; 135 (67%) had been on ECMO since listing, and 67 (

82 Two patients weaned from ECMO, and 2 patients died on ECMO on the waiting list.

83 Fifteen patients were withdrawn from ECMO support due to severe neurologic impairment or lack

84 seline and postexercise pulmonary functions, ECMO graduates have similar aerobic capacity to age-matc

85 4 patients, mean age 40.2 (18-83) years, had ECMO duration of mean 25.2 days/median 21.0 days (range:

86 ix-adjusted analysis, higher annual hospital ECMO volume was associated with lower mortality in 1989-

87 The measure of hospital ECMO volume was age group-specific and adjusted for pati

88 yzed factors associated with in-ICU death in ECMO recipients, and the potential benefit of ECMO using

89 ing greater interest and explosive growth in ECMO worldwide.

90 in predicting long-term pulmonary outcome in ECMO graduates is the duration of oxygen use following d

91 ly increased in recent years, and increasing ECMO duration did not alter the survival fraction in the

92 tion, ECMO duration of >14 days, and initial ECMO indication as a bridge to recovery.

93 pment of end-organ injury on ECMO and longer ECMO duration were associated with increased mortality.

94 lower ICU mortality rate than the 52 matched ECMO patients (22% vs. 50%; P < 0.01).

95 reached at 174 days, whereas in the matched ECMO group, the median survival was 13 days (P<0.001 by

96 For participants in cohort 2 and the matched ECMO group, the median survival was 144 days and 10 days

97 all survival rates of 50% to 70% with median ECMO duration of 10 days.

98 function, and pulmonary function in neonatal ECMO survivors using graded exercise testing, echocardio

99 ical ventilation, 52 could be matched to non-ECMO patients of comparable severity, using a one-to-one

100 vanced cardiogenic shock, the application of ECMO is described.

101 MO warrants careful consideration because of ECMO's high pre- and post-Tx mortality.

102 CMO recipients, and the potential benefit of ECMO using a propensity score-matched (1:1) cohort analy

103 en patients were treated with 225 courses of ECMO.

104 ase have undergone a total of 216 courses of ECMO; 60 catheterizations were performed on 54 patients

105 On the day of ECMO explantation (median, postoperative day 8), LV diam

106 None of the children requiring >4 days of ECMO support survived.

107 The duration of ECMO support or MV, respectively, was comparable in both

108 Mean duration of ECMO was 2.8 days for survivors (median 3 days) compared

109 Although longer duration of ECMO was not associated with increased mortality risk, p

110 ality risk, patients with longer duration of ECMO were less likely to survive without heart transplan

111 An adverse effect of ECMO at the time of lung transplant was evident in low-v

112 ining the efficacy and cost-effectiveness of ECMO should be a critical future goal.

113 Objective data on the safety and efficacy of ECMO for this indication are limited.

114 Influences of ECMO on post-transplant survival were estimated among ad

115 mechanical ventilation before initiation of ECMO, and patients who developed renal or hepatic failur

116 lexity measures can predict the mortality of ECMO patients.

117 CMO volume was associated with lower odds of ECMO mortality for neonates and adults but not for pedia

118 We describe the outcomes of ECMO as a bridge to heart transplantation to serve as pe

119 Outcomes of ECMO have improved despite increasing comorbidity.

120 ifetime model predicted the cost per QALY of ECMO to be pound19 252 (95% CI 7622-59 200) at a discoun

121 On postoperative day 2, reduction of ECMO flow resulted in increasing LA and decreasing syste

122 tively analyzed an international registry of ECMO support from 1989 to 2013.

123 warranted to define and validate the role of ECMO, including studying the pharmacodynamics and pharma

124 dmission, but not antibiotics at the time of ECMO cannulation, was associated with subsequently devel

125 2 years, there was significantly less use of ECMO (75% vs. 52%) and an increased use of inhaled nitri

126 The use of ECMO (hazard ratio [HR]=3.820, 95% confidence interval [

127 f infants with CDH with less frequent use of ECMO and a greater use of iNO in high-risk patients with

128 The use of ECMO for treatment of severe respiratory adult patients

129 a bridge to lung transplantation, the use of ECMO in awake patients, liver transplantation, as well a

130 zed control trials have supported the use of ECMO in neonates with respiratory failure.

131 Yet the use of ECMO outpaces the data.

132 encourage restraint in the widespread use of ECMO until we have a better appreciation for both the po

133 In multivariable analysis, earlier year of ECMO, lower hospital volume, indication for ECMO after a

134 ifteen children were successfully weaned off ECMO and discharged alive (54%).

135 lume in 2005-2010, with 8,228 adults (279 on ECMO) who underwent transplants at these centers between

136 nderwent Tx from ECMO; 135 (67%) had been on ECMO since listing, and 67 (33%) had deteriorated to ECM

137 Transplantation of patients bridged on ECMO to LTX is feasible and results in acceptable outcom

138 ons and outcomes of patients catheterized on ECMO from a single, large pediatric tertiary care center

139 d on the waiting list after 9 and 63 days on ECMO, respectively.

140 ion (93.3%) died after 40.3 +/- 27.8 days on ECMO.

141 nts weaned from ECMO, and 2 patients died on ECMO on the waiting list.

142 of patients with severe ARF, with a focus on ECMO.

143 Development of end-organ injury on ECMO and longer ECMO duration were associated with incre

144 Eight percent of patients were listed on ECMO, and within 12 months, 49% had undergone Tx, 35% we

145 lar assist device at listing (76%) or not on ECMO or ventricular assist device at listing (76%; P<0.0

146 assist device at Tx (3 years: 84%) or not on ECMO/ventricular assist device at Tx (3 years: 85%; P<0.

147 erm survival was similar between patients on ECMO alone and those not on support but significantly wo

148 ng (censored at Tx) was worse in patients on ECMO at listing (50%) compared with ventricular assist d

149 breathing patients compared with patients on ECMO with mechanical ventilation, but this strategy has

150 s for cardiac catheterization in patients on ECMO, but no large series has been reported.

151 on of donor hearts to children waitlisted on ECMO warrants careful consideration because of ECMO's hi

152 .93%) required only iMV, 119 (0.96%) were on ECMO + iMV, and the remaining 11,607 (94.6%) required no

153 Sixty-five patients (0.52%) were on ECMO only, 612 (4.93%) required only iMV, 119 (0.96%) we

154 developed renal or hepatic failure while on ECMO.

155 ent of renal or hepatic dysfunction while on ECMO.

156 us inotropes+/-mechanical ventilation (6) or ECMO (3) before BiVAD implantation.

157 om 2011 to 2015 who received a TCS device or ECMO as a bridge to transplant were identified using Org

158 HLT recipients bridged by MV or ECMO have increased short-term and long-term mortality.

159 ly worse with patients requiring iMV only or ECMO + iMV.

160 iption of the optimal approach to organizing ECMO programs for ARF in adult patients.

161 supported with ECPR were identified from our ECMO database.

162 hildren a meaningful survival advantage over ECMO.

163 eed for extracorporeal membrane oxygenation (ECMO) (P < .001) and gestational age at delivery (P = .0

164 ovenous extracorporeal membrane oxygenation (ECMO) and extracorporeal carbon dioxide removal to suppo

165 Extracorporeal membrane oxygenation (ECMO) and mechanical ventilation (MV) can be used as a b

166 ce with extracorporeal membrane oxygenation (ECMO) application.

167 n using extracorporeal membrane oxygenation (ECMO) as a treatment for acute respiratory failure.

168 ents on extracorporeal membrane oxygenation (ECMO) bridge into the focus of interest.

169 ness of extracorporeal membrane oxygenation (ECMO) compared with conventional ventilation support.

170 use of extracorporeal membrane oxygenation (ECMO) for both respiratory and cardiac failure in adults

171 come of extracorporeal membrane oxygenation (ECMO) for early primary graft failure and determine its

172 use of extracorporeal membrane oxygenation (ECMO) for severe acute respiratory failure (ARF) in adul

173 s, and extra-corporeal membrane oxygenation (ECMO) has allowed approximately half of cardiogenic shoc

174 Extracorporeal membrane oxygenation (ECMO) has been used to support cardiorespiratory functio

175 Extracorporeal membrane oxygenation (ECMO) has long served as the standard of care for short-

176 Extracorporeal membrane oxygenation (ECMO) has served for >2 decades as the standard of care

177 use of extracorporeal membrane oxygenation (ECMO) in patients who are awake and spontaneously breath

178 Extracorporeal membrane oxygenation (ECMO) is being increasingly used as a bridge to lung tra

179 tion of extracorporeal membrane oxygenation (ECMO) is expanding despite limited outcome data defining

180 use of extracorporeal membrane oxygenation (ECMO) is growing rapidly, and centers providing ECMO mus

181 IONALE: Extracorporeal membrane oxygenation (ECMO) is used for respiratory and cardiac failure in chi

182 When extracorporeal membrane oxygenation (ECMO) is used in the setting of severe myocardial dysfun

183 ovenous extracorporeal membrane oxygenation (ECMO) may therefore rescue the sickest patients with ARD

184 Extracorporeal membrane oxygenation (ECMO) provides circulatory and respiratory support for p

185 fect of extracorporeal membrane oxygenation (ECMO) support at the time of listing and the time of Tx

186 esponse extracorporeal membrane oxygenation (ECMO) to aid cardiopulmonary resuscitation (ECPR).

187 nsplant extracorporeal membrane oxygenation (ECMO) was the strongest predictor for fungal infection (

188 VAD) or extracorporeal membrane oxygenation (ECMO).

189 ergoing extracorporeal membrane oxygenation (ECMO).

190 tion of extracorporeal membrane oxygenation (ECMO).

191 eonatal extracorporeal membrane oxygenation (ECMO).

192 ed with extracorporeal membrane oxygenation (ECMO).

193 rterial extracorporeal membrane oxygenation (ECMO).

194 mainly extracorporeal membrane oxygenation (ECMO).

195 elies on extracorporeal membrane oxygenator (ECMO).

196 Although P-ECMO survival rates are less than short ECMO runs, P-ECM

197 tutional studies have examined outcomes of P-ECMO for severe respiratory failure.

198 Increased prevalence of P-ECMO was noted with 72% (701/974) of all cases reported

199 adult (>/=18 years) patients who required P-ECMO for severe respiratory failure from 1989 to 2013 we

200 vival rates are less than short ECMO runs, P-ECMO support is justified.

201 ogistic regression analysis confirmed that P-ECMO patients 2007 to 2013 had a lower risk of death [od

202 ns and the optimal techniques for performing ECMO.

203 Perinatally, ECMO requirement and gestational age at delivery are use

204 In 23 BLTx for severe PH, ECMO used during BLTx was continued for a minimum of 5 d

205 aim of this paper is to provide physicians, ECMO center directors and coordinators, hospital directo

206 race (OR 0.65, 95% CI 0.45 to 0.94), and pre-ECMO arterial blood pH >7.17 (OR 0.50, 95% CI 0.30 to 0.

207 In a multivariable model, pre-ECMO factors such as cardiac disease (odds ratio [OR] 0.

208 The RESP score was developed using pre-ECMO variables independently associated with hospital su

209 study was to determine if pretransplantation ECMO or MV affects survival in HLT.

210 , 3.2; 95% CI, 1.3-7.9), use of blood-primed ECMO circuit (OR, 7.1; 95% CI, 1.4-36), and arterial pH

211 erred for patients with favorable prognoses, ECMO for patients with hemodynamic compromise, and durab

212 Prolonged ECMO survival significantly increased in recent years, a

213 Prolonged ECMO use for adult respiratory failure was associated wi

214 989 to 2013, a total of 290 centers provided ECMO support to 56,222 patients (30,909 neonates, 14,725

215 O) is growing rapidly, and centers providing ECMO must strive to meet stringent quality standards suc

216 68 (75%) patients actually received ECMO; 63% (57/90) of patients allocated to consideration

217 Adult patients who received ECMO from September 1, 2002, to December 31, 2012, were

218 survival outcomes for patients who received ECMO.

219 l, 0.46-0.80) compared with adults receiving ECMO at hospitals with less than six annual cases.

220 Patients receiving ECMO at hospitals with more than 30 adult annual ECMO ca

221 Of 103 patients receiving ECMO during the first week of mechanical ventilation, 52

222 l to predict survival for patients receiving ECMO for respiratory failure.

223 iaturized assist devices intended to replace ECMO.

224 r congenital heart disease (n = 23) required ECMO support.

225 Of these, 15 (2.8%) required ECMO and 22 (4.1%) required MV as a bridge to transplant

226 died, required Fontan takedown, or required ECMO.

227 trospective review of all children requiring ECMO in the early period after transplantation from 1990

228 Early post-operative graft failure requiring ECMO can complicate heart transplantation.

229 Pediatric patients requiring ECMO support before heart Tx have poor outcomes.

230 ess of initial pathology, patients requiring ECMO were critically ill with similar guarded prognoses.

231 egression was used to create the Respiratory ECMO Survival Prediction (RESP) score using bootstrappin

232 gh P-ECMO survival rates are less than short ECMO runs, P-ECMO support is justified.

233 For 1989-2013, higher age group-specific ECMO volume was associated with lower odds of ECMO morta

234 categorical variables: hemodynamic support (ECMO, ventilator support, VAD support vs. medical therap

235 r type of pretransplant support: no support, ECMO only, invasive mechanical ventilation (iMV) only, a

236 ently, following the advances in technology, ECMO is now recommended as a definitive treatment for ac

237 Importantly, this will help ensure that ECMO is delivered safely and proficiently, such that fut

238 CENT FINDINGS: Currently, results imply that ECMO is superior to conventional ventilation providing l

239 The ECMO cohort had worse survival than the control group at

240 Although the ECMO group exhibited baseline and postexercise lung func

241 ity were significantly different between the ECMO group and the control group.

242 ing and mild lower airway obstruction in the ECMO group, compared with mean pulmonary functions in th

243 There was 100% 3-year survival in the ECMO survivor group, with 13 patients (46%) currently al

244 septal left atrial drain incorporated in the ECMO venous circuit.

245 of a left atrial drain incorporated into the ECMO circuit.

246 a drain (8- to 15-Fr) incorporated into the ECMO venous circuit.

247 Compared with the ECMO cohort, the PS-matched TCS cohort had longer surviv

248 ce listing, and 67 (33%) had deteriorated to ECMO support while waiting.

249 nt survival with a TCS device is superior to ECMO after adjusting for patient differences.

250 dosis before ECMO support, and uncomplicated ECMO course were associated with improved survival.

251 Under ECMO, an ultraprotective ventilation strategy minimizing

252 of age, lactate, and plateau pressure under ECMO were associated with death.

253 Compared with patients undergoing ECMO before 2009, later patients were older (54.4 versus

254 1286 patients aged >/=18 years who underwent ECMO in New York State from 2003 to 2014.

255 ogy score (SAPS) II 61 +/- 20) who underwent ECMO support for >48 hours for a total of 2942 ECMO days

256 age 30.1 years, range 13-66 years) underwent ECMO support with intention to bridge to primary LTX.

257 the daily routine of the Hershey group using ECMO for therapy of advanced cardiogenic shock, the appl

258 eries have described increased success using ECMO in spontaneously breathing patients compared with p

259 tients who received the latest generation VA-ECMO still had a high risk of developing NIs, particular

260 We compared outcomes of 80 patients on VA-ECMO at listing to outcomes of the comparison group.

261 rimary therapy on survival in patients on VA-ECMO at listing.

262 a survival benefit in listed patients on VA-ECMO even if posttransplant survival remains inferior th

263 us is granted to transplant candidates on VA-ECMO than to those on long-term mechanical circulatory s

264 Patients on VA-ECMO were more often on ventilator and dialysis and had

265 e primary therapy in selected patients on VA-ECMO.

266 rial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used as a short-term circulatory s

267 rial extracorporeal membrane oxygenation (VA-ECMO) support for refractory cardiogenic shock have rare

268 f a large series of patients who received VA-ECMO in our intensive care unit (ICU) from January 2003

269 ar posttransplant survival was 70% in the VA-ECMO group and 81% in comparison group (P = 0.06).

270 In the VA-ECMO group, a Cox proportional hazard model with transpl

271 In the VA-ECMO group, transplantation was associated with a lower

272 emains inferior than for patients without VA-ECMO.

273 Venoarterial ECMO has been used successfully as a therapeutic option

274 effectively bridged with awake venoarterial ECMO.

275 The use of venoarterial ECMO has been expanded and applied to critically ill adu

276 Venovenous ECMO support was most common (venovenous: 79.5%, venoart

277 Venovenous ECMO was used in 10, venoarterial in 4, interventional l

278 Successful venovenous ECMO treatment in patients with extremely severe H1N1-as

279 longer durations of mechanical ventilation, ECMO support, and hospital stays.

280 ng lung transplantation, those supported via ECMO with spontaneous breathing demonstrated improved su

281 urvival statistics deteriorated sharply when ECMO was required for >3 days.

282 l compared with nonsupport patients, whereas ECMO alone was not significant.

283 spiratory failure but do not predict whether ECMO will enhance survival.

284 ant that was modestly reduced (from 45% with ECMO to 39% with TCS).

285 Fewer than half of patients bridged with ECMO survive to hospital discharge.

286 n 3-month survival for patients bridged with ECMO to LTX (78%, 78%, and 63%) was not worse than for o

287 e reviewed our institutional experience with ECMO as a bridge to LTX.

288 Patients managed with ECMO following cardiac surgery were analyzed separately

289 In a series of 137 patients managed with ECMO in a pediatric cardiac intensive care unit, surviva

290 study period, 137 patients were managed with ECMO in the pediatric cardiac intensive care unit.

291 e merged to identify children supported with ECMO and listed for heart transplantation from 1994 to 2

292 S)-matched cohort of children supported with ECMO as a bridge to transplant.

293 performed safely on patients supported with ECMO.

294 with the ventricular assist device than with ECMO.

295 influenza A(H1N1)-related ARDS treated with ECMO were compared with conventionally treated patients,

296 Twenty-one were treated with ECMO.

297 ge was 45.4% (443/974) and did not vary with ECMO duration.

298 two historic control groups of BLTx without ECMO (BLTx ventilation) or combined heart-lung transplan

299 respiratory failure treated with or without ECMO from March 2012 to August 2015.

300 e unmatched, severely hypoxemic, and younger ECMO-treated patients had, however, a lower mortality.