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Open AccessArticle

Conversion from Venovenous to Venoarterial Extracorporeal Membrane Oxygenation in Adults

1
ECMO Centre Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, 17176 Stockholm, Sweden
2
Department of Physiology and Pharmacology, Karolinska Institutet, 171 76 Stockholm, Sweden
3
Department of Clinical Neuroscience, Karolinska Institutet, 171 76 Stockholm, Sweden
4
Department of Neurosurgery, Karolinska University Hospital, 171 76 Stockholm, Sweden
*
Author to whom correspondence should be addressed.
Academic Editor: Maria Norberta de Pinho
Membranes 2021, 11(3), 188; https://doi.org/10.3390/membranes11030188
Received: 23 January 2021 / Revised: 26 February 2021 / Accepted: 2 March 2021 / Published: 9 March 2021
(This article belongs to the Special Issue Advances in Extracorporeal Membrane Oxygenation)
No major study has been performed on the conversion from venovenous (VV) to venoarterial (VA) extracorporeal membrane oxygenation (ECMO) in adults. This single-center retrospective cohort study aimed to investigate the incidence, indication, and outcome in patients who converted from VV to VA ECMO. All adult patients (≥18 years) who commenced VV ECMO at our center between 2005 and 2018 were screened. Of 219 VV ECMO patients, 21% (n = 46) were converted to VA ECMO. The indications for conversion were right ventricular failure (RVF) (65%), cardiogenic shock (26%), and other (9%). In the converted patients, there was a significant increase in Sequential Organ Failure Assessment (SOFA) scores between admission 12 (9–13) and conversion 15 (13–17, p < 0.001). Compared to non-converted patients, converted patients also had a higher mortality rate (62% vs. 16%, p < 0.001) and a lower admission Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score (p < 0.001). Outcomes were especially unfavorable in those converted due to RVF. These results indicate that VA ECMO, as opposed to VV ECMO, should be considered as the first mode of choice in patients with respiratory failure and signs of circulatory impairment, especially in those with impaired RV function. For the remaining patients, Pre-admission RESP score, daily echocardiography, and SOFA score trajectories may help in the early identification of those where conversion from VV to VA ECMO is warranted. Multi-centric studies are warranted to validate these findings. View Full-Text
Keywords: extracorporeal membrane oxygenation; conversion; venoarterial; venovenous; ECMO; VA; VV extracorporeal membrane oxygenation; conversion; venoarterial; venovenous; ECMO; VA; VV
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MDPI and ACS Style

Falk, L.; Fletcher-Sandersjöö, A.; Hultman, J.; Broman, L.M. Conversion from Venovenous to Venoarterial Extracorporeal Membrane Oxygenation in Adults. Membranes 2021, 11, 188. https://doi.org/10.3390/membranes11030188

AMA Style

Falk L, Fletcher-Sandersjöö A, Hultman J, Broman LM. Conversion from Venovenous to Venoarterial Extracorporeal Membrane Oxygenation in Adults. Membranes. 2021; 11(3):188. https://doi.org/10.3390/membranes11030188

Chicago/Turabian Style

Falk, Lars; Fletcher-Sandersjöö, Alexander; Hultman, Jan; Broman, Lars M. 2021. "Conversion from Venovenous to Venoarterial Extracorporeal Membrane Oxygenation in Adults" Membranes 11, no. 3: 188. https://doi.org/10.3390/membranes11030188

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