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Veno-Venous Extracorporeal Membrane Oxygenation (ECMO): Future Application in the Critical Care and Anesthesia

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Intensive Care".

Deadline for manuscript submissions: 20 September 2024 | Viewed by 3940

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Special Issue Editors

Dr. Gianmaria Cammarota

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Guest Editor

Department of Medicine and Surgery, University of Perugia, 06121 Perugia, Italy
Interests: intensive care medicine; critical care medicine; ARDS; acute respiratory failure; advanced respiratory monitoring; ultrasound; esophageal pressure; electrical impedance tomography; electrical activity of the diaphragm; airway management; resuscitation; mechanical ventilation; extracorporeal support

Dr. Davide Colombo

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Guest Editor

1. Department of Anesthesia and Intensive Care Medicine, Ospedale Ss. Trinità, Borgomanero, Italy
2. CRIMEDIM Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
Interests: intensive care medicine; mechanical ventilation; critical care medicine; anesthesiology; ventilation; airway management; emergency management; extracorporeal carbon dioxide removal

Dr. Rachele Simonte

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Guest Editor Assistant

Department of Medicine and Surgery, Università degli Studi di Perugia, Perugia, Italy
Interests: acute respiratory failure; mechanical ventilation; lung ultrasound; advanced respiratory monitoring

Special Issue Information

Dear Colleagues,

The role of extracorporeal membrane oxygenation (ECMO) support for patients with acute respiratory failure is evolving, particularly due to the recent COVID-19 pandemic. The recent COVID-19 emergency has placed an unprecedented burden on hospital resources, with a massive influx of patients requiring intensive care. This wave of critically ill patients has challenged healthcare systems around the world and prompted physicians to improve their skills in managing respiratory support, including the application of ECMO.

The experience gained from treating COVID-19 patients with severe respiratory failure has provided valuable insights into the optimization of ECMO therapy. Clinicians have refined their knowledge of ventilator management, adjusting ventilator settings and strategies to minimize ventilator-induced lung injury. This improved understanding of respiratory support and the integration of ECMO into the treatment algorithm may lead to changes in the application of venovenous ECMO in the future.

The evaluation of this potential shift in ECMO application is crucial to ensure the best outcomes for patients with acute respiratory failure. By analyzing the evolving role of ECMO in the management of acute respiratory failure, healthcare professionals can determine the most effective and appropriate use of this life-saving therapy.

This Special Issue highlights the importance of assessing and understanding the evolving landscape of ECMO application as a rescue therapy for severe acute respiratory failure and its potential implications for future clinical practice and anesthesia field.

Dr. Gianmaria Cammarota
Dr. Davide Colombo
Guest Editors

Dr. Rachele Simonte
Guest Editor Assistant

Manuscript Submission Information

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Keywords

VV ECMO
carbon dioxide (CO₂) exchange
advanced monitoring
ECMO team
respiratory distress
trialing off
weaning
rescue therapy

Published Papers (4 papers)

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Research

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11 pages, 1432 KiB

Open AccessArticle

Microvesicles Are Associated with Early Veno Venous ECMO Circuit Change during Severe ARDS: A Prospective Observational Pilot Study

by Christophe Guervilly, Giovanni Bousquet, Laurent Arnaud, Ines Gragueb-Chatti, Florence Daviet, Mélanie Adda, Jean-Marie Forel, Françoise Dignat-George, Laurent Papazian, Antoine Roch, Romaric Lacroix and Sami Hraiech

J. Clin. Med. 2023, 12(23), 7281; https://doi.org/10.3390/jcm12237281 - 24 Nov 2023

Cited by 1 | Viewed by 676

Abstract

Background: Veno venous Extra Corporeal Membrane Oxygenation (vvECMO) is associated with frequent hematological ECMO-related complications needing ECMO circuit change. Microvesicles (MVs) interplay during the thrombosis-fibrinolysis process. The main objective of the study was to identify subpopulations of MVs associated with indications of early vvECMO circuit change. Methods: This is a prospective observational monocenter cohort study. Blood gas was sampled on the ECMO circuit after the membrane oxygenator to measure the PO_{2 post oxy} at inclusion, day 3, day 7 and the day of ECMO circuit removal. Blood samples for MV analysis were collected at inclusion, day 3, day 7 and the day of ECMO circuit removal. MV subpopulations were identified by flow cytometry. Results: Nineteen patients were investigated. Seven patients (37%) needed an ECMO circuit change for hemolysis (n = 4), a pump thrombosis with fibrinolysis (n = 1), persistent thrombocytopenia with bleeding (n = 1) and a decrease of O₂ transfer (n = 1). Levels of leukocyte and endothelial MVs were significantly higher at inclusion for patients who thereafter had an ECMO circuit change (p = 0.01 and p = 0.001). The areas under the received operating characteristics curves for LeuMVs and EndoMVs sampled the day of cannulation and the need for ECMO circuit change were 0.84 and 0.92, respectively. PO_{2 post oxy} did not significantly change except for in one patient during the ECMO run. Conclusions: Our pilot study supports the potential interest of subpopulations of microvesicles early associated with hematological ECMO-related complications. Our results warrant further studies. Full article

(This article belongs to the Special Issue Veno-Venous Extracorporeal Membrane Oxygenation (ECMO): Future Application in the Critical Care and Anesthesia)

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11 pages, 3554 KiB

Open AccessArticle

COVID-19 versus Other Disease Etiologies as the Cause of ARDS in Patients Necessitating Venovenous Extracorporeal Membrane Oxygenation—A Comparison of Patients’ Data during the Three Years of the COVID-19 Pandemic

by Sua Kim, Hyeri Seok, Beong Ki Kim, Jinwook Hwang, Dae Won Park, Jae Seung Shin and Je Hyeong Kim

J. Clin. Med. 2023, 12(21), 6752; https://doi.org/10.3390/jcm12216752 - 25 Oct 2023

Cited by 1 | Viewed by 830

Abstract

Considering the characteristics of coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS), we compared the clinical course and outcomes of patients with ARDS who received venovenous extracorporeal membrane oxygenation (VV ECMO) based on the etiology of ARDS. This retrospective single-center study included adult patients with severe ARDS necessitating VV ECMO during the COVID-19 pandemic. Among 45 patients who received VV ECMO, 21 presented with COVID-19. COVID-19 patients exhibited lower sequential organ failure assessment scores (9 [8–12.75] versus 8 [4–11.5], p = 0.033) but longer duration of VV ECMO support (10.5 days [3.25–29.25] versus 28 days [10.5–70.5] p = 0.018), which was accompanied by an weaning off rate from VV ECMO in 12/24 (50%) versus 12/21 (57.1%) and 28-day mortality in 9/24 [37.5%] versus 2/21 [9.5%] in non-COVID-19 and COVID-19 patients (p = 0.767, p = 0.040), respectively. Finally, in the adjusted Cox regression model for hospital mortality, the hazard ratio of COVID-19 was not significant (hazard ratio 0.350, 95% confidence interval 0.110–1.115, p = 0.076). Although the VV ECMO period was longer, COVID-19 did not significantly impact ECMO weaning off and mortality rates. Nonetheless, judicious patient selections based on risk factors should be followed. Full article

(This article belongs to the Special Issue Veno-Venous Extracorporeal Membrane Oxygenation (ECMO): Future Application in the Critical Care and Anesthesia)

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Review

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16 pages, 1363 KiB

Open AccessReview

Advanced Respiratory Monitoring during Extracorporeal Membrane Oxygenation

by Rachele Simonte, Gianmaria Cammarota, Luigi Vetrugno, Edoardo De Robertis, Federico Longhini and Savino Spadaro

J. Clin. Med. 2024, 13(9), 2541; https://doi.org/10.3390/jcm13092541 - 26 Apr 2024

Viewed by 746

Abstract

Advanced respiratory monitoring encompasses a diverse range of mini- or noninvasive tools used to evaluate various aspects of respiratory function in patients experiencing acute respiratory failure, including those requiring extracorporeal membrane oxygenation (ECMO) support. Among these techniques, key modalities include esophageal pressure measurement (including derived pressures), lung and respiratory muscle ultrasounds, electrical impedance tomography, the monitoring of diaphragm electrical activity, and assessment of flow index. These tools play a critical role in assessing essential parameters such as lung recruitment and overdistention, lung aeration and morphology, ventilation/perfusion distribution, inspiratory effort, respiratory drive, respiratory muscle contraction, and patient–ventilator synchrony. In contrast to conventional methods, advanced respiratory monitoring offers a deeper understanding of pathological changes in lung aeration caused by underlying diseases. Moreover, it allows for meticulous tracking of responses to therapeutic interventions, aiding in the development of personalized respiratory support strategies aimed at preserving lung function and respiratory muscle integrity. The integration of advanced respiratory monitoring represents a significant advancement in the clinical management of acute respiratory failure. It serves as a cornerstone in scenarios where treatment strategies rely on tailored approaches, empowering clinicians to make informed decisions about intervention selection and adjustment. By enabling real-time assessment and modification of respiratory support, advanced monitoring not only optimizes care for patients with acute respiratory distress syndrome but also contributes to improved outcomes and enhanced patient safety. Full article

(This article belongs to the Special Issue Veno-Venous Extracorporeal Membrane Oxygenation (ECMO): Future Application in the Critical Care and Anesthesia)

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11 pages, 810 KiB

Open AccessReview

Extra-Corporeal Membrane Oxygenation in Pregnancy

by Tatsiana Romenskaya, Yaroslava Longhitano, Aman Mahajan, Gabriele Savioli, Antonio Voza, Manfredi Tesauro and Christian Zanza

J. Clin. Med. 2024, 13(6), 1634; https://doi.org/10.3390/jcm13061634 - 13 Mar 2024

Viewed by 1308

Abstract

Extracorporeal membrane oxygenation (ECMO) is a cardiac or pulmonary function support system that is used in cases of refractory organ failure in addition to conventional treatment. Currently, Level I evidence is not yet available, which reflects improved outcomes with ECMO in pregnant women, the use in pregnancy should be indicated in selected cases and only in specialized centers. We searched articles in the most important scientific databases from 2009 until 31 December 2023 consulting also the site ClinicalTrials.com to find out about studies that have been recently conducted or are currently ongoing. We matched the combination of the following keywords: “ECMO and pregnancy”, “H1N1 and pregnancy”, “COVID-19 and pregnancy”, “ARDS and pregnancy”, “ECMO and pregnancy AND (cardiac arrest)”. We selected the following number of articles for each keyword combination: “ECMO and pregnancy” (665 articles); “ECMO and influenza H1N1” (384 articles); “pregnancy and influenza H1N1” (1006 articles); “pregnancy and ARDS” (2930 articles); “ECMO and pregnancy and ARDS and influenza H1N1” (24 articles); and “[ECMO and pregnancy AND (cardiac arrest)]” (74 articles). After careful inspection, only 43 papers fitted our scope. There are two types of ECMO: venous-venous (VV-ECMO) and venous-arterial (VA-ECMO). The first-one is necessary to cope with severe hypoxia: oxygen-depleted blood is taken from the venous circulation, oxygenated, and carbon dioxide removed from the extracorporeal circuit and returned to the same venous system. The VA-ECMO is a type of mechanical assistance to the circulatory system that allows to put the failing organ at rest by ensuring adequate oxygenation and systemic de-oxygenation, avoiding multi-organ failure. The main indications for ECMO support in pregnant women are cardiogenic shock, acute respiratory distress syndrome (ARDS), pulmonary embolism, and eclampsia. There are also fetal indications for ECMO, and they are fetal distress, hypoxic-ischemic encephalopathy (HIE), and twin-to-twin transfusion syndrome (TTTS). Until now, based on the outcomes of the numerous clinical studies conducted, ECMO has been shown to be a successful therapeutic strategy in cases where medical treatment has been unsuccessful. In well-selected pregnant patients, it appears to be safe and associated with a low risk of maternal and fetal complications. The aim of this review is to report the main properties of ECMO (VV and VA) and the indications for its use in pregnant women. Full article

(This article belongs to the Special Issue Veno-Venous Extracorporeal Membrane Oxygenation (ECMO): Future Application in the Critical Care and Anesthesia)

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