Membranes

Research

Jump to: Review

16 pages, 3546 KiB

Open AccessEditor’s ChoiceArticle

Electron Microscopic Confirmation of Anisotropic Pore Characteristics for ECMO Membranes Theoretically Validating the Risk of SARS-CoV-2 Permeation

by Makoto Fukuda, Tomoya Furuya, Kazunori Sadano, Asako Tokumine, Tomohiro Mori, Hitoshi Saomoto and Kiyotaka Sakai

Membranes 2021, 11(7), 529; https://doi.org/10.3390/membranes11070529 - 14 Jul 2021

Cited by 8 | Viewed by 5412

Abstract

The objective of this study is to clarify the pore structure of ECMO membranes by using our approach and theoretically validate the risk of SARS-CoV-2 permeation. There has not been any direct evidence for SARS-CoV-2 leakage through the membrane in ECMO support for [...] Read more.

The objective of this study is to clarify the pore structure of ECMO membranes by using our approach and theoretically validate the risk of SARS-CoV-2 permeation. There has not been any direct evidence for SARS-CoV-2 leakage through the membrane in ECMO support for critically ill COVID-19 patients. The precise pore structure of recent membranes was elucidated by direct microscopic observation for the first time. The three types of membranes, polypropylene, polypropylene coated with thin silicone layer, and polymethylpentene (PMP), have unique pore structures, and the pore structures on the inner and outer surfaces of the membranes are completely different anisotropic structures. From these data, the partition coefficients and intramembrane diffusion coefficients of SARS-CoV-2 were quantified using the membrane transport model. Therefore, SARS-CoV-2 may permeate the membrane wall with the plasma filtration flow or wet lung. The risk of SARS-CoV-2 permeation is completely different due to each anisotropic pore structure. We theoretically demonstrate that SARS-CoV-2 is highly likely to permeate the membrane transporting from the patient’s blood to the gas side, and may diffuse from the gas side outlet port of ECMO leading to the extra-circulatory spread of the SARS-CoV-2 (ECMO infection). Development of a new generation of nanoscale membrane confirmation is proposed for next-generation extracorporeal membrane oxygenator and system with long-term durability is envisaged. Full article

(This article belongs to the Special Issue Advances in Extracorporeal Membrane Oxygenation)

► Show Figures

Figure 1

12 pages, 2329 KiB

Open AccessArticle

Comparison of Circular and Parallel-Plated Membrane Lungs for Extracorporeal Carbon Dioxide Elimination

by Leonie S. Schwärzel, Anna M. Jungmann, Nicole Schmoll, Stefan Caspari, Frederik Seiler, Ralf M. Muellenbach, Moritz Bewarder, Quoc Thai Dinh, Robert Bals, Philipp M. Lepper and Albert J. Omlor

Membranes 2021, 11(6), 398; https://doi.org/10.3390/membranes11060398 - 27 May 2021

Cited by 3 | Viewed by 2991

Abstract

Extracorporeal carbon dioxide removal (ECCO₂R) is an important technique to treat critical lung diseases such as exacerbated chronic obstructive pulmonary disease (COPD) and mild or moderate acute respiratory distress syndrome (ARDS). This study applies our previously presented ECCO₂R mock [...] Read more.

Extracorporeal carbon dioxide removal (ECCO₂R) is an important technique to treat critical lung diseases such as exacerbated chronic obstructive pulmonary disease (COPD) and mild or moderate acute respiratory distress syndrome (ARDS). This study applies our previously presented ECCO₂R mock circuit to compare the CO₂ removal capacity of circular versus parallel-plated membrane lungs at different sweep gas flow rates (0.5, 2, 4, 6 L/min) and blood flow rates (0.3 L/min, 0.9 L/min). For both designs, two low-flow polypropylene membrane lungs (Medos Hilte 1000, Quadrox-i Neonatal) and two mid-flow polymethylpentene membrane lungs (Novalung Minilung, Quadrox-iD Pediatric) were compared. While the parallel-plated Quadrox-iD Pediatric achieved the overall highest CO₂ removal rates under medium and high sweep gas flow rates, the two circular membrane lungs performed relatively better at the lowest gas flow rate of 0.5 L/min. The low-flow Hilite 1000, although overall better than the Quadrox i-Neonatal, had the most significant advantage at a gas flow of 0.5 L/min. Moreover, the circular Minilung, despite being significantly less efficient than the Quadrox-iD Pediatric at medium and high sweep gas flow rates, did not show a significantly worse CO₂ removal rate at a gas flow of 0.5 L/min but rather a slight advantage. We suggest that circular membrane lungs have an advantage at low sweep gas flow rates due to reduced shunting as a result of their fiber orientation. Efficiency for such low gas flow scenarios might be relevant for possible future portable ECCO₂R devices. Full article

(This article belongs to the Special Issue Advances in Extracorporeal Membrane Oxygenation)

► Show Figures

Figure 1

11 pages, 3814 KiB

Open AccessArticle

Diabetic Pathophysiology Enhances Inflammation during Extracorporeal Membrane Oxygenation in a Rat Model

by Yutaka Fujii, Takuya Abe and Kikuo Ikegami

Membranes 2021, 11(4), 283; https://doi.org/10.3390/membranes11040283 - 11 Apr 2021

Cited by 12 | Viewed by 3646

Abstract

Systemic inflammatory responses in patients undergoing extracorporeal membrane oxygenation (ECMO) contribute significantly to ECMO-associated morbidity and mortality. In recent years, the number of type 2 diabetes mellitus patients has increased, and the number of these patients undergoing ECMO has also increased. Type 2 [...] Read more.

Systemic inflammatory responses in patients undergoing extracorporeal membrane oxygenation (ECMO) contribute significantly to ECMO-associated morbidity and mortality. In recent years, the number of type 2 diabetes mellitus patients has increased, and the number of these patients undergoing ECMO has also increased. Type 2 diabetes mellitus is a high-risk factor for complications during ECMO. We studied the effects of ECMO on inflammatory response in a diabetic rat ECMO model. Twenty-eight rats were divided into 4 groups: normal SHAM group (normal rats: n = 7), diabetic SHAM group (diabetic rats: n = 7), normal ECMO group (normal rats: n = 7), and diabetic ECMO group (diabetic rats: n = 7). We measured the plasma levels of cytokines, tumor necrosis factor-α, and interleukin-6. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), blood urea nitrogen (BUN), creatinine (Cr), and liver-type fatty acid binding protein (L-FABP) were examined in the rat cardiopulmonary bypass model to ascertain organ damage. In addition, the lung wet-to-dry weight (W/D) ratio was measured as an index of pulmonary tissue edema. A pathologic evaluation of kidneys was conducted by hematoxylin-eosin (HE) and periodic-acid-methenamine-silver (PAM) staining. In the diabetic ECMO group, levels of cytokines, AST, ALT, LDH, and L-FABP increased significantly, reaching a maximum at the end of ECMO in comparison with other groups (p < 0.05). In addition, hematoxylin-eosin and periodic acid-methenamine-silver staining of renal tissues showed marked injury in the ECMO group (normal ECMO and diabetic ECMO groups). Furthermore, when the normal ECMO and diabetic ECMO groups were compared, severe organ injury was seen in the diabetic ECMO group. There was remarkable organ injury in the diabetic ECMO group. These data demonstrate that diabetes enhances proinflammatory cytokine release, renal damage, and pulmonary edema during ECMO in an animal model. Full article

(This article belongs to the Special Issue Advances in Extracorporeal Membrane Oxygenation)

► Show Figures

Figure 1

12 pages, 1311 KiB

Open AccessArticle

Mode of Death after Extracorporeal Cardiopulmonary Resuscitation

by Viviane Zotzmann, Corinna N. Lang, Xavier Bemtgen, Markus Jäckel, Annabelle Fluegler, Jonathan Rilinger, Christoph Benk, Christoph Bode, Alexander Supady, Tobias Wengenmayer and Dawid L. Staudacher

Membranes 2021, 11(4), 270; https://doi.org/10.3390/membranes11040270 - 8 Apr 2021

Cited by 10 | Viewed by 3310

Abstract

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) might be a lifesaving therapy for patients with cardiac arrest and no return of spontaneous circulation during advanced life support. However, even with ECPR, mortality of these severely sick patients is high. Little is known on the exact [...] Read more.

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) might be a lifesaving therapy for patients with cardiac arrest and no return of spontaneous circulation during advanced life support. However, even with ECPR, mortality of these severely sick patients is high. Little is known on the exact mode of death in these patients. Methods: Retrospective registry analysis of all consecutive patients undergoing ECPR between May 2011 and May 2020 at a single center. Mode of death was judged by two researchers. Results: A total of 274 ECPR cases were included (age 60.0 years, 47.1% shockable initial rhythm, median time-to-extracorporeal membrane oxygenation (ECMO) 53.8min, hospital survival 25.9%). The 71 survivors had shorter time-to-ECMO durations (46.0 ± 27.9 vs. 56.6 ± 28.8min, p < 0.01), lower initial lactate levels (7.9 ± 4.5 vs. 11.6 ± 8.4 mg/dL, p < 0.01), higher PREDICT-6h (41.7 ± 17.0% vs. 25.3 ± 19.0%, p < 0.01), and SAVE (0.4 ± 4.8 vs. −0.8 ± 4.4, p < 0.01) scores. Most common mode of death in 203 deceased patients was therapy resistant shock in 105/203 (51.7%) and anoxic brain injury in 69/203 (34.0%). Comparing patients deceased with shock to those with cerebral damage, patients with shock were significantly older (63.2 ± 11.5 vs. 54.3 ± 16.5 years, p < 0.01), more frequently resuscitated in-hospital (64.4% vs. 29.9%, p < 0.01) and had shorter time-to-ECMO durations (52.3 ± 26.8 vs. 69.3 ± 29.1min p < 0.01). Conclusions: Most patients after ECPR decease due to refractory shock. Older patients with in-hospital cardiac arrest might be prone to development of refractory shock. Only a minority die from cerebral damage. Research should focus on preventing post-CPR shock and treating the shock in these patients. Full article

(This article belongs to the Special Issue Advances in Extracorporeal Membrane Oxygenation)

► Show Figures

Figure 1

9 pages, 236 KiB

Open AccessArticle

Initial Arterial pCO₂ and Its Course in the First Hours of Extracorporeal Cardiopulmonary Resuscitation Show No Association with Recovery of Consciousness in Humans: A Single-Centre Retrospective Study

by Loes Mandigers, Corstiaan A. den Uil, Jeroen J. H. Bunge, Diederik Gommers and Dinis dos Reis Miranda

Membranes 2021, 11(3), 208; https://doi.org/10.3390/membranes11030208 - 15 Mar 2021

Cited by 3 | Viewed by 2494

Abstract

Background: Cardiac arrest is a severe condition with high mortality rates, especially in the case of prolonged low-flow durations resulting in severe ischaemia and reperfusion injury. Changes in partial carbon dioxide concentration (pCO₂) may aggravate this injury. Extracorporeal cardiopulmonary resuscitation (ECPR) [...] Read more.

Background: Cardiac arrest is a severe condition with high mortality rates, especially in the case of prolonged low-flow durations resulting in severe ischaemia and reperfusion injury. Changes in partial carbon dioxide concentration (pCO₂) may aggravate this injury. Extracorporeal cardiopulmonary resuscitation (ECPR) shortens the low-flow duration and enables close regulation of pCO₂. We examined whether pCO₂ is associated with recovery of consciousness. Methods: We retrospectively analysed ECPR patients ≥ 16 years old treated between 2010 and 2019. We evaluated initial arterial pCO₂ and the course of pCO₂ ≤ 6 h after initiation of ECPR. The primary outcome was the rate of recovery of consciousness, defined as Glasgow coma scale motor score of six. Results: Out of 99 ECPR patients, 84 patients were eligible for this study. The mean age was 47 years, 63% were male, 93% had a witnessed arrest, 45% had an out-of-hospital cardiac arrest, and 38% had a recovery of consciousness. Neither initial pCO₂ (Odds Ratio (OR) 0.93, 95% confidence interval 95% (CI) 0.78–1.08) nor maximum decrease of pCO₂ (OR 1.03, 95% CI 0.95–1.13) was associated with the recovery of consciousness. Conclusion: Initial arterial pCO₂ and the course of pCO₂ in the first six hours after initiation of ECPR were not associated with the recovery of consciousness. Full article

(This article belongs to the Special Issue Advances in Extracorporeal Membrane Oxygenation)

► Show Figures

Graphical abstract

14 pages, 935 KiB

Open AccessArticle

Impact of CRRT in Patients with PARDS Treated with VV-ECMO

by Sébastien Redant, Océane Barbance, Ashita Tolwani, Xavier Beretta-Piccoli, Jacques Massaut, David De Bels, Fabio S. Taccone, Patrick M. Honoré and Dominique Biarent

Membranes 2021, 11(3), 195; https://doi.org/10.3390/membranes11030195 - 11 Mar 2021

Cited by 4 | Viewed by 3228

Abstract

The high mortality of pediatric acute respiratory distress syndrome (PARDS) is partly related to fluid overload. Extracorporeal membrane oxygenation (ECMO) is used to treat pediatric patients with severe PARDS, but can result in acute kidney injury (AKI) and worsening fluid overload. The objective [...] Read more.

The high mortality of pediatric acute respiratory distress syndrome (PARDS) is partly related to fluid overload. Extracorporeal membrane oxygenation (ECMO) is used to treat pediatric patients with severe PARDS, but can result in acute kidney injury (AKI) and worsening fluid overload. The objective of this study was to determine whether the addition of CRRT to ECMO in patients with PARDS is associated with increased mortality. Methods: We conducted a retrospective 7-year study of patients with PARDS requiring ECMO and divided them into those requiring CRRT and those not requiring CRRT. We calculated severity of illness scores, the amount of blood products administered to both groups, and determined the impact of CRRT on mortality and morbidity. Results: We found no significant difference in severity of illness scores except the vasoactive inotropic score (VIS, 45 ± 71 vs. 139 ± 251, p = 0.042), which was significantly elevated during the initiation and the first three days of ECMO. CRRT was associated with an increase in the use of blood products and noradrenaline (p < 0.01) without changing ECMO duration, length of PICU stay or mortality. Conclusion: The addition of CRRT to ECMO is associated with a greater consumption of blood products but no increase in mortality. Full article

(This article belongs to the Special Issue Advances in Extracorporeal Membrane Oxygenation)

► Show Figures

Figure 1

13 pages, 448 KiB

Open AccessArticle

Conversion from Venovenous to Venoarterial Extracorporeal Membrane Oxygenation in Adults

by Lars Falk, Alexander Fletcher-Sandersjöö, Jan Hultman and Lars Mikael Broman

Membranes 2021, 11(3), 188; https://doi.org/10.3390/membranes11030188 - 9 Mar 2021

Cited by 10 | Viewed by 2332

Abstract

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. [...] Read more.

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. Full article

(This article belongs to the Special Issue Advances in Extracorporeal Membrane Oxygenation)

► Show Figures

Figure 1

13 pages, 1060 KiB

Open AccessArticle

Outcome Prediction in Patients with Severe COVID-19 Requiring Extracorporeal Membrane Oxygenation—A Retrospective International Multicenter Study

by Alexander Supady, Jeff DellaVolpe, Fabio Silvio Taccone, Dominik Scharpf, Matthias Ulmer, Philipp M. Lepper, Maximilian Halbe, Stephan Ziegeler, Alexander Vogt, Raj Ramanan, David Boldt, Stephanie-Susanne Stecher, Andrea Montisci, Tobias Spangenberg, Olivier Marggraf, Chandra Kunavarapu, Lorenzo Peluso, Sebastian Muenz, Monica Buerle, Naveen G. Nagaraj, Sebastian Nuding, Catalin Toma, Vadim Gudzenko, Hans Joachim Stemmler, Federico Pappalardo, Georg Trummer, Christoph Benk, Guido Michels, Daniel Duerschmied, Constantin von zur Muehlen, Christoph Bode, Klaus Kaier, Daniel Brodie, Tobias Wengenmayer and Dawid L. Staudacher Show full author list Hide full author list

Membranes 2021, 11(3), 170; https://doi.org/10.3390/membranes11030170 - 27 Feb 2021

Cited by 31 | Viewed by 4516

Abstract

The role of veno-venous extracorporeal membrane oxygenation therapy (V-V ECMO) in severe COVID-19 acute respiratory distress syndrome (ARDS) is still under debate and conclusive data from large cohorts are scarce. Furthermore, criteria for the selection of patients that benefit most from this highly [...] Read more.

The role of veno-venous extracorporeal membrane oxygenation therapy (V-V ECMO) in severe COVID-19 acute respiratory distress syndrome (ARDS) is still under debate and conclusive data from large cohorts are scarce. Furthermore, criteria for the selection of patients that benefit most from this highly invasive and resource-demanding therapy are yet to be defined. In this study, we assess survival in an international multicenter cohort of COVID-19 patients treated with V-V ECMO and evaluate the performance of several clinical scores to predict 30-day survival. Methods: This is an investigator-initiated retrospective non-interventional international multicenter registry study (NCT04405973, first registered 28 May 2020). In 127 patients treated with V-V ECMO at 15 centers in Germany, Switzerland, Italy, Belgium, and the United States, we calculated the Sequential Organ Failure Assessment (SOFA) Score, Simplified Acute Physiology Score II (SAPS II), Acute Physiology And Chronic Health Evaluation II (APACHE II) Score, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) Score, Predicting Death for Severe ARDS on V-V ECMO (PRESERVE) Score, and 30-day survival. Results: In our study cohort which enrolled 127 patients, overall 30-day survival was 54%. Median SOFA, SAPS II, APACHE II, RESP, and PRESERVE were 9, 36, 17, 1, and 4, respectively. The prognostic accuracy for all these scores (area under the receiver operating characteristic—AUROC) ranged between 0.548 and 0.605. Conclusions: The use of scores for the prediction of mortality cannot be recommended for treatment decisions in severe COVID-19 ARDS undergoing V-V ECMO; nevertheless, scoring results below or above a specific cut-off value may be considered as an additional tool in the evaluation of prognosis. Survival rates in this cohort of COVID-19 patients treated with V-V ECMO were slightly lower than those reported in non-COVID-19 ARDS patients treated with V-V ECMO. Full article

(This article belongs to the Special Issue Advances in Extracorporeal Membrane Oxygenation)

► Show Figures

Figure 1

12 pages, 2005 KiB

Open AccessArticle

Validation of Prognostic Scores in Extracorporeal Life Support: A Multi-Centric Retrospective Study

by Christoph Fisser, Luis Alberto Rincon-Gutierrez, Tone Bull Enger, Fabio Silvio Taccone, Lars Mikael Broman, Mirko Belliato, Leda Nobile, Federico Pappalardo and Maximilian V. Malfertheiner

Membranes 2021, 11(2), 84; https://doi.org/10.3390/membranes11020084 - 24 Jan 2021

Cited by 30 | Viewed by 3143

Abstract

Multiple prognostic scores have been developed for both veno-arterial (VA) and veno-venous (VV) extracorporeal membrane oxygenation (ECMO), mostly in single-center cohorts. The aim of this study was to compare and validate different prediction scores in a large multicenter ECMO-population. Methods: Data from five [...] Read more.

Multiple prognostic scores have been developed for both veno-arterial (VA) and veno-venous (VV) extracorporeal membrane oxygenation (ECMO), mostly in single-center cohorts. The aim of this study was to compare and validate different prediction scores in a large multicenter ECMO-population. Methods: Data from five ECMO centers included 300 patients on VA and 329 on VV ECMO support (March 2008 to November 2016). Different prognostic scores were compared between survivors and non-survivors: APACHE II, SOFA, SAPS II in all patients; SAVE, modified SAVE and MELD-XI in VA ECMO; RESP, PRESET, ROCH and PRESERVE in VV ECMO. Model performance was compared using receiver-operating-curve analysis and assessment of model calibration. Survival was assessed at intensive care unit discharge. Results: The main indication for VA ECMO was cardiogenic shock; overall survival was 51%. ICU survivors had higher Glasgow Coma Scale scores and pH, required cardiopulmonary resuscitation (CPR) less frequently, had lower lactate levels and shorter ventilation time pre-ECMO at baseline. The best discrimination between survivors and non-survivors was observed with the SAPS II score (area under the curve [AUC] of 0.73 (95% CI 0.67–0.78)). The main indication for VV ECMO was pneumonia; overall survival was 60%. Lower PaCO₂, higher pH, lower lactate and lesser need for CPR were observed among survivors. The best discrimination between survivors and non-survivors was observed with the PRESET score (AUC 0.66 (95% CI 0.60–0.72)). Conclusion: The prognostic performance of most scores was moderate in ECMO patients. The use of such scores to decide about ECMO implementation in potential candidates should be discouraged. Full article

(This article belongs to the Special Issue Advances in Extracorporeal Membrane Oxygenation)

► Show Figures

Figure 1

11 pages, 1132 KiB

Open AccessArticle

Early Findings after Implementation of Veno-Arteriovenous ECMO: A Multicenter European Experience

by Aaron Blandino Ortiz, Mirko Belliato, Lars Mikael Broman, Olivier Lheureux, Maximilian Valentin Malfertheiner, Angela Xini, Federico Pappalardo and Fabio Silvio Taccone

Membranes 2021, 11(2), 81; https://doi.org/10.3390/membranes11020081 - 22 Jan 2021

Cited by 10 | Viewed by 3824

Abstract

Extracorporeal membrane oxygenation (ECMO) is increasingly used to treat cardiopulmonary failure in critically ill patients. Peripheral cannulation may be complicated by a persistent low cardiac output in case of veno-venous cannulation (VV-ECMO) or by differential hypoxia (e.g., lower PaO₂ in the upper [...] Read more.

Extracorporeal membrane oxygenation (ECMO) is increasingly used to treat cardiopulmonary failure in critically ill patients. Peripheral cannulation may be complicated by a persistent low cardiac output in case of veno-venous cannulation (VV-ECMO) or by differential hypoxia (e.g., lower PaO₂ in the upper than in the lower body) in case of veno-arterial cannulation (VA-ECMO) and severe impairment of pulmonary function associated with cardiac recovery. The treatment of such complications remains challenging. We report the early effects of the use of veno-arterial-venous (V-AV) ECMO in this setting. Methods: Retrospective analysis including patients from five different European ECMO centers (January 2013 to December 2016) who required V-AV ECMO. We collected demographic data as well as comorbidities and ECMO characteristics, hemodynamics, and arterial blood gas values before and immediately after (i.e., within 2 h) V-AV implementation. Results: A total of 32 patients (age 53 (interquartiles, IQRs: 31–59) years) were identified: 16 were initially supported with VA-ECMO and 16 with VV-ECMO. The median time to V-AV conversion was 2 (1–5) days. After V-AV implantation, heart rate and norepinephrine dose significantly decreased, while PaO₂ and SaO₂ significantly increased compared to baseline values. Lactate levels significantly decreased from 3.9 (2.3–7.1) to 2.8 (1.4–4.4) mmol/L (p = 0.048). A significant increase in the overall ECMO blood flow (from 4.5 (3.8–5.0) to 4.9 (4.3–5.9) L/min; p < 0.01) was observed, with 3.0 (2.5–3.2) L/min for the arterial and 2.8 (2.1–3.6) L/min for the venous return flows. Conclusions: In ECMO patients with differential hypoxia or persistently low cardiac output syndrome, V-AV conversion was associated with improvement in some hemodynamic and respiratory parameters. A significant increase in the overall ECMO blood flow was also observed, with similar flow distributed into the arterial and venous return cannulas. Full article

(This article belongs to the Special Issue Advances in Extracorporeal Membrane Oxygenation)

► Show Figures

Graphical abstract

11 pages, 466 KiB

Open AccessArticle

Mechanical Power during Veno-Venous Extracorporeal Membrane Oxygenation Initiation: A Pilot-Study

by Mirko Belliato, Francesco Epis, Luca Cremascoli, Fiorenza Ferrari, Maria Giovanna Quattrone, Christoph Fisser, Maximilian Valentin Malfertheiner, Fabio Silvio Taccone, Matteo Di Nardo, Lars Mikael Broman and Roberto Lorusso

Membranes 2021, 11(1), 30; https://doi.org/10.3390/membranes11010030 - 2 Jan 2021

Cited by 9 | Viewed by 3299

Abstract

Mechanical power (MP) represents a useful parameter to describe and quantify the forces applied to the lungs during mechanical ventilation (MV). In this multi-center, prospective, observational study, we analyzed MP variations following MV adjustments after veno-venous extra-corporeal membrane oxygenation (VV ECMO) initiation. We [...] Read more.

Mechanical power (MP) represents a useful parameter to describe and quantify the forces applied to the lungs during mechanical ventilation (MV). In this multi-center, prospective, observational study, we analyzed MP variations following MV adjustments after veno-venous extra-corporeal membrane oxygenation (VV ECMO) initiation. We also investigated whether the MV parameters (including MP) in the early phases of VV ECMO run may be related to the intensive care unit (ICU) mortality. Thirty-five patients with severe acute respiratory distress syndrome were prospectively enrolled and analyzed. After VV ECMO initiation, we observed a significant decrease in median MP (32.4 vs. 8.2 J/min, p < 0.001), plateau pressure (27 vs. 21 cmH₂O, p = 0.012), driving pressure (11 vs. 8 cmH₂O, p = 0.014), respiratory rate (RR, 22 vs. 14 breaths/min, p < 0.001), and tidal volume adjusted to patient ideal body weight (V_T/IBW, 5.5 vs. 4.0 mL/kg, p = 0.001) values. During the early phase of ECMO run, RR (17 vs. 13 breaths/min, p = 0.003) was significantly higher, while positive end-expiratory pressure (10 vs. 14 cmH₂O, p = 0.048) and V_T/IBW (3.0 vs. 4.0 mL/kg, p = 0.028) were lower in ICU non-survivors, when compared to the survivors. The observed decrease in MP after ECMO initiation did not influence ICU outcome. Waiting for large studies assessing the role of these parameters in VV ECMO patients, RR and MP monitoring should not be underrated during ECMO. Full article

(This article belongs to the Special Issue Advances in Extracorporeal Membrane Oxygenation)

► Show Figures

Figure 1

9 pages, 1685 KiB

Open AccessArticle

Evaluation of a New Extracorporeal CO₂ Removal Device in an Experimental Setting

by Matteo Di Nardo, Filippo Annoni, Fuhong Su, Mirko Belliato, Roberto Lorusso, Lars Mikael Broman, Maximilian Malfertheiner, Jacques Creteur and Fabio Silvio Taccone

Membranes 2021, 11(1), 8; https://doi.org/10.3390/membranes11010008 - 23 Dec 2020

Cited by 4 | Viewed by 3991

Abstract

Background: Ultra-protective lung ventilation in acute respiratory distress syndrome or early weaning and/or avoidance of mechanical ventilation in decompensated chronic obstructive pulmonary disease may be facilitated by the use of extracorporeal CO₂ removal (ECCO₂R). We tested the CO₂ removal [...] Read more.

Background: Ultra-protective lung ventilation in acute respiratory distress syndrome or early weaning and/or avoidance of mechanical ventilation in decompensated chronic obstructive pulmonary disease may be facilitated by the use of extracorporeal CO₂ removal (ECCO₂R). We tested the CO₂ removal performance of a new ECCO₂R (CO₂RESET) device in an experimental animal model. Methods: Three healthy pigs were mechanically ventilated and connected to the CO₂RESET device (surface area = 1.8 m², EUROSETS S.r.l., Medolla, Italy). Respiratory settings were adjusted to induce respiratory acidosis with the adjunct of an external source of pure CO₂ (target pre membrane lung venous PCO₂ (P_preCO₂): 80–120 mmHg). The amount of CO₂ removed (VCO₂, mL/min) by the membrane lung was assessed directly by the ECCO₂R device. Results: Before the initiation of ECCO₂R, the median P_preCO₂ was 102.50 (95.30–118.20) mmHg. Using fixed incremental steps of the sweep gas flow and maintaining a fixed blood flow of 600 mL/min, VCO₂ progressively increased from 0 mL/min (gas flow of 0 mL/min) to 170.00 (160.00–200.00) mL/min at a gas flow of 10 L/min. In particular, a high increase of VCO₂ was observed increasing the gas flow from 0 to 2 L/min, then, VCO₂ tended to progressively achieve a steady-state for higher gas flows. No animal or pump complications were observed. Conclusions: Medium-flow ECCO₂R devices with a blood flow of 600 mL/min and a high surface membrane lung (1.8 m²) provided a high VCO₂ using moderate sweep gas flows (i.e., >2 L/min) in an experimental swine models with healthy lungs. Full article

(This article belongs to the Special Issue Advances in Extracorporeal Membrane Oxygenation)

► Show Figures

Figure 1

Review

Jump to: Research

24 pages, 8983 KiB

Open AccessReview

A Review of Human Circulatory System Simulation: Bridging the Gap between Engineering and Medicine

by Abdulrahman Mahmoud, Abdullah Alsalemi, Faycal Bensaali, Ali Ait Hssain and Ibrahim Hassan

Membranes 2021, 11(10), 744; https://doi.org/10.3390/membranes11100744 - 28 Sep 2021

Cited by 6 | Viewed by 5321

Abstract

(1) Background: Simulation-based training (SBT) is the practice of using hands-on training to immerse learners in a risk-free and high-fidelity environment. SBT is used in various fields due to its risk-free benefits from a safety and an economic perspective. In addition, SBT provides [...] Read more.

(1) Background: Simulation-based training (SBT) is the practice of using hands-on training to immerse learners in a risk-free and high-fidelity environment. SBT is used in various fields due to its risk-free benefits from a safety and an economic perspective. In addition, SBT provides immersive training unmatched by traditional teaching the interactive visualization needed in particular scenarios. Medical SBT is a prevalent practice as it allows for a platform for learners to learn in a risk-free and cost-effective environment, especially in critical care, as mistakes could easily cause fatalities. An essential category of care is human circulatory system care (HCSC), which includes essential-to-simulate complications such as cardiac arrest. (2) Methods: In this paper, a deeper look onto existing human circulatory system medical SBT is presented to assess and highlight the important features that should be present with a focus on extracorporeal membrane oxygenation cannulation (ECMO) simulators and cardiac catheterization. (3) Results: A list of features is also suggested for an ideal simulator to bridge the gap between medical studies and simulator engineering, followed by a case study of an ECMO SBT system design. (4) Conclusions: a collection and discussion of existing work for HCSC SBT are portrayed as a guide for researchers and practitioners to compare existing SBT and recreating them effectively. Full article

(This article belongs to the Special Issue Advances in Extracorporeal Membrane Oxygenation)

► Show Figures

Figure 1

17 pages, 1838 KiB

Open AccessEditor’s ChoiceReview

Physiological Basis of Extracorporeal Membrane Oxygenation and Extracorporeal Carbon Dioxide Removal in Respiratory Failure

by Barbara Ficial, Francesco Vasques, Joe Zhang, Stephen Whebell, Michael Slattery, Tomas Lamas, Kathleen Daly, Nicola Agnew and Luigi Camporota

Membranes 2021, 11(3), 225; https://doi.org/10.3390/membranes11030225 - 22 Mar 2021

Cited by 28 | Viewed by 12110

Abstract

Extracorporeal life support (ECLS) for severe respiratory failure has seen an exponential growth in recent years. Extracorporeal membrane oxygenation (ECMO) and extracorporeal CO₂ removal (ECCO₂R) represent two modalities that can provide full or partial support of the native lung function, [...] Read more.

Extracorporeal life support (ECLS) for severe respiratory failure has seen an exponential growth in recent years. Extracorporeal membrane oxygenation (ECMO) and extracorporeal CO₂ removal (ECCO₂R) represent two modalities that can provide full or partial support of the native lung function, when mechanical ventilation is either unable to achieve sufficient gas exchange to meet metabolic demands, or when its intensity is considered injurious. While the use of ECMO has defined indications in clinical practice, ECCO₂R remains a promising technique, whose safety and efficacy are still being investigated. Understanding the physiological principles of gas exchange during respiratory ECLS and the interactions with native gas exchange and haemodynamics are essential for the safe applications of these techniques in clinical practice. In this review, we will present the physiological basis of gas exchange in ECMO and ECCO₂R, and the implications of their interaction with native lung function. We will also discuss the rationale for their use in clinical practice, their current advances, and future directions. Full article

(This article belongs to the Special Issue Advances in Extracorporeal Membrane Oxygenation)

► Show Figures

Figure 1

9 pages, 522 KiB

Open AccessReview

Multitarget Approach to Cardiogenic Shock after Acute Myocardial Infarction: Extracorporeal Life Support (ECLS) and Beyond

by Federico Pappalardo, Giulia Malara and Andrea Montisci

Membranes 2021, 11(2), 87; https://doi.org/10.3390/membranes11020087 - 27 Jan 2021

Cited by 2 | Viewed by 3324

Abstract

Cardiogenic shock following acute myocardial infarction is associated with high mortality, substantially unchanged for the previous 20 years. Several approaches have been sought to achieve a therapeutic breakthrough, from myocardial revascularization strategies to the use of mechanical circulatory support. Many issues are, as [...] Read more.

Cardiogenic shock following acute myocardial infarction is associated with high mortality, substantially unchanged for the previous 20 years. Several approaches have been sought to achieve a therapeutic breakthrough, from myocardial revascularization strategies to the use of mechanical circulatory support. Many issues are, as yet, unresolved. Systemic inflammation seems to play a key role but is still lacking in effective therapies, and is potentially compounded by the death spiral of hypoperfusion and/or artificial devices. In this review, a multitarget approach to cardiogenic shock following acute myocardial infarction is proposed. Full article

(This article belongs to the Special Issue Advances in Extracorporeal Membrane Oxygenation)

► Show Figures

Figure 1

Journal Menu

Journal Browser

Advances in Extracorporeal Membrane Oxygenation

Share This Special Issue

Special Issue Editor

Special Issue Information

Keywords

Benefits of Publishing in a Special Issue

Published Papers (15 papers)

Research

Review

Further Information

Guidelines

MDPI Initiatives

Follow MDPI