Extracorporeal Life Support

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Robert H. Bartlett - One of the best experts on this subject based on the ideXlab platform.

  • Anticoagulation for Extracorporeal Life Support: Direct Thrombin Inhibitors and Heparin.
    ASAIO journal (American Society for Artificial Internal Organs : 1992), 2015
    Co-Authors: Megan A. Coughlin, Robert H. Bartlett
    Abstract:

    Since its introduction to bedside clinical practice over 40 years ago, Extracorporeal Life Support (ECLS) has been continually changing and improving as a Life-saving technology. Extracorporeal Life Support disrupts the normal finely maintained balance of coagulation and fibrinolysis by exposing large amounts of blood to nonendothelial surfaces. This leads to an inflammatory response with activation of the coagulation cascade and the need for systemic anticoagulation. Unfractionated heparin (UNFH) is currently the standard anticoagulant in ECLS. Alternative anticoagulants have been recently developed with improved safety profiles and reliable monitoring. Within this group of agents are the direct thrombin inhibitors (DTIs) bivalirudin and argatroban. The purpose of this article is to compare these DTIs to the current standard of UNFH anticoagulation during ECLS, to evaluate the current literature surrounding the use of these drugs in ECLS, and finally to propose therapeutic guidelines for their use in ECLS.

  • Extracorporeal Life Support for massive pulmonary embolism.
    The Journal of trauma, 2007
    Co-Authors: Paul M. Maggio, Mark R. Hemmila, Jonathan W. Haft, Robert H. Bartlett
    Abstract:

    Background:Massive pulmonary embolism is frequently lethal because of acute irreversible pulmonary and cardiac failure. Extracorporeal Life Support (ECLS) has been used for cardiopulmonary failure in our institution since 1988, and we reviewed our experience with its use in the management of massive

  • Extracorporeal Life Support.
    Seminars in pediatric surgery, 2006
    Co-Authors: Sean C. Skinner, Ronald B. Hirschl, Robert H. Bartlett
    Abstract:

    Extracorporeal Life Support (ECLS) denotes the use of prolonged Extracorporeal cardiopulmonary bypass in patients with acute, reversible cardiac or respiratory failure. As technology has advanced, organ Support functions other than gas exchange, such as liver, renal, and cardiac Support, have been provided by ECLS, and others, such as immunologic Support, will be developed. The future of ECLS will include improvements in devices accompanied by circuit simplification and auto-regulation. Such enhancements in technology will allow application of ECLS to populations currently excluded from such Support; for example, thromboresistant circuits will eliminate the need for systemic anticoagulation and lead to the use of this technique in premature newborns. As the ECLS technique becomes safer and simpler, and as morbidity and mortality are minimized, criteria for application of ECLS will be relaxed. New approaches to ECLS, such as pumpless arteriovenous bypass, the artificial placenta, arteriovenous CO 2 removal (AVCO 2 R), and intravenous oxygenators (IVOX), will become more commonly applied. Such advances in technology will allow broader and more routine application of ECLS for lung and other organ system failure.

  • Extracorporeal Life Support history and new directions
    Asaio Journal, 2005
    Co-Authors: Robert H. Bartlett
    Abstract:

    This commentary recounts the development of Extracorporeal Life Support (ECLS, ECMO) from the laboratory and early clinical trials to routine clinical application. Lessons from neonatal ECMO have led to better understanding of neonatal lung physiology, improved methods of treatment, and application of ECLS to other patient populations.

  • Extracorporeal Life Support history and new directions
    Seminars in Perinatology, 2005
    Co-Authors: Robert H. Bartlett
    Abstract:

    This review recounts the development of Extracorporeal Life Support (ECLS, ECMO) from the laboratory and early clinical trials to routine clinical application. Lessons from neonatal ECMO have led to better understanding of neonatal lung physiology, improved methods of treatment, and application of ECLS to other patient populations.

Joseph R Custer - One of the best experts on this subject based on the ideXlab platform.

  • Pediatric Extracorporeal Life Support after high frequency ventilation: predictors of survival.
    ASAIO journal (American Society for Artificial Internal Organs : 1992), 2002
    Co-Authors: Robyn J Meyer, Gail M Annich, Norma J Maxvold, Frank W. Moler, Folafoluwa O. Odetola, Roxanne Sadowski, Joseph R Custer
    Abstract:

    Previous studies of Extracorporeal Life Support in pediatric patients have identified variables associated with survival. However, none of these studies focused on Extracorporeal Life Support after failure of high frequency ventilation (HFV). In the present study, we determined variables associated with survival for pediatric respiratory failure patients who received HFV prior to Extracorporeal Life Support, using data reported to the Extracorporeal Life Support Organization Registry from 1992 to 1998. Patients with neonatal diagnoses, immune compromising conditions, or congenital cardiac defects were excluded. The 243 patients who met inclusion criteria had a 58% survival rate (95% CI 48-66%). The mean age was 22 +/- 39 months. Mean duration of mechanical ventilation prior to Extracorporeal Life Support was 6.6 +/- 5.8 days. Venoarterial Extracorporeal Life Support was used in 72% of the patients; venovenous in 28%. The survival rate for the subset of patients with an oxygenation index greater than 42 cm H2O/torr on HFV (n = 122) was not significantly different from the overall sample. We determined that lower mean airway pressure, lower pressure amplitude, decreased oxygenation index, increased PaO2, and increased oxygen saturation on HFV were associated with increased survival in patients who were subsequently treated with Extracorporeal Life Support.

  • survival and renal function in pediatric patients following Extracorporeal Life Support with hemofiltration
    Pediatric Critical Care Medicine, 2001
    Co-Authors: Robyn J Meyer, Patrick D Brophy, Timothy E Bunchman, Gail M Annich, Norma J Maxvold, Theresa Mottes, Joseph R Custer
    Abstract:

    OBJECTIVE: To determine variables associated with survival in pediatric patients treated with hemofiltration while receiving Extracorporeal Life Support and to determine the probability for recovery of renal function among survivors. DESIGN: Retrospective database analysis. SETTING: University of Michigan pediatric nephrology database. PATIENTS: All pediatric patients treated with continuous hemofiltration while on Extracorporeal Life Support at the University of Michigan between January 1990 and May 1999. A pediatric patient was defined as any child between birth and 18 yrs of age, including children treated in both the pediatric intensive care unit and neonatal intensive care unit. Indications for Extracorporeal Life Support included both cardiac and pulmonary failure. INTERVENTIONS: Data analysis of patients who were treated with hemofiltration while on Extracorporeal Life Support. Hemofiltration includes both ultrafiltration and hemofiltration with countercurrent dialysis. MEASUREMENTS AND MAIN RESULTS: Thirty-five patients with a mean age of 39 +/- 65 months (median, 3 months) underwent hemofiltration while on Extracorporeal Life Support. Forty-three percent survived to hospital discharge (95% CI, 26%-60%). All deaths occurred in the intensive care unit. Recovery of renal function occurred in 93% of survivors (95% CI, 79%-108%). Mean duration of hemofiltration in survivors, including time during and after Extracorporeal Life Support, was 9 +/- 6 days. All nonsurvivors were on renal replacement therapy at the time of death. In this analysis, decreased survival was significantly associated with the use of vasopressor infusions (p =.01) and the presence of complications (p =.006). Vasopressor infusions were required in 89% of patients, and 37% of patients experienced complications. CONCLUSIONS: In patients receiving hemofiltration while on Extracorporeal Life Support, survival is comparable to that reported in other Extracorporeal Life Support or hemofiltration populations. Decreased survival in these patients may be associated with the use of vasopressor infusions and the occurrence of complications. Recovery of renal function occurs in most survivors.

  • Venovenous versus venoarterial Extracorporeal Life Support for pediatric respiratory failure: are there differences in survival and acute complications?
    Critical care medicine, 2000
    Co-Authors: Jihad Zahraa, Gail M Annich, Norma J Maxvold, Frank W. Moler, Robert H. Bartlett, Joseph R Custer
    Abstract:

    Objectives:To examine the Extracorporeal Life Support Organization (ELSO) registry database of infants and children with acute respiratory failure to compare outcome and complications of venovenous (VV) vs. venoarterial (VA) Extracorporeal Life Support (ECLS).Design:Retrospective cohort study.Settin

  • Alveolar-arterial oxygen gradients before Extracorporeal Life Support for severe pediatric respiratory failure: Improved outcome for Extracorporeal Life Support-managed patients?
    Critical care medicine, 1994
    Co-Authors: Frank W. Moler, Joseph R Custer, John Palmisano, Jon N. Meliones, Robert H. Bartlett
    Abstract:

    Objective: Recent reports have described the usefulness of the alveolar-arterial oxygen tension difference (P[A-a]o 2 ) in predicting mortality in children with acute respiratory failure managed with mechanical ventilation. We reviewed our experience with Extracorporeal Life Support for acute pediatric respiratorg failure and specifically examined P(A-a)o 2 measurements during the 24 hrs before Extracorporeal Life Support to determine if defined cutoffs established with conventional mechanical ventilation were applicable to Extracorporeal Life-Support survival. Design: Strospective, case-series chart review. Setting: A university tertiary medical center

  • Extracorporeal Life Support for pediatric respiratory failure: predictors of survival from 220 patients.
    Critical care medicine, 1993
    Co-Authors: Frank W. Moler, John Palmisano, Joseph R Custer
    Abstract:

    Objective The purpose of this report was to examine the Extracorporeal Life Support Organization registry database for predictors of outcome for severe pediatric respiratory failure managed with Extracorporeal Life Support. Design Retrospective cohort study. Setting Extracorporeal Life Support Organization data registry. Patients All nonneonatal pediatric patients who were treated in the United States with Extracorporeal Life Support for severe pediatric respiratory failure reported to the Extracorporeal Life Support Organization registry as of August 1991. Patients with congenital heart disease and congenital gastrointestinal malformations were excluded from study. Interventions Venoarterial or venovenous Extracorporeal Life Support for severe Life-threatening pulmonary failures. Measurements and main results As of August 1991, 220 pediatric patients meeting study entry criteria were reported to the Registry having received Extracorporeal Life Support for severe pulmonary failure, since 1982. Forty-six percent (102 of 220 patients) were successfully managed with this technology and survived to hospital discharge. The mean patient age was 36.8 +/- 51.6 months. Fifty-one percent of the patients were male. The mean duration of mechanical ventilation before Extracorporeal Life Support was 6.3 +/- 5.9 days. Mean blood gas and ventilatory measurements obtained before Extracorporeal Life Support were as follows: PaCO2 52 +/- 23 torr (6.9 +/- 3.0 kPa); PaO2 59 +/- 32 torr (7.8 +/- 4.3 kPa); estimated alveolar-arterial oxygen gradient 561 +/- 63.4 torr (74.8 +/- 8.5 kPa); peak airway pressure 49.5 +/- 13.1 cm H2O; mean airway pressure 24.3 +/- 8.2 cm H2O; positive end-expiratory pressure 11.8 +/- 6.3 cm H2O; ventilator rate 58 +/- 64.4 breaths/min; and FIO2 0.98 +/- 0.07. The mean duration of Extracorporeal Life Support for all patients was 247 +/- 164 hrs. For the 102 survivors, the mean time for decannulation from Extracorporeal Life Support to extubation from mechanical ventilation was 6.5 +/- 7.6 days. Stepwise multivariate logistic regression modeling found the following variables to be associated with patient survival: a) patient age, b) days of mechanical ventilation before Extracorporeal Life Support, c) peak inspiratory pressure, d) alveolar-arterial oxygen gradient, and e) Extracorporeal Life Support administered since December 31, 1988 (all p Conclusions Extracorporeal Life Support may represent an effective rescue therapy for some selected pediatric patients with severe respiratory failure for whom conventional mechanical ventilation Support has failed to improve. Predictors of survival for this Life-Support therapy exist that may be helpful for individual patient prognostication and future prospective study.

David Michael Mcmullan - One of the best experts on this subject based on the ideXlab platform.

  • Indications and outcomes of Extracorporeal Life Support in trauma patients.
    The journal of trauma and acute care surgery, 2018
    Co-Authors: Justyna Swol, Ravi R. Thiagarajan, Ryan P. Barbaro, David Michael Mcmullan, Roberto Lorusso, Daniel Brodie, Lena M. Napolitano, Pauline K. Park, Nicholas C. Cavarocchi, Ali Ait Hssain
    Abstract:

    BACKGROUNDThe use of Extracorporeal Life Support (ECLS) in the trauma population remains controversial and has been reported only in small cohort studies. Recent ECLS technical advances have increased its use as an advanced critical care option in trauma. Given the degree of resource utilization, co

  • Racial and Ethnic Variation in Pediatric Cardiac Extracorporeal Life Support Survival.
    Critical care medicine, 2017
    Co-Authors: Titus Chan, Jane L. Di Gennaro, Reid W. D. Farris, Monique Radman, David Michael Mcmullan
    Abstract:

    OBJECTIVES Previous studies have suggested an association between nonwhite race and poor outcomes in small subsets of cardiac surgery patients who require Extracorporeal Life Support. This study aims to examine the association of race/ethnicity with mortality in pediatric patients who receive Extracorporeal Life Support for cardiac Support. DESIGN Retrospective analysis of registry data. SETTING Prospectively collected multi-institutional registry data. SUBJECTS Data from all North American pediatric patients in the Extracorporeal Life Support International Registry who received Extracorporeal Life Support for cardiac Support between 1998 and 2012 were analyzed. Multivariate regression models were constructed to examine the association between race/ethnicity and hospital mortality, adjusting for demographics, diagnosis, pre-Extracorporeal Life Support care, Extracorporeal Life Support variables, and Extracorporeal Life Support-related complications. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of 7,106 patients undergoing cardiac Extracorporeal Life Support, the majority of patients were of white race (56.9%) with black race (16.7%), Hispanic ethnicity (15.8%), and Asian race (2.8%) comprising the other major race/ethnic groups. The mortality rate was 53.9% (n = 3,831). After adjusting for covariates, multivariate analysis identified black race (relative risk = 1.10; 95% CI, 1.04-1.16) and Hispanic ethnicity (relative risk = 1.08; 95% CI, 1.02-1.14) as independent risk factors for mortality. CONCLUSIONS Black race and Hispanic ethnicity are independently associated with mortality in children who require cardiac Extracorporeal Life Support.

  • Extracorporeal Life Support for the neonatal cardiac patient: Outcomes and new directions
    Seminars in perinatology, 2014
    Co-Authors: Andrew L. Mesher, David Michael Mcmullan
    Abstract:

    Extracorporeal Life Support is an important therapy for neonates with Life-threatening cardiopulmonary failure. Utilization of Extracorporeal Life Support in neonates with congenital heart disease has increased dramatically during the past three decades. Despite increased usage, overall survival in these patients has changed very little and Extracorporeal Life Support-related morbidity, including bleeding, neurologic injury, and renal failure, remains a major problem. Although survival is lower and neurologic complications are higher in premature infants than term infants, cardiac Extracorporeal Life Support including Extracorporeal cardiopulmonary resuscitation is effective in preventing death in many of these high-risk patients. Miniaturized ventricular assist devices and compact integrated Extracorporeal Life Support systems are being developed to provide additional therapeutic options for neonates.

  • Risk of Extracorporeal Life Support circuit-related hyperkalemia is reduced by prebypass ultrafiltration.
    Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Car, 2013
    Co-Authors: Meghan Delaney, Renee Lynn Axdorff-dickey, Greg Irwin Crockett, Amy Lynne Falconer, Michael James Levario, David Michael Mcmullan
    Abstract:

    OBJECTIVES Pediatric patients who receive large volume blood transfusions are at risk for experiencing transfusion-related hyperkalemic cardiac arrest. Prebypass ultrafiltration of blood used to prime cardiopulmonary bypass circuits is commonly used in pediatric cardiac surgery to create a more physiologic and electrolyte balanced priming solution prior to initiation of cardiopulmonary bypass. This study was undertaken to determine the efficacy of prebypass ultrafiltration in normalizing Extracorporeal Life Support circuit priming solution before initiating Extracorporeal Life Support. DESIGN Prospective study. SETTING PICU and neonatal ICU in a tertiary academic center. PATIENTS Patients requiring venovenous Extracorporeal Life Support. INTERVENTIONS Prebypass ultrafiltration of Extracorporeal Life Support circuits. MEASUREMENTS AND MAIN RESULTS Hematocrit, electrolyte, and lactate concentrations were measured in blood-primed Extracorporeal Life Support circuits before and after ultrafiltration and in blood collected from patients before and after initiation of Extracorporeal Life Support. Clinically significant elevation of K concentration was observed in all Extracorporeal Life Support circuits prior to prebypass ultrafiltration, despite the fact that 93% of red blood cell units were collected ≤ 7 days prior to use. Prebypass ultrafiltration significantly reduced concentrations of K (10.9 vs 6.0 mEq/L, p = 0.001) and lactate (7.0 vs 3.6 mmol/L, p < 0.001) and increased hematocrit (37% vs 48%, p < 0.001) and concentrations of ionized calcium (0.64 vs 1.16 mg/dL, p < 0.001) and Na (129 vs 144 mEq/L, p < 0.001). Serum electrolyte concentrations remained within the normal physiologic range in all patients following initiation of venovenous Extracorporeal Life Support with circuits that underwent prebypass ultrafiltration. CONCLUSIONS Prebypass ultrafiltration normalizes the electrolyte balance of blood-primed Extracorporeal Life Support circuits. Prebypass ultrafiltration processing may reduce the risk of transfusion-related hyperkalemic cardiac arrest in small children who require venovenous Extracorporeal Life Support.

Peter T. Rycus - One of the best experts on this subject based on the ideXlab platform.

  • The Extracorporeal Life Support Organization Registry: update and perspectives
    Annals of cardiothoracic surgery, 2019
    Co-Authors: Roberto Lorusso, Peter T. Rycus, Peta M A Alexander, Ryan P. Barbaro
    Abstract:

    From the birth of the Extracorporeal Life Support Organization (ELSO) Registry in 1989, collecting the most relevant information about Extracorporeal Life Support (ECLS) for refractory cardiac or respiratory compromise, was created in order to provide useful information and benchmark for ECLS users. Throughout the years, the Registry has continuously developed, achieving in 2018 more than 100,000 patients included with almost 500 ELSO centers around the world. Based on the relevance and impact of database analysis, and due to the growing need for more advanced and high-quality clinical investigations, the ELSO Registry is under substantial re-engineering which will allow and provide the ELSO members and the scientific community an enhanced scientific tool to elucidate various aspects of the ECLS settings, including trends and disease-specific information, to perform benchmarking about our own results and outcomes as compared to regional or worldwide results, and to provide an invaluable source of data for clinical investigations.

  • pediatric Extracorporeal Life Support organization registry international report 2016
    Asaio Journal, 2017
    Co-Authors: Ryan P. Barbaro, Peter T. Rycus, Matthew L. Paden, Yigit S. Guner, Lakshmi Raman, Lindsay M Ryerson, Peta M A Alexander, Viviane G Nasr, Melania M Bembea, Ravi R. Thiagarajan
    Abstract:

    The purpose of this report is to describe the international growth, outcomes, complications, and technology used in pediatric Extracorporeal Life Support (ECLS) from 2009 to 2015 as reported by participating centers in the Extracorporeal Life Support Organization (ELSO). To date, there are 59,969 children who have received ECLS in the ELSO Registry; among those, 21,907 received ECLS since 2009 with an overall survival to hospital discharge rate of 61%. In 2009, 2,409 ECLS cases were performed at 157 centers. By 2015, that number grew to 2,992 cases in 227 centers, reflecting a 24% increase in patients and 55% growth in centers. ECLS delivered to neonates (0-28 days) for respiratory Support was the largest subcategory of ECLS among children <18-years old. Overall, 48% of ECLS was delivered for respiratory Support and 52% was for cardiac Support or Extracorporeal Life Support to Support cardiopulmonary resuscitation (ECPR). During the study period, over half of children were Supported on ECLS with centrifugal pumps (51%) and polymethylpentene oxygenators (52%). Adverse events including neurologic events were common during ECLS, a fact that underscores the opportunity and need to promote quality improvement work.

  • Extracorporeal Life Support Organization Registry International Report 2016.
    ASAIO journal (American Society for Artificial Internal Organs : 1992), 2017
    Co-Authors: Ravi R. Thiagarajan, Steven A. Conrad, Peter T. Rycus, Ryan P. Barbaro, D. Michael Mcmullan, James D. Fortenberry, Matthew L. Paden
    Abstract:

    Data on Extracorporeal Life Support (ECLS) use and survival submitted to the Extracorporeal Life Support Organization's data registry from the inception of the registry in 1989 through July 1, 2016, are summarized in this report. The registry contained information on 78,397 ECLS patients with 58% survival to hospital discharge. Extracorporeal Life Support use and centers providing ECLS have increased worldwide. Extracorporeal Life Support use in the Support of adults with respiratory and cardiac failure represented the largest growth in the recent time period. Extracorporeal Life Support indications are expanding, and it is increasingly being used to Support cardiopulmonary resuscitation in children and adults. Adverse events during the course of ECLS are common and underscore the need for skilled ECLS management and appropriately trained ECLS personnel and teams.

  • Pediatric Extracorporeal Life Support Organization Registry International Report 2016.
    ASAIO journal (American Society for Artificial Internal Organs : 1992), 2017
    Co-Authors: Ryan P. Barbaro, Peter T. Rycus, Matthew L. Paden, Yigit S. Guner, Lakshmi Raman, Lindsay M Ryerson, Peta M A Alexander, Viviane G Nasr, Melania M Bembea, Ravi R. Thiagarajan
    Abstract:

    The purpose of this report is to describe the international growth, outcomes, complications, and technology used in pediatric Extracorporeal Life Support (ECLS) from 2009 to 2015 as reported by participating centers in the Extracorporeal Life Support Organization (ELSO). To date, there are 59,969 children who have received ECLS in the ELSO Registry; among those, 21,907 received ECLS since 2009 with an overall survival to hospital discharge rate of 61%. In 2009, 2,409 ECLS cases were performed at 157 centers. By 2015, that number grew to 2,992 cases in 227 centers, reflecting a 24% increase in patients and 55% growth in centers. ECLS delivered to neonates (0-28 days) for respiratory Support was the largest subcategory of ECLS among children

  • Extracorporeal Life Support for victims of drowning.
    Resuscitation, 2016
    Co-Authors: Christopher R Burke, Peter T. Rycus, Thomas V. Brogan, Ravi R. Thiagarajan, Laurance Lequier, Titus Chan, D. Michael Mcmullan
    Abstract:

    Abstract Aim Unintentional drowning is a significant public health concern in the United States and represents a leading cause of death in the pediatric population. Extracorporeal Life Support (ECLS) may be used to Support drowning victims, but outcomes have not been well defined. This study examined survival rates and risk factors for death in this population. Methods Retrospective data from the Extracorporeal Life Support Organization registry was examined to determine outcomes of ECLS and risk factors for death in drowning victims. Results Two hundred forty-seven patients who received ECLS following a drowning event between 1986 and 2015 were identified. Eighty-four (34%) did not experience cardiac arrest prior to ECLS, whereas 86 (35%) experienced a pre-ECLS cardiac arrest but had return of spontaneous circulation prior to ECLS, and 77 (31%) were placed on ECLS during cardiopulmonary resuscitation (ECPR). Overall survival was 51.4%; 71.4% in patients who did not experience a cardiac arrest, 57.0% in patients who required cardiopulmonary resuscitation prior to ECLS, and 23.4% in patients who received ECPR ( p Conclusions Outcomes in drowning victims Supported with ECLS are encouraging; particularly in patients who do not experience cardiac arrest. These data suggest that early initiation of ECLS in drowning patients with respiratory insufficiency may be beneficial to reduce the likelihood of complete cardiopulmonary failure and ECPR. Additionally, ECLS appears to improve survival in patients who experience post-drowning cardiac arrest.

Frank W. Moler - One of the best experts on this subject based on the ideXlab platform.

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