Top

Published in:

01-05-2015 | What's New in Intensive Care

How to wean a patient from veno-arterial extracorporeal membrane oxygenation

Authors: Nadia Aissaoui, Aly El-Banayosy, Alain Combes

Published in: Intensive Care Medicine | Issue 5/2015

Excerpt

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can rescue patients with medical, postcardiotomy, or post-cardiac arrest refractory cardiogenic shock (CS) [1, 2]. It can be used as a bridge to cardiac transplantation, to a long-term ventricular assist device (VAD), or until recovery of myocardial function. Weaning success from VA-ECMO is defined as device removal and no further requirement for mechanical support because of recurring CS over the following 30 days [3]. However, to date, only very few studies have reported weaning strategies and outcomes in VA-ECMO patients recovering from severe CS. …

Abrams D, Combes A, Brodie D (2014) What’s new in extracorporeal membrane oxygenation for cardiac failure and cardiac arrest in adults? Intensive Care Med 40:609–612CrossRefPubMed

Ghodsizad A, Koerner MM, Brehm CE, El-Banayosy A (2014) The role of extracorporeal membrane oxygenation circulatory support in the crash and burn patient: from implantation to weaning. Curr Opin Cardiol 29:275–280CrossRefPubMed

Aissaoui N, Luyt CE, Leprince P, Trouillet JL, Léger P, Pavie A, Diebold B, Chastre J, Combes A (2011) Predictors of successful extracorporeal membrane oxygenation (ECMO) weaning after assistance for refractory cardiogenic shock. Intensive Care Med 37:1738–1745CrossRefPubMed

Combes A, Leprince P, Luyt CE, Bonnet N, Trouillet JL, Leger P, Pavie A, Chastre J (2008) Outcomes and longterm quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Crit Care Med 36:1404–1411CrossRefPubMed

Smedira NG, Moazami N, Golding CM, McCarthy PM, Apperson-Hansen C, Blackstone EH, Cosgrove DM 3rd (2001) Clinical experience with 202 adults receiving extracorporeal membrane oxygenation for cardiac failure: survival at 5 years. J Thorac Cardiovasc Surg 122:92–102CrossRefPubMed

Rastan AJ, Dege A, Mohr M, Doll N, Falk V, Walther T, Mohr FW (2010) Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. J Thorac Cardiovasc Surg 139:302–311CrossRefPubMed

Sheu JJ, Tsai TH, Lee FY, Fang HY, Sun CK, Leu S, Yang CH, Chen SM, Hang CL, Hsieh YK, Chen CJ, Wu CJ, Yip HK (2010) Early extracorporeal membrane oxygenator-assisted primary percutaneous coronary intervention improved 30-day clinical outcomes in patients with ST-segment elevation myocardial infarction complicated with profound cardiogenic shock. Crit Care Med 38:1810–1817CrossRefPubMed

Chen YC, Tsai FC, Chang CH, Lin CY, Jenq CC, Juan KC, Hsu HH, Chang MY, Tian YC, Hung CC, Fang JT, Yang CW (2011) Prognosis of patients on extracorporeal membrane oxygenation: the impact of acute kidney injury on mortality. Ann Thorac Surg 91:137–142CrossRefPubMed

Distelmaier K, Winter MP, Rutzler K, Heinz G, Lang IM, Maurer G, Koinig H, Steinlechner B, Niessner A, Goliasch G (2014) Serum butyrylcholinesterase predicts survival after extracorporeal membrane oxygenation after cardiovascular surgery. Crit Care 18:R24CrossRefPubMedCentralPubMed

10.

Li C, Wang H, Jia M, Ma N, Meng X, Hou X (2014) The early dynamic behavior of lactate is linked to mortality in postcardiotomy patients with extracorporeal membrane oxygenation support: a retrospective observational study. J Thorac Cardiovasc Surg 24:S0022–S5223

11.

Luyt CE, Landivier A, Leprince P, Bernard M, Pavie A, Chastre J, Combes A (2012) Usefulness of cardiac biomarkers to predict cardiac recovery in patients on extracorporeal membrane oxygenation support for refractory cardiogenic shock. J Crit Care 27:7–14CrossRef

12.

Schmidt M, Zogheib E, Rozé H, Repesse X, Lebreton G, Luyt CE, Trouillet JL, Bréchot N, Nieszkowska A, Dupont H, Ouattara A, Leprince P, Chastre J, Combes A (2013) The preserve mortality risk score and analysis of long-term outcomes after extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. Intensive Care Med 39:1704–1713CrossRefPubMed

13.

Aissaoui N, Guerot E, Combes A, Delouche A, Chastre J, Leprince P, Leger P, Diehl JL, Fagon JY, Diebold B (2012) Two-dimensional strain rate and Doppler tissue myocardial velocities: analysis by echocardiography of hemodynamic and functional changes of the failed left ventricle during different degrees of extracorporeal life support. J Am Soc Echocardiogr 25:632–640CrossRefPubMed

14.

Cavarocchi NC, Pitcher HT, Yang Q, Karbowski P, Miessau J, Hastings HM, Hirose H (2013) Weaning of extracorporeal membrane oxygenation using continuous hemodynamic transesophageal echocardiography. J Thorac Cardiovasc Surg 146:1474–1479CrossRefPubMed

15.

Affronti A, di Bella I, Carino D, Ragni T (2013) Levosimendan may improve weaning outcomes in venoarterial ECMO patients. ASAIO J 59:554–557CrossRefPubMed

Title: How to wean a patient from veno-arterial extracorporeal membrane oxygenation
Authors: Nadia Aissaoui
Aly El-Banayosy
Alain Combes
Publication date: 01-05-2015
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 5/2015
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-015-3663-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

How to wean a patient from veno-arterial extracorporeal membrane oxygenation

Excerpt

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Excerpt

Please log in to get access to this content

Other articles of this Issue 5/2015

Phenotypic clusters within sepsis-associated multiple organ dysfunction syndrome

Early physical rehabilitation in intensive care patients with sepsis syndromes: a pilot randomised controlled trial

Effects of noninvasive ventilation on heart rate variability after coronary bypass grafting: comparison between ventilators

Safety and feasibility of a strategy of early central venous catheter insertion in a deployed UK military Ebola virus disease treatment unit

From the intensive care bed: we need to hear and listen

Direct extubation onto high-flow nasal cannulae post-cardiac surgery versus standard treatment in patients with a BMI ≥30: a randomised controlled trial