11 results on '"Broman, Lars Mikael"'
Search Results
2. Extracorporeal life support provision in COVID-19 patients - An international EuroELSO 2022 update survey.
- Author
-
Fleig, Marcel, Müller, Thomas, Antonini, Velia M, Riera, Jordi, Belliato, Mirko, Broman, Lars Mikael, Fowles, Jo-Anne, Belohlavek, Jan, Lorusso, Roberto, Vercaemst, Leen, Jones, Tim, Roeleveld, Peter P, Di Nardo, Matteo, Barrett, Nicholas, and Swol, Justyna
- Subjects
EVALUATION of medical care ,RESEARCH ,RELATIVE medical risk ,LIFE support systems in critical care ,DEXAMETHASONE ,EXTRACORPOREAL membrane oxygenation ,PEDIATRICS ,INSTITUTIONAL review boards ,POPULATION geography ,RESPIRATORY measurements ,LUNG physiology ,SURVEYS ,CATASTROPHIC illness ,NEUROMUSCULAR blockade ,QUESTIONNAIRES ,DESCRIPTIVE statistics ,RESPIRATION ,DATA analysis software ,SOCIODEMOGRAPHIC factors ,COVID-19 pandemic ,LONG-term health care - Abstract
Introduction: An analysis on the ECLS use for patients with respiratory or cardiac support in COVID-19 based on an international response to EuroELSO survey, aims to generate a more comprehensive understanding of ECLS role during the recent viral pandemic. Methods: EuroELSO announced the survey at the 10th annual congress in London, May 2022. The survey covered 26 multiple-choice questions. Results: The survey returned 69 questionnaires from 62 centers across 22 European countries and seven centers across five non-European countries. Most of the centers providing ECLS for COVID-19 patients had more than 30 runs for respiratory support since December 2019. In the same period, at least 31 runs in adult COVID-19 patients have been performed in 48 of 69 centers (69.6%). The reported pediatric data from 18 centers is limited to less than the patients per center. Conclusion: Majority of the COVID-19 patients received respiratory ECLS support and adult patients dominated. The indications and contraindications are broadly aligned with available guidelines. Most of the centers considered age >65 or biological age as a relative or absolute contraindication for ECLS in COVID-19. ECLS withdrawal criteria in COVID-19 are controversial because the long-term outcomes after ECLS in COVID-19 and the impact of critical illness and the impact of long-COVID are still not known. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
3. Blood Pumps for Extracorporeal Membrane Oxygenation: Platelet Activation During Different Operating Conditions
- Author
-
Fiusco, Francesco, Broman, Lars Mikael, and Prahl Wittberg, Lisa
- Subjects
low flow ,Infant, Newborn ,Pediatric Circulatory Support ,computational fluid dynamics ,centrifugal pump ,Platelet Activation ,Hemolysis ,Extracorporeal Membrane Oxygenation ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,Hydrodynamics ,Humans ,backflow ,Assisted Circulation ,ECMO ,thrombogenicity - Abstract
Supplemental Digital Content is available in the text., Extracorporeal membrane oxygenation (ECMO) is a therapy used in severe cardiopulmonary failure. Blood is pumped through an artificial circuit exposing it to nonphysiologic conditions, which promote platelet activation and coagulation. Centrifugal pumps used at lower flow rates than their design point may lose pump efficiency and increase the risk of hemolysis. In this study, thrombogenic properties of two ECMO pumps designed for adult and neonatal use were evaluated using simulations in different flow scenarios. Three scenarios, adult pump in adult mode (4 L/min), adult pump in baby mode (300 ml/min), and neonatal pump used in its design point (300 ml/min), were simulated using computational fluid dynamics. The flow was numerically seeded with platelets, whose activation state was computed considering the stress history that acted along their respective path lines. Statistical distributions of activation state and residence time were drawn. The results showed that using the adult pump in baby mode increased the fraction of platelets with higher activation state confirming that low-pump flow rate impacts thrombogenicity. The neonatal pump showed a backflow at the inlet, which carried platelets in a retrograde motion contributing to an increased thrombogenic potential compared with the adult mode scenario.
- Published
- 2021
4. ECMO for COVID-19 patients in Europe and Israel
- Author
-
Lorusso, Roberto, Combes, Alain, Coco, Valeria Lo, De Piero, Maria Elena, Belohlavek, Jan, Delnoij, Thijs, van der Horst, Iwan, Miranda, Dinis Reis, van der Linden, Marcel, van der Heijden, JJ, Scholten, Erik, van Belle-van Haren, Nicole, Lagrand, Wim, de Jong, Sytse, Candura, Dario, Maas, Jacinta, van den Berg, MJ van Gijlswijk, Malfertheiner, Maximilian, Dreier, Esther, Mueller, Thomas, Boeken, Udo, Akhyari, Payam, Lichtenberg, Artur, Saeed, Diyar, Thiele, Holger, Baumgaertel, Matthias, Schmitto, Jan D, Mariani, Silvia, Thielmann, Matthias, Brenner, Thorsten, Benk, Cristoph, Czerny, Martin, Kalbhenn, Johannes, Maier, Sven, Schibilsky, David, Staudacher, Dawid L, Henn, Philipp, Iuliu, Torje, Muellenbach, Ralf, Reyher, Christian, Rolfes, Caroline, Zacharowski, Kai, Lotz, Gosta, Sonntagbauer, Michael, Kersten, Alexander, Karagiannidis, Christian, Schafer, Simone, Fichte, Julia, Hopf, Hans-Bernd, Samalavicius, Robertas, Lorini, Luca, Ghitti, Davide, Grazioli, Lorenzo, Loforte, Antonio, Baiocchi, Massimo, Checco, Erika Dal, Pacini, Davide, Meani, Paolo, Cappai, Antioco, Russo, Claudio Francesco, Bottiroli, Maurizio, Mondino, Michele, Ranucci, Marco, Fina, Dario, Ballotta, Andrea, Scandroglio, Anna Mara, Zangrillo, Alberto, Pieri, Marina, Nardelli, Pasquale, Fominskiy, Evgeny, Landoni, Giovanni, Fanelli, Vito, Brazzi, Luca, Montrucchio, Giorgia, Sales, Gabriele, Simonetti, Umberto, Urbino, Rosario, Livigni, Sergio, Degani, Antonella, Raffa, Giuseppe, Pilato, Michele, Martucci, Gennaro, Arcadipane, Antonio, Chiarini, Giovanni, Latronico, Nicola, Cattaneo, Sergio, Puglia, Carmine, Reina, Gianfranco, Sponga, Sandro, Livi, Ugolino, Foti, Giuseppe, Giani, Marco, Rona, Roberto, Avalli, Leonello, Bombino, Michela, Costa, Maria Cristina, Carozza, Roberto, Donati, Abele, Piciche, Marco, Favaro, Alessandro, Salvador, Loris, Danzi, Vinicio, Zanin, Anita, Condello, Ignazio, Fiore, Flavio, Moscarelli, Marco, Nasso, Giuseppe, Speziale, Giuseppe, Sandrelli, Luca, Montalto, Andrea, Musumeci, Francesco, Circelli, Alessandro, Gamberini, Emiliano, Russo, Emanuele, Benni, Marco, Agnoletti, Vanni, Rociola, Ruggero, Milano, Aldo D, Grasso, Salvatore, Civita, Antonio, Murgolo, Francesco, Pilato, Emanuele, Comentale, Giuseppe, Montisci, Andrea, Alessandri, Francesco, Tosi, Antonella, Pugliese, Francesco, Carelli, Simone, Grieco, Domenico Luca, Antonelli, Massimo, Ramoni, Enrico, Di Nardo, Matteo, Maisano, Francesco, Bettex, Dominique, Weber, Alberto, Grunenfelder, Jurg, Consiglio, Jolanda, Hansjoerg, Jenni, Haenggi, Matthias, Agus, Gianluca, Doeble, Thomas, Zenklusen, Urs, Bechtold, Xavier, Stockman, Bernard, De Backer, Daniel, Giglioli, Simone, Meyns, Bart, Vercaemst, Leen, Herman, Greet, Meersseman, Philippe, Vandenbriele, Christophe, Dauwe, Dieter, Vlasselaers, Dirk, Raes, Matthias, Debeuckelaere, Gerdy, Rodrigus, Inez, Biston, Patrick, Piagnerelli, Michael, Peperstraete, Harlinde, Germay, Olivier, Vandewiele, Korneel, Vandeweghe, Dimitri, Witters, Ine, Havrin, Sven, Bourgeois, Marc, Taccone, Fabio Silvio, Nobile, Leda, Lheureux, Olivier, Brasseur, Alexandre, Creteur, Jacques, Defraigne, Jean-Olivier, Misset, Benoit, Courcelle, Romain, Timmermans, Philippe, Lehaen, Jeroen, Frederik, Bonte, Riera, Jordi, Castro, Miguel angel, Gallart, Elisabet, Martinez-Martinez, Maria, Argudo, Eduard, Garcia-de-Acilu, Marina, de Pablo Sanchez, Raul, Ortiz, Aaron Blandino, Cabanes, Mari-Paz Fuset, Higa, Karina Osorio, Cassina, Albert Miralles, Berbel, Daniel Ortiz, Sanchez-Salado, Jose Carlos, Arnau, Blasco-Lucas, de Gopegui, Pablo Ruiz, Ricart, Pilar, Sandoval, Elena, Veganzones, Javier, Millan, Pablo, de la Sota, Perez, Santa Teresa, Patricia, Alcantara, Sara, Alvarez, Jorge Duerto, Gonzalez, Anxela Vidal, Lopez, Marta, Gordillo, Antonio, Naranjo-Izurieta, Jose, Costa, Ricardo Gimeno, Albacete Moreno, Carlos L, de Ayala, Jose angel, Blanco-Schweizer, Pablo, Andres, Nicolas Hidalgo, Boado, Victoria, Martinez, Jose Maria Nunez, Casal, Vanesa Gomez, Garcia, Esperanza Fernandez, Martin-Villen, Luis, Climent, Joaquin Colomina, Pinto, Luis F, Leprince, Pascal, Lebreton, Guillaume, Juvin, Charles, Schmidt, Matthieu, Pineton, Marc, Folliguet, Thierry, Saiydoun, Gabriel, Gaudard, Philippe, Colson, Pascal, Obadia, Jean-Francois, Pozzi, Matteo, Fellahi, Jean Luc, Yonis, Hodane, Richard, Jean Christophe, Parasido, Alessandro, Verhoye, Jean-Philippe, Flecher, Erwan, Ajrhourh, Lucrezia, Nesseler, Nicolas, Mansour, Alexandre, Guinot, Pierre-Gregoire, Zarka, Jonathan, Besserve, Patricia, Makhoul, Maged, Bolotin, Gil, Kassif, Yigal, Soufleris, Dimitros, Schellongowski, Peter, Bonaros, Nikolaos, Krapf, Christoph, Ebert, Kathrin, Mair, Peter, Kothleutner, Florian, Kowalewsky, Mariusz, Christensen, Steffen, Pedersen, Finn Moller, Balik, Martin, Blaha, Jan, Lips, Michal, Otahal, Michal, Camporota, Luigi, Daly, Kathleen, Agnew, Nicola, Barker, Julian, Head, Laura, Garcia, Miguel, Ledot, Stephane, Aquino, Verna, Lewis, Rebecca, Worthy, Jennifer, Noor, Hamza, Scott, Ian, O'Brien, Serena, Conrick-Martin, Ian, Carton, Edmund, Gillon, Stuart, Flemming, Lucy, Broman, Lars Mikael, Grins, Edgars, Ketskalo, Michail, Tsarenko, Sergey, Popugaev, Konstantin, Minin, Sergei, Kornilov, Igor, Skopets, Alexander, Kornelyuk, Roman, Turchaninov, Alexandr, Gorjup, Vojka, Shelukhin, Daniil, Dsouki, Youssef El, Sargin, Murat, Kaygin, Mehmet Ali, Liana, Shestakova, Puss, Severin, Soerensen, Gro, Magnus, Rosen, Kanetoft, Mikael, Watson, Pia, Redfors, Bengt, Krenner, Niklas, Velia Antonini, M, Barrett, Nicholas A, Belliato, Mirko, Davidson, Mark, Finney, Simon, Fowles, Jo-Anne, Halbe, Maximilian, Hennig, Felix, Jones, Tim, Pinto, Luis, Smith, Jonathan, Roeleveld, Peter, Swol, Justyna, Maastricht University Medical Centre (MUMC), Maastricht University [Maastricht], Cardiovascular Research Institute Maastricht (CARIM), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Sorbonne Université - Faculté de Médecine (SU FM), Sorbonne Université (SU), First Faculty of Medicine Charles University [Prague], Intensive Care Medicine, AII - Inflammatory diseases, ANS - Neuroinfection & -inflammation, EuroECMO COVID-19 Working Group, Euro-ELSO Steering Committee, Lorusso, Roberto, Combes, Alain, Coco, Valeria Lo, De Piero, Maria Elena, Belohlavek, Jan (EuroECMO COVID-19, Workinggroup, Euro-ELSO Steering, Committee), Zangrillo, A, Landoni, G, CTC, MUMC+: MA Med Staf Spec CTC (9), RS: Carim - V04 Surgical intervention, MUMC+: MA Alg Ond Onderz CTC (9), Lorusso, R, Combes, A, Coco, V, De Piero, M, Belohlavek, J, Delnoij, T, van der Horst, I, Miranda, D, van der Linden, M, van der Heijden, J, Scholten, E, van Belle-van Haren, N, Lagrand, W, de Jong, S, Candura, D, Maas, J, van den Berg, M, Malfertheiner, M, Dreier, E, Mueller, T, Boeken, U, Akhyari, P, Lichtenberg, A, Saeed, D, Thiele, H, Baumgaertel, M, Schmitto, J, Mariani, S, Thielmann, M, Brenner, T, Benk, C, Czerny, M, Kalbhenn, J, Maier, S, Schibilsky, D, Staudacher, D, Henn, P, Iuliu, T, Muellenbach, R, Reyher, C, Rolfes, C, Zacharowski, K, Lotz, G, Sonntagbauer, M, Kersten, A, Karagiannidis, C, Schafer, S, Fichte, J, Hopf, H, Samalavicius, R, Lorini, L, Ghitti, D, Grazioli, L, Loforte, A, Baiocchi, M, Checco, E, Pacini, D, Meani, P, Cappai, A, Russo, C, Bottiroli, M, Mondino, M, Ranucci, M, Fina, D, Ballotta, A, Scandroglio, A, Pieri, M, Nardelli, P, Fominskiy, E, Fanelli, V, Brazzi, L, Montrucchio, G, Sales, G, Simonetti, U, Urbino, R, Livigni, S, Degani, A, Raffa, G, Pilato, M, Martucci, G, Arcadipane, A, Chiarini, G, Latronico, N, Cattaneo, S, Puglia, C, Reina, G, Sponga, S, Livi, U, Foti, G, Giani, M, Rona, R, Avalli, L, Bombino, M, Costa, M, Carozza, R, Donati, A, Piciche, M, Favaro, A, Salvador, L, Danzi, V, Zanin, A, Condello, I, Fiore, F, Moscarelli, M, Nasso, G, Speziale, G, Sandrelli, L, Montalto, A, Musumeci, F, Circelli, A, Gamberini, E, Russo, E, Benni, M, Agnoletti, V, Rociola, R, Milano, A, Grasso, S, Civita, A, Murgolo, F, Pilato, E, Comentale, G, Montisci, A, Alessandri, F, Tosi, A, Pugliese, F, Carelli, S, Grieco, D, Antonelli, M, Ramoni, E, Di Nardo, M, Maisano, F, Bettex, D, Weber, A, Grunenfelder, J, Consiglio, J, Hansjoerg, J, Haenggi, M, Agus, G, Doeble, T, Zenklusen, U, Bechtold, X, Stockman, B, De Backer, D, Giglioli, S, Meyns, B, Vercaemst, L, Herman, G, Meersseman, P, Vandenbriele, C, Dauwe, D, Vlasselaers, D, Raes, M, Debeuckelaere, G, Rodrigus, I, Biston, P, Piagnerelli, M, Peperstraete, H, Germay, O, Vandewiele, K, Vandeweghe, D, Witters, I, Havrin, S, Bourgeois, M, Taccone, F, Nobile, L, Lheureux, O, Brasseur, A, Creteur, J, Defraigne, J, Misset, B, Courcelle, R, Timmermans, P, Lehaen, J, Frederik, B, Riera, J, Castro, M, Gallart, E, Martinez-Martinez, M, Argudo, E, Garcia-de-Acilu, M, de Pablo Sanchez, R, Ortiz, A, Cabanes, M, Higa, K, Cassina, A, Berbel, D, Sanchez-Salado, J, Arnau, B, de Gopegui, P, Ricart, P, Sandoval, E, Veganzones, J, Millan, P, de la Sota, P, Santa Teresa, P, Alcantara, S, Alvarez, J, Gonzalez, A, Lopez, M, Gordillo, A, Naranjo-Izurieta, J, Costa, R, Albacete Moreno, C, de Ayala, J, Blanco-Schweizer, P, Andres, N, Boado, V, Martinez, J, Casal, V, Garcia, E, Martin-Villen, L, Climent, J, Pinto, L, Leprince, P, Lebreton, G, Juvin, C, Schmidt, M, Pineton, M, Folliguet, T, Saiydoun, G, Gaudard, P, Colson, P, Obadia, J, Pozzi, M, Fellahi, J, Yonis, H, Richard, J, Parasido, A, Verhoye, J, Flecher, E, Ajrhourh, L, Nesseler, N, Mansour, A, Guinot, P, Zarka, J, Besserve, P, Makhoul, M, Bolotin, G, Kassif, Y, Soufleris, D, Schellongowski, P, Bonaros, N, Krapf, C, Ebert, K, Mair, P, Kothleutner, F, Kowalewsky, M, Christensen, S, Pedersen, F, Balik, M, Blaha, J, Lips, M, Otahal, M, Camporota, L, Daly, K, Agnew, N, Barker, J, Head, L, Garcia, M, Ledot, S, Aquino, V, Lewis, R, Worthy, J, Noor, H, Scott, I, O'Brien, S, Conrick-Martin, I, Carton, E, Gillon, S, Flemming, L, Broman, L, Grins, E, Ketskalo, M, Tsarenko, S, Popugaev, K, Minin, S, Kornilov, I, Skopets, A, Kornelyuk, R, Turchaninov, A, Gorjup, V, Shelukhin, D, Dsouki, Y, Sargin, M, Kaygin, M, Liana, S, Puss, S, Soerensen, G, Magnus, R, Kanetoft, M, Watson, P, Redfors, B, Krenner, N, Velia Antonini, M, Barrett, N, Belliato, M, Davidson, M, Finney, S, Fowles, J, Halbe, M, Hennig, F, Jones, T, Smith, J, Roeleveld, P, Swol, J, Lorusso R., Combes A., Coco V.L., De Piero M.E., and Belohlavek J, EuroECMO COVID-19 WorkingGroup, and Euro-ELSO Steering Committee, Pacini D
- Subjects
2019-20 coronavirus outbreak ,medicine.medical_specialty ,Letter ,Coronavirus disease 2019 (COVID-19) ,Pain medicine ,medicine.medical_treatment ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,[SDV]Life Sciences [q-bio] ,MEDLINE ,610 Medicine & health ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,covid, ecmo, respiratory failure ,0302 clinical medicine ,Critical Care Medicine ,General & Internal Medicine ,Anesthesiology ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Israel ,ComputingMilieux_MISCELLANEOUS ,Science & Technology ,business.industry ,COVID-19 ,030208 emergency & critical care medicine ,3. Good health ,Europe ,Emergency medicine ,Human medicine ,ECMO ,business ,Life Sciences & Biomedicine ,Human - Abstract
ispartof: INTENSIVE CARE MEDICINE vol:47 issue:3 pages:344-348 ispartof: location:United States status: published
- Published
- 2021
5. Numerical and experimental investigation of a lighthouse tip drainage cannula used in extracorporeal membrane oxygenation.
- Author
-
Fiusco, Francesco, Rorro, Federico, Broman, Lars Mikael, and Prahl Wittberg, Lisa
- Subjects
EXTRACORPOREAL membrane oxygenation ,DRAINAGE ,PARTICLE image velocimetry ,COMPUTATIONAL fluid dynamics ,FLUID dynamics ,CATHETERS - Abstract
Background: Extracorporeal membrane oxygenation is a life‐saving therapy used in case of acute respiratory/circulatory failure. Exposure of blood to non‐physiological surfaces and high shear stresses is related to hemolytic damage and platelet activation. A detailed knowledge of the fluid dynamics of the components under different scenarios is thus paramount to assess the thrombogenicity of the circuit. Methods: An investigation of the flow structures developing in a conventional lighthouse tip (single‐staged) drainage cannula was performed with cross‐validated computational fluid dynamics and particle image velocimetry. The aim was to quantify the variation in drainage performance and stress levels induced by different fluid models, hematocrit and vessel‐to‐cannula flow rate ratios. Results: The results showed that the 90° bends of the flow through the side holes created a recirculation zone inside the cannula which increased residence time. Flow structures resembling a jet in a crossflow were also observed. The use of different hematocrits did not significantly affect drainage performances. The most proximal set of holes drained the largest fraction of fluid. However, different flow rate ratios altered the flow rate drained through the tip. The use of 2D data led to a 50% underestimation of shear rate levels. In the drainage zone the non‐Newtonian behavior of blood was less relevant. Conclusions: The most proximal holes drained the largest amount of fluid. The flow features and distribution of flow rates among the holes showed little dependence on the hematocrit. The non‐Newtonian behavior of blood had a small influence on the dynamics of the flow. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
6. Defining and understanding the "extra‐corporeal membrane oxygenation gap" in the veno‐venous configuration: Timing and causes of death.
- Author
-
Heuts, Samuel, Makhoul, Maged, Mansouri, Abdulrahman N., Taccone, Fabio Silvio, Obeid, Amir, Belliato, Mirko, Broman, Lars Mikael, Malfertheiner, Maximilian, Meani, Paolo, Raffa, Giuseppe Maria, Delnoij, Thijs, Maessen, Jos, Bolotin, Gil, and Lorusso, Roberto
- Subjects
EXTRACORPOREAL membrane oxygenation ,CAUSES of death ,MULTIPLE organ failure ,HOSPITAL admission & discharge ,HOSPITAL mortality - Abstract
In‐hospital mortality of adult veno‐venous extracorporeal membrane oxygenation (V‐V ECMO) patients remains invariably high. However, little is known regarding timing and causes of in‐hospital death, either on‐ECMO or after weaning. The current review aims to investigate the timing and causes of death of adult patients during hospital admittance for V‐V ECMO, and to define the V‐V ECMO gap, which is represented by the patients that are successfully weaned of ECMO but still die during hospital stay. A systematic search was performed using electronic MEDLINE and EMBASE databases through PubMed. Studies reporting on adult V‐V ECMO patients from January 2006 to December 2020 were screened. Studies that did not report on at least on‐ECMO mortality and discharge rate were excluded from analysis as they could not provide the required information regarding the proposed V‐V ECMO‐gap. Mortality rates on‐ECMO and after weaning, as well as weaning and discharge rates, were analyzed as primary outcomes. Secondary outcomes were the causes of death and complications. Initially, 35 studies were finally included in this review. Merely 24 of these studies (comprising 975 patients) reported on prespecified V‐V ECMO outcomes (on‐ECMO mortality and discharge rate). Mortality on V‐V ECMO support was 27.8% (95% confidence interval (CI) 22.5%‐33.2%), whereas mortality after successful weaning was 12.7% (95% CI 8.8%‐16.6%, defining the V‐V ECMO gap). 72.2% of patients (95% CI 66.8%‐77.5%) were weaned successfully from support and 56.8% (95% CI 49.9%‐63.8%) of patients were discharged from hospital. The most common causes of death on ECMO were multiple organ failure, bleeding, and sepsis. Most common causes of death after weaning were multiorgan failure and sepsis. Although the majority of patients are weaned successfully from V‐V ECMO support, a significant proportion of subjects still die during hospital stay, defining the V‐V ECMO gap. Overall, timing and causes of death are poorly reported in current literature. Future studies on V‐V ECMO should describe morbidity and mortality outcomes in more detail in relation to the timing of the events, to improve patient management, due to enhanced understanding of the clinical course. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
7. ECMO for premature neonates- Are we there yet?
- Author
-
Mesas Burgos, Carmen, Rintoul, Natalie, and Broman, Lars Mikael
- Abstract
Despite ECMO being a well-accepted and established life-saving support for newborns, prematurity (<34 weeks of gestation) and low birth weight <2.0 kg are still considered relative contraindications due to the fear of intracranial bleeding complications. In the last decades, outcome in extracorporeal life support for pre-term babies has improved, and morbidity dominated by intracranial bleedings has decreased. With the introduction of new methodologies and technological development, the current ELSO guideline for ECMO (GA >34 w, BW > 2.0 kg) deserves to be challenge. The authors suggest that Prem-ECMO (GA 32-33) could be considered when r estricted to experienced high-volume neonatal ECMO centers , with closed monitoring and rigorous reporting to the ELSO registry , providing close targeting of oxygen delivery for prevention of retinopathy and being active participants in continuous development of technology and devices for improved biocompatibility for use in the neonate. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
8. Serial S100B Sampling Detects Intracranial Lesion Development in Patients on Extracorporeal Membrane Oxygenation.
- Author
-
Fletcher-Sandersjöö, Alexander, Lindblad, Caroline, Thelin, Eric Peter, Bartek Jr., Jiri, Sallisalmi, Marko, Elmi-Terander, Adrian, Svensson, Mikael, Bellander, Bo-Michael, and Broman, Lars Mikael
- Subjects
EXTRACORPOREAL membrane oxygenation ,COMPUTED tomography ,BRAIN injuries ,ROBUST control ,HEMORRHAGE - Abstract
Introduction: Intracranial lesion development is a recognized complication in adults treated with extracorporeal membrane oxygenation (ECMO) and is associated with increased mortality. As neurological assessment during ECMO treatment remains challenging, protein biomarkers of cerebral injury could provide an opportunity to detect intracranial lesion development at an early stage. The aim of this study was to determine if serially sampled S100B could be used to detect intracranial lesion development during ECMO treatment. Methods: We conducted an observational cohort study of all patients treated with ECMO at ECMO Center Karolinska (Karolinska University Hospital, Stockholm, Sweden) between January and August 2018, excluding patients who did not undergo a computerized tomography scan (CT) during treatment. S100B was prospectively collected at hospital admission and then once daily. The primary end-point was any type of CT verified intracranial lesion. Receiver operating characteristics (ROC) curves and Cox proportional hazards models were employed. Results: Twenty-nine patients were included, of which 15 (52%) developed an intracranial lesion and exhibited higher levels of S100B overall. S100B had a robust association with intracranial lesion development, especially during the first 200 hours following admission. The best area-under-curve (AUC) to predict intracranial lesion development was 40 and 140 hours following ECMO initiation, were a S100B level of 0.69μg/L had an AUC of 0.81 (0.628-0.997). S100B levels were markedly increased following the development of intracranial hemorrhage. Conclusions: Serial serum S100B samples in ECMO patients were both significantly elevated and had an increasing trajectory in patients developing intracranial lesions. Larger prospective trials are warranted to validate these findings and to ascertain their clinical utility. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
9. Conversion from Venovenous to Venoarterial Extracorporeal Membrane Oxygenation in Adults.
- Author
-
Falk, Lars, Fletcher-Sandersjöö, Alexander, Hultman, Jan, Broman, Lars Mikael, and Pinho, Maria Norberta de
- Subjects
EXTRACORPOREAL membrane oxygenation ,ADULTS ,CARDIOGENIC shock ,OXYGENATORS ,INTRA-aortic balloon counterpulsation - 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. 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. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
10. Validation of Prognostic Scores in Extracorporeal Life Support: A Multi-Centric Retrospective Study.
- Author
-
Fisser, Christoph, Rincon-Gutierrez, Luis Alberto, Enger, Tone Bull, Taccone, Fabio Silvio, Broman, Lars Mikael, Belliato, Mirko, Nobile, Leda, Pappalardo, Federico, Malfertheiner, Maximilian V., and Martucci, Gennaro
- Subjects
EXTRACORPOREAL membrane oxygenation ,GLASGOW Coma Scale ,INTENSIVE care units ,CARDIOGENIC shock ,CARDIOPULMONARY resuscitation ,INTRA-aortic balloon counterpulsation - 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 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 PaCO
2 , 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. [ABSTRACT FROM AUTHOR]- Published
- 2021
- Full Text
- View/download PDF
11. Early Findings after Implementation of Veno-Arteriovenous ECMO: A Multicenter European Experience.
- Author
-
Blandino Ortiz, Aaron, Belliato, Mirko, Broman, Lars Mikael, Lheureux, Olivier, Malfertheiner, Maximilian Valentin, Xini, Angela, Pappalardo, Federico, Taccone, Fabio Silvio, and de Pinho, Maria Norberta
- Subjects
BLOOD flow ,CARDIAC output ,EXTRACORPOREAL membrane oxygenation ,HEART beat ,MIDDLE East respiratory syndrome ,HEMODYNAMICS ,BLOOD gases - 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 PaO
2 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. [ABSTRACT FROM AUTHOR]- Published
- 2021
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.