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Abstract: We wished to evaluate the safety and the advantages of using heparin-bonded extracorporeal membrane oxygenation (ECMO) to replace conventional cardiopulmonary bypass (CPB) in deep hypothermic circulation for complex cerebral aneurysm surgery.Heparin-bonded ECMO without the bridging tube and the cardiotomy reservoir was set up through the femoral vessels. Limited heparin was infused. In deep hypothermia, the ECMO blood flow was temporarily decreased as low as the neurosurgeons' request. It was applied to 4 patients with difficult intracranial aneurysms who were selected for the procedure. Clipping, wrapping, or vascular bypass was implemented to manage the aneurysms under deep hypothermia. The total heparin dosage used in the whole procedure was 9,875 ± 1,625 U, and the mean ECMO time was 270 ± 105 min. The blood consumption was packed red blood cell 3.0 ± 0.5 U and fresh frozen plasma 3.8 ± 2.3 U. Compared with our previous experiences using conventional CPB, ECMO did need less heparin and blood transfusions. Clipping was applied in 2 patients, wrapping in 1, and venous graft interposition was performed in 1. Mortality occurred in 1 patient (25%) due to brain herniation. This preliminary study suggested that the heparin-bonded ECMO without reservoir in deep hypothermia could be safe in cerebral aneurysm surgery under a low flow circuit. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Extracorporeal cardiopulmonary resuscitation (ECPR) has been shown to have survival benefit over conventional CPR (CCPR) in patients with in-hospital cardiac arrest of cardiac origin. We compared the survival of patients who had return of spontaneous beating (ROSB) after ECPR with the survival of those who had return of spontaneous circulation (ROSC) after conventional CPR. Methods: Propensity score-matched cohort of adults with in-hospital prolonged CPR (>10min) of cardiac origin in a university-affiliated tertiary extracorporeal resuscitation center were included in this study. Fifty-nine patients with ROSB after ECPR and 63 patients with sustained ROSC by CCPR were analyzed. Main outcome measures were survival at hospital discharge, 30 days, 6 months, and one year, and neurological outcome. Results: There was no statistical difference in survival to discharge (29.1% of ECPR responders vs. 22.2% of CCPR responders, p =0.394) and neurological outcome at discharge and one year later. In the propensity score-matched groups, 9 out of 27 ECPR patients survived to one month (33.3%) and 7 out of 27 CCPR patients survived (25.9%). Survival analysis showed no survival difference (HR: 0.856, p =0.634, 95% CI: 0.453–1.620) between the groups, either at 30 days or at the end of one year (HR: 0.602, p =0.093, 95% CI: 0.333–1.088). Conclusions: This study failed to demonstrate a survival difference between patients who had ROSB after institution of ECMO and those who had ROSC after conventional CPR. Further studies evaluating the role of ECMO in conventional CPR rescued patients are warranted. [Copyright &y& Elsevier]

The article reports on the results of a study of factors associated with survival among pediatric patients following extracorporeal cardiopulmonary resuscitation (ECPR) for in-hospital cardiac arrest. A description of the experimental set-up and measurement methods is presented. The study concluded that ECPR successfully rescued some pediatric patients who failed rescue with conventional in-hospital CPR.

Patients with cardiogenic shock refractory to conventional management require advanced mechanical circulatory support such as extracorporeal membrane oxygenation (ECMO). In hospitals lacking ECMO facilities, interhospital transportation is necessary for further patient management. Thirty-one adult cardiac patients, who were transported to our hospital by our ECMO transport team between January 1998 and July 2004, were enrolled in this study. The median transportation distance was 200 km (range: 3–300 km). During transportation, the ECMO circuit per se and the patients did not have complications. Of the 31 patients, 20 (64.2%) were weaned off ECMO or bridged to ventricular assist devices and 10 patients (32.1%) survived to discharge. Delayed transfer (>2 days) and high organ dysfunction score were associated with poor outcomes. The survival rate was similar to that of our in-hospital group (survival rate: 32.8%, n = 64). In conclusion, adult cardiogenic shock patients requiring interhospital ECMO transport had a reasonable chance of survival. [ABSTRACT FROM AUTHOR]

Background: Extracorporeal membrane oxygenation (ECMO), instead of ventricular assist device (VAD), could work as the first-line treatment of choice for fulminant myocarditis (FM) with profound shock if intraaortic balloon pumping was inadequate. We reviewed our experience in treating FM with ECMO and compared it with the literature that described the use of VAD.Methods: Fifteen consecutive patients (age 27.1 ± 19.3 years) who had FM with profound shock were rescued with ECMO emergently. Hypotension, depressed left ventricular ejection fraction (19.1% ± 6.1%), and oliguria occurred in all patients with high-dose catecholamine (inotropic equivalents: 69.0 ± 37.7 μg/kg/min) and ventilator support. Before ECMO support, 6 patients received intraaortic balloon pumping support, 5 received external cardiac massage, 5 needed a temporary pacemaker, and 4 needed continuous hemofiltration. The pre-ECMO cardiac enzyme and liver enzyme levels were abnormally high.Results: Fourteen patients (93.3%) could be weaned off mechanical support. Three of 14 successfully weaned patients died later as a result of complications. Survival to discharge was 73.3%, and none of survivors needed heart transplantation. The ECMO duration was 137.7 ± 74.5 hours. The ECMO-related neurological complication (6.7%) and the reexploration rate for hemostasis (8.9%) were lower than the myocarditis group supported by VAD from the literature review. The 11 survivors exhibited no cardiac dysfunction during the follow-up period.Conclusions: Owning to advantages of fewer complications, easier application, and biventricular support, ECMO can be considered as the first-line treatment of mechanical support for FM with profound shock when intraaortic balloon pumping is inadequate or infeasible. [Copyright &y& Elsevier]

: ObjectivesWe conducted this study to determine the result of prolonged cardiopulmonary resuscitation (CPR) with extracorporeal membrane oxygenation (ECMO) and the predictive factors for hospital discharge and ECMO weaning.: BackgroundProlonged CPR carries considerable associated mortality and morbidity. As yet, ECMO for prolonged CPR has no definite results. Only small groups of patients and no detailed analysis have been reported.: MethodsCandidates for ECMO resuscitation were patients in cardiac arrest receiving CPR >10 min without return of spontaneous circulation and no absolute contraindication. Venoarterial ECMO was set up during CPR. We reviewed the data of 57 prolonged CPR patients who received ECMO during CPR over a six-year period.: ResultsThe mean duration of CPR was 47.6 ± 13.4 min and that of ECMO was 96.1 ± 87.9 h. The rate of weaning was 66.7%, and the survival rate was 31.6%. Multiple-organ failure was the major reason for mortality, despite successful weaning. Among survivors, long-term follow-up revealed 88.9% survival, and only 5.6% had a severe neurologic deficit. The results indicate that a shorter CPR duration, postcardiotomy arrest, myocardial indicators, a hepatic indicator, and lactic acid are significantly correlated with both weaning and survival, whereas late damage (level on the third or seventh day of reperfusion) rather than initial damage (level on the first day) was more predictive of the results.: ConclusionsProlonged CPR rescue by ECMO provides an acceptable survival rate and outcome in survivors. Our results of the selected cases encourage further investigations of the wider application of ECMO in CPR. [Copyright &y& Elsevier]

Abstract: Adult respiratory distress syndrome (ARDS) has been the major cause of mortality in burn injury. The authors reported the experience of using extracorporeal membrane oxygenation (ECMO) to treat adult burn patient with ARDS. Three patients with burn or electric injury, around 48.9% of body surface area over second-degree burns, developed ARDS after resuscitation. All had positive blood culture and depended on a ventilator more than 5 days before ECMO. Venovenous (VV) ECMO was started at the beginning of severe respiratory failure with an oxygen index of 61.6 ± 15.5 cm H2O/mm Hg (≧40 cm H2O/mm Hg), partial arterial oxygen tension to inspired oxygen fraction (Pao2/Fio2) of 46.1 ± 7.0 mm Hg (≤200 mm Hg), positive end expiratory pressure (PEEP) of 15.7 ± 1.6 cm H2O (≧10 cm H2O), alveolar-arterial difference in oxygen concentration (A-a Do2) of 618.9 ± 19.3 mm Hg (≧300 mm Hg), and lung compliance of 17.3 ± 4.6 ml/cm H2O (≤30 ml/cm H2O). The VV type had to be converted to the newly designed veno-venoarterial (V-VA) ECMO due to the myocardial dysfunction. Two of three patients survived. The duration of ECMO was 160.2 ± 51.1 h. Two patients received debridement of escar during ECMO support and desmopressin infusion, and no increased bleeding or coagulopathy was found. The respiratory parameters were significantly improved after ECMO, especially in the survivors. ECMO is also suitable for ARDS in adult burn injury. [ABSTRACT FROM AUTHOR]

Summary: Cardiopulmonary resuscitation (CPR) for 10–30min without return of spontaneous circulation is considered to have a grave prognosis. We report a 27-year-old woman who experienced in-hospital, witnessed cardiac arrest and underwent prolonged CPR with manual chest compressions for 280min. Adequate chest compression was monitored with femoral arterial pressure monitoring. During this time, she was alert and responsive. She was then supported with extracorporeal membrane oxygenation (ECMO) for 9 days without her heart beating. After combined heart and kidney transplantation, she recovered well with intact cerebral performance. This successful case report supports the endeavours for relentless CPR efforts. [Copyright &y& Elsevier]