Effects of adding the second drainage cannula in severely hypoxemic patients supported with VV ECMO due to COVID-19-associated ARDS
© 2023 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC..
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is a recognized method of support in patients with severe and refractory acute respiratory distress syndrome (ARDS) caused by SARS-CoV-2 infection. While veno-venous (VV) ECMO is the most common type, some patients with severe hypoxemia may require modifications to the ECMO circuit. In this study, we aimed to investigate the effects of adding a second drainage cannula to the circuit in patients with refractory hypoxemia, on their gas exchange, mechanical ventilation, ECMO settings, and clinical outcomes.
METHODS: We conducted an observational retrospective study based on a single-center institutional registry including all consecutive cases of COVID-19 patients requiring ECMO admitted to the Centre of Extracorporeal Therapies in Warsaw between March 1, 2020 and March 1, 2022. We selected patients who had an additional drainage cannula inserted. Changes in ECMO and ventilator settings, blood oxygenation, and hemodynamic parameters, as well as clinical outcomes were assessed.
RESULTS: Of 138 VV ECMO patients, 12 (9%) patients met the inclusion criteria. Ten patients (83%) were men, and mean age was 42.2 ± 6.8. An addition of drainage cannula resulted in a significant raise in ECMO blood flow (4.77 ± 0.44 to 5.94 ± 0.81 [L/min]; p = 0.001), and the ratio of ECMO blood flow to ECMO pump rotations per minute (RPM), whereas the raise in ECMO RPM alone was not statistically significant (3432 ± 258 to 3673 ± 340 [1/min]; p = 0.064). We observed a significant drop in ventilator FiO2 and a raise in PaO2 to FiO2 ratio, while blood lactates did not change significantly. Nine patients died in hospital, one was referred to lung transplantation center, two were discharged uneventfully.
CONCLUSIONS: The use of an additional drainage cannula in severe ARDS associated with COVID-19 allows for an increased ECMO blood flow and improved oxygenation. However, we observed no further improvement in lung-protective ventilation and poor survival.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:47 |
|---|---|
| Enthalten in: |
Artificial organs - 47(2023), 10 vom: 13. Okt., Seite 1622-1631 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Szułdrzyński, Konstanty [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Additional venous cannula |
|---|
| Anmerkungen: |
Date Completed 31.10.2023 Date Revised 31.10.2023 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1111/aor.14591 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM357206681 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM357206681 | ||
| 003 | DE-627 | ||
| 005 | 20231226072104.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1111/aor.14591 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1190.xml |
| 035 | |a (DE-627)NLM357206681 | ||
| 035 | |a (NLM)37218216 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Szułdrzyński, Konstanty |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Effects of adding the second drainage cannula in severely hypoxemic patients supported with VV ECMO due to COVID-19-associated ARDS |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 31.10.2023 | ||
| 500 | |a Date Revised 31.10.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC. | ||
| 520 | |a BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is a recognized method of support in patients with severe and refractory acute respiratory distress syndrome (ARDS) caused by SARS-CoV-2 infection. While veno-venous (VV) ECMO is the most common type, some patients with severe hypoxemia may require modifications to the ECMO circuit. In this study, we aimed to investigate the effects of adding a second drainage cannula to the circuit in patients with refractory hypoxemia, on their gas exchange, mechanical ventilation, ECMO settings, and clinical outcomes | ||
| 520 | |a METHODS: We conducted an observational retrospective study based on a single-center institutional registry including all consecutive cases of COVID-19 patients requiring ECMO admitted to the Centre of Extracorporeal Therapies in Warsaw between March 1, 2020 and March 1, 2022. We selected patients who had an additional drainage cannula inserted. Changes in ECMO and ventilator settings, blood oxygenation, and hemodynamic parameters, as well as clinical outcomes were assessed | ||
| 520 | |a RESULTS: Of 138 VV ECMO patients, 12 (9%) patients met the inclusion criteria. Ten patients (83%) were men, and mean age was 42.2 ± 6.8. An addition of drainage cannula resulted in a significant raise in ECMO blood flow (4.77 ± 0.44 to 5.94 ± 0.81 [L/min]; p = 0.001), and the ratio of ECMO blood flow to ECMO pump rotations per minute (RPM), whereas the raise in ECMO RPM alone was not statistically significant (3432 ± 258 to 3673 ± 340 [1/min]; p = 0.064). We observed a significant drop in ventilator FiO2 and a raise in PaO2 to FiO2 ratio, while blood lactates did not change significantly. Nine patients died in hospital, one was referred to lung transplantation center, two were discharged uneventfully | ||
| 520 | |a CONCLUSIONS: The use of an additional drainage cannula in severe ARDS associated with COVID-19 allows for an increased ECMO blood flow and improved oxygenation. However, we observed no further improvement in lung-protective ventilation and poor survival | ||
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a ECMO | |
| 650 | 4 | |a additional venous cannula | |
| 650 | 4 | |a conversion | |
| 650 | 4 | |a drainage cannula | |
| 700 | 1 | |a Kowalewski, Mariusz |e verfasserin |4 aut | |
| 700 | 1 | |a Jankowski, Miłosz |e verfasserin |4 aut | |
| 700 | 1 | |a Staromłyński, Jakub |e verfasserin |4 aut | |
| 700 | 1 | |a Prokop, Joanna |e verfasserin |4 aut | |
| 700 | 1 | |a Pasierski, Michał |e verfasserin |4 aut | |
| 700 | 1 | |a Chudziński, Kamil |e verfasserin |4 aut | |
| 700 | 1 | |a Drobiński, Dominik |e verfasserin |4 aut | |
| 700 | 1 | |a Martucci, Gennaro |e verfasserin |4 aut | |
| 700 | 1 | |a Lorusso, Roberto |e verfasserin |4 aut | |
| 700 | 1 | |a Wierzba, Waldemar |e verfasserin |4 aut | |
| 700 | 1 | |a Zaczyński, Artur |e verfasserin |4 aut | |
| 700 | 1 | |a Król, Zbigniew |e verfasserin |4 aut | |
| 700 | 1 | |a Suwalski, Piotr |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Artificial organs |d 1992 |g 47(2023), 10 vom: 13. Okt., Seite 1622-1631 |w (DE-627)NLM000347590 |x 1525-1594 |7 nnns |
| 773 | 1 | 8 | |g volume:47 |g year:2023 |g number:10 |g day:13 |g month:10 |g pages:1622-1631 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1111/aor.14591 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 47 |j 2023 |e 10 |b 13 |c 10 |h 1622-1631 | ||