Vascular Complications After Venoarterial Extracorporeal Membrane Oxygenation Support: A CT Study.

Vascular complications after venoarterial extracorporeal membrane oxygenation (ECMO) remains poorly studied, although they may highly impact patient management after ECMO removal. Our aim was to assess their frequency, predictors, and management. Retrospective, observational cohort study. Two ICUs from a tertiary referral academic hospital. Adult patients who were successfully weaned from venoarterial ECMO between January 2021 and January 2022. None. Vascular complications frequency related to ECMO cannula. A total of 288 patients were implanted with venoarterial ECMO during the inclusion period. One hundred ninety-four patients were successfully weaned, and 109 underwent a CT examination to assess for vascular complications until 4 days after the weaning procedure. The median age of the cohort was 58 years (interquartile range [IQR], 46-64 yr), with a median duration of ECMO support of 7 days (IQR, 5-12 d). Vascular complications were observed in 88 patients (81%). The most frequent complication was thrombosis, either cannula-associated deep vein thrombosis (CaDVT) ( n = 63, 58%) or arterial thrombosis ( n = 36, 33%). Nonthrombotic arterial complications were observed in 48 patients (44%), with 35 (31%) presenting with bleeding. The most common site of CaDVT was the inferior vena cava, occurring in 33 (50%) of cases, with 20% of patients presenting with pulmonary embolism. There was no association between thrombotic complications and ECMO duration, anticoagulation level, or ECMO rotation flow. CT scans influenced management in 83% of patients. In-hospital mortality was 17% regardless of vascular complications. Vascular complications related to venoarterial ECMO cannula are common after ECMO implantation. CT allows early detection of complications after weaning and impacts patient management. Patients should be routinely screened for vascular complications by CT after decannulation.

Djavidi N ，Boussouar S ，Duceau B ，Bahroum P ，Rivoal S ，Hariri G ，Lancelot A ，Dureau P ，Abbes A ，Omar E ，Charfeddine A ，Lebreton G ，Redheuil A ，Luyt CE ，Bouglé A ... -  《-》

Feasibility of Ultrasound-Guided Percutaneous Axillary Artery Cannulation for Veno-Arterial Extracorporeal Membrane Oxygenation and its Effect on the Recovery of Spontaneous Heartbeat in Patients with ECPR.

Liu M ，Zhang G ，Cao Y ，Li C ，Shi B ，Zhao M ，Lin G ，Chang X ，Ma X ，Li Q ，Zhao J ，Chen D ，Zhang L ... -  《ALTERNATIVE THERAPIES IN HEALTH AND MEDICINE》

Venoarterial extracorporeal membrane oxygenation using magnetic levitation centrifugal pumps for fulminant myocarditis in infants, children and young adults.

Fulminant myocarditis (FM) is a potentially lethal disease with a wide spectrum of clinical presentation, thus making the diagnosis hard to depict. In cases where acute circulatory failure occurs venoarterial (VA) extracorporeal membrane oxygenation (ECMO) support is a valid management strategy, especially in the pediatric and adult patients. This study aims to report the results of VA ECMO for FM in our Institution. Between April 2009 and January 2021, 17 consecutive patients presenting with FM were supported using VA ECMO. We collected data dividing the population between infants, children and young adults. There were 8 male and 9 female patients, median age of 5.2 years [interquartile range (IQR), 2 months to 32 years] and median body weight of 16 kg (IQR, 3.8-56 kg). FM etiology was viral in 8 patients (47%), bacterial in 1 (6%), 2 giant cellular myocarditis (12%) and in 6 patients (35%) the etiology was unknown. Where it was possible also a cardiac biopsy was performed, usually during ECMO or vent implant. The endpoints of the study are: survival, incidence of ECMO-related complications, weaning rate from ECMO, recovery of cardiac function and the association between rescue ECMO (r-ECMO) and no-weaning/mortality. For the survival analysis we divided the population into three groups: infants (0-2 months; n=5), children (2-6 years; n=5) and young adults (24-40 years; n=7). After a median duration of 168 hours (IQR, 120-240 hours), 13 patients were weaned from support (weaning rate 76 %), 2 (12%) underwent respectively cardiac transplantation and Bi-Vad Berlin Heart implantation and 2 (12%) died while on ECMO support. Bleeding occurred in 6 (35%) patients, infection in 8 (47%) and 5 (29%), all of them infants, required peritoneal dialysis for acute kidney injury. Overall mortality was 35% (6/17 patients): two patients died during ECMO support due to persistent cardiac failure, arrhythmias and bleeding; three patients died after ECMO weaning (2 due to recurrent ventricular failure and 1 for respiratory complications) and 1 died due to multi-organ failure (MOF) after Bi-VAD implantation. Overall survival at follow-up was 65%, with a statistically significant difference (P=0.05) between age groups: in the infant group was 20% (1/5), in the children group 60% (3/5) and in the adult group 100% (7/7). There was no association between r-ECMO and weaning failure (P=0.55) or hospital mortality (P>0.99). During a median follow-up of 76 months (IQR, 52-99 months), there were no late deaths, 1 patient presented a minor neurological sequela, while cardiac function had fully recovered in all late survivors. The present experience shows that VA ECMO is an effective bridge to myocardial function recovery in patients with FM, including those with circulatory collapse. The rate of hospital complications is decent when in light of the otherwise fatal course of the disease.

Hoxha S ，Poretti G ，Gardellini J ，Tonelli F ，De Laurentis E ，Parolo M ，Menon T ，Prioli AM ，Luciani GB ... -  《Translational Pediatrics》

Erratum: Eyestalk Ablation to Increase Ovarian Maturation in Mud Crabs.

《Jove-Journal of Visualized Experiments》

Treatment time limit for successful weaning from veno-arterial extracorporeal membrane oxygenation in cardiogenic shock.

Knowing the upper time limit for successful weaning from temporary mechanical circulatory support in cardiogenic shock will help with decision-making regarding advanced heart failure (HF) therapy or considering withdrawal of care. The aim of this study was to investigate the association between the support duration and successful weaning from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiogenic shock. A retrospective single-centre cohort study was conducted between January 2013 and June 2023. It included 100 consecutive patients with cardiogenic shock who were treated with VA-ECMO. Patients with out-of-hospital cardiac arrest were excluded. The primary outcome was successful weaning from VA-ECMO (i.e., VA-ECMO decannulation and survival to discharge). The association between the length of support duration and the weaning success rate was analysed. Patients were divided into three groups according to ECMO support duration: Group A (≤7 days), Group B (8-14 days), and Group C (≥15 days). Multivariable logistic regression analysis was used to evaluate the impact of the length of support duration on successful weaning of VA-ECMO. The median age was 67 years, and 73% of study participants were male. The underlying aetiologies of cardiogenic shock were as follows: acute myocardial infarction, 50; fulminant myocarditis, 19; cardiomyopathy, 15; valvular heart disease, 8; and other, 8. Seventy-five patients (75%) were attempted to wean VA-ECMO, and 67 moved on to decannulation. In total, 43 (43%) patients were successfully weaned from VA-ECMO. The median length of ECMO support duration was 8 [3-15] days. Compared with those who underwent successful ECMO decannulation, those who did not had a significantly longer support duration of VA-ECMO (5 [3-9] days vs. 12 [3-22] days, P = 0.004). The weaning success rate was significantly higher in patients with short support duration; 58% (29/50), 40% (10/25), 16% (4/25) in Groups A, B, and C, respectively (P = 0.002). Overall, none of the patients supported for over 24 days (0/11) were successfully weaned from VA-ECMO. On multivariable logistic regression analysis, the length of support duration was independently associated with successful weaning after adjusting for age, sex, underlying aetiology, and left ventricular ejection fraction (odds ratio, 0.813 [per 3 days]; 95% confidence interval, 0.679-0.914; P = 0.025). Long support duration of VA-ECMO was significantly associated with a low rate of successful weaning in patients with cardiogenic shock. Patients who require VA-ECMO for over 1 week should start considering advanced HF therapy or withdrawal of care.

Suzuki S ，Ito K ，Teraoka N ，Okuma Y ，Kimura K ，Minamisawa M ，Ebisawa S ，Motoki H ，Imamura H ，Seto T ，Kuwahara K ... -  《ESC Heart Failure》