TY  - JOUR
T1  - Application of a mechanical heart and lung apparatus to cardiac surgery.
A1  - Gibbon, JH
Y1  - 1954/03//
KW  - CARDIOVASCULAR DEFECTS
KW  - CONGENITAL/surgery
KW  - HEART/artificial
JF  - Minnesota medicine
VL  - 37
IS  - 3
SP  - 171
EP  - 185; passim
UR  - http://www.ncbi.nlm.nih.gov/pubmed/13154149
ER  - 
TY  - JOUR
T1  - Extracorporeal Life Support (ELSO) Guidelines for Adult Respiratory Failure
A1  - Extracorporeal Life Support Organization
Y1  - 2013///
IS  - August
SP  - 1
EP  - 10
UR  - http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00003246-199801001-00104%5Cnpapers3://publication/doi/10.1097/00003246-199801001-00104
N2  - This adult respiratory failure guideline is a supplement to ELSO’s “General Guidelines for all ECLS Cases” which describes prolonged extracorporeal life support (ECLS, ECMO). This supplement addresses specific discussion for adult respiratory failure. This guideline describes prolonged extracorporeal life support (ECLS, ECMO). This guideline describes useful and safe practice, but these are not necessarily consensus recommendations. These guidelines are not intended as a standard of care, and are revised at regular intervals as new information, devices, medications, and techniques become available. The background, rationale, and references for these guidelines are found in "ECMO: Extracorporeal Cardiopulmonary Support in Intensive Care (The Red Book)" published by ELSO. These guidelines address technology and patient management during ECLS. Equally important issues such as personnel, training, credentialing, resources, follow up, reporting, and quality assurance are addressed in other ELSO documents or are center-specific.
ER  - 
TY  - JOUR
T1  - Extracorporeal Life Support Organization ( ELSO ) General Guidelines for all ECLS Cases
A1  - This, Introduction
A1  - Support, Extracorporeal Cardiopulmonary
A1  - Care, Intensive
A1  - Book, The Red
A1  - Guidelines, Elso
Y1  - 2009///
JF  - ELSO Guideline
IS  - April
SP  - 1
EP  - 24
UR  - www.elso.org
N2  - This guideline describes prolonged extracorporeal life support (ECLS, ECMO). Related guidelines with more specific discussion for categories of patients follow the same outline. These guidelines describes useful and safe practice, but these are not necessarily consensus recommendations. These guidelines are not intended as a standard of care, and are revised at regular intervals as new information, devices, medications, and techniques become available. The background, rationale, and references for these guidelines are found in "ECMO: Extracorporeal Cardiopulmonary Support in Intensive Care (The Red Book)" published by ELSO. These guidelines address technology and patient management during ECLS. Equally important issues such as personnel, training, credentialing, resources, follow up, reporting, and quality assurance are addressed in other ELSO documents or are center- specific.
ER  - 
TY  - JOUR
T1  - Extracorporeal membrane oxygenation (ECMO) for critically ill adults in the emergency department: History, current applications, and future directions
A1  - Mosier, Jarrod M.
A1  - Kelsey, Melissa
A1  - Raz, Yuval
A1  - Gunnerson, Kyle J.
A1  - Meyer, Robyn
A1  - Hypes, Cameron D.
A1  - Malo, Josh
A1  - Whitmore, Sage P.
A1  - Spaite, Daniel W.
Y1  - 2015/12//
JF  - Critical Care
VL  - 19
IS  - 1
SP  - 431
EP  - 431
DO  - 10.1186/s13054-015-1155-7
UR  - http://www.ncbi.nlm.nih.gov/pubmed/26672979
UR  - http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC4699333
UR  - http://ccforum.com/content/19/1/431
N2  - Extracorporeal membrane oxygenation (ECMO) is a mode of extracorporeal life support that augments oxygenation, ventilation and/or cardiac output via cannulae connected to a circuit that pumps blood through an oxygenator and back into the patient. ECMO has been used for decades to support cardiopulmonary disease refractory to conventional therapy. While not robust, there are promising data for the use of ECMO in acute hypoxemic respiratory failure, cardiac arrest, and cardiogenic shock and the potential indications for ECMO continue to increase. This review discusses the existing literature on the potential use of ECMO in critically ill patients within the emergency department.
ER  - 
TY  - JOUR
T1  - Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study
A1  - Zapol, W. M.
Y1  - 1979/11//
JF  - JAMA: The Journal of the American Medical Association
VL  - 242
IS  - 20
SP  - 2193
EP  - 2196
DO  - 10.1001/jama.242.20.2193
UR  - http://www.ncbi.nlm.nih.gov/pubmed/490805
N2  - Nine medical centers collaborated in a prospective randomized study to evaluate prolonged extracorporeal membrane oxygenation (ECMO) as a therapy for severe acute respiratory failure (ARF). Ninety adult patients were selected by common criteria of arterial hypoxemia and treated with either conventional mechanical ventilation (48 patients) or mechanical ventilation supplemented with partial venoarterial bypass (42 patients). Four patients in each group survived. The majority of patients suffered acute bacterial or viral pneumonia (57%). All nine patients with pulmonary embolism and six patients with posttraumatic acute respiratory failure died. The majority of patients died of progressive reduction of transpulmonary gas exchange and decreased compliance due to diffuse pulmonary inflammation, necrosis, and fibrosis. We conclude that ECMO can support respiratory gas exchange but did not increase the probability of long-term survival in patients with severe ARF.
ER  - 
TY  - JOUR
T1  - Central venous-arterial carbon dioxide difference as an indicator of cardiac index
A1  - Cuschieri, Joseph
A1  - Rivers, Emanuel P.
A1  - Donnino, Michael W.
A1  - Katilius, Marius
A1  - Jacobsen, Gordon
A1  - Nguyen, H. Bryant
A1  - Pamukov, Nikolai
A1  - Horst, H. Mathilda
Y1  - 2005/06//
KW  - Carbon dioxide
KW  - Cardiac output
KW  - Central venous
KW  - Hemodynamics
KW  - Venous-arterial pCO2 difference
JF  - Intensive Care Medicine
VL  - 31
IS  - 6
SP  - 818
EP  - 822
DO  - 10.1007/s00134-005-2602-8
UR  - http://www.ncbi.nlm.nih.gov/pubmed/15803301
UR  - http://link.springer.com/10.1007/s00134-005-2602-8
N2  - Objective: The mixed venous-arterial (v-a) pCO2 difference has been shown to be inversely correlated with the cardiac index (CI). A central venous pCO2, which is easier to obtain, may provide similar information. The purpose of this study was to examine the correlation between the central venous-arterial pCO2 difference and CI. Design: Prospective, cohort study. Setting: Intensive care unit of an urban tertiary care hospital. Patients and participants: Eighty-three consecutive intensive care unit patients. Measurements: Simultaneous blood gases from the arterial, pulmonary artery (PA), and central venous (CV) catheters were obtained. At the same time point, cardiac indices were measured by the thermodilution technique (an average of three measurements). The cardiac indices obtained by the venous-arterial differences were compared with those determined by thermodilution. Results: The correlation (R2) between the mixed venous-arterial pCO2 difference and cardiac index was 0.903 ( p <0.0001), and the correlation between the central venous-arterial pCO 2 difference and cardiac index was 0.892 ( p <0.0001). The regression equations for these relationships were natural log (CI)=1.837-0.159 (v-a) CO2 for the PA and natural log (CI)=1.787-0.151 (v-a) CO 2 for the CV ( p <0.0001 for both). The root-mean-squared error for the PA and CV regression equations were 0.095 and 0.101, respectively. Conclusion: Venous-arterial pCO2 differences obtained from both the PA and CV circulations inversely correlate with the cardiac index. Substitution of a central for a mixed venous-arterial pCO2 difference provides an accurate alternative method for calculation of cardiac output. © Springer-Verlag 2005.
ER  - 
TY  - JOUR
T1  - Noninvasive assessment of hemodynamic variables using near-infrared spectroscopy in patients experiencing cardiogenic shock and individuals undergoing venoarterial extracorporeal membrane oxygenation.
A1  - Ostadal, Petr
A1  - Kruger, Andreas
A1  - Vondrakova, Dagmar
A1  - Janotka, Marek
A1  - Psotova, Hana
A1  - Neuzil, Petr
Y1  - 2014/08//
KW  - Aged
KW  - Blood Pressure
KW  - Body Surface Area
KW  - Cardiogenic shock
KW  - Cerebrovascular Circulation
KW  - Extracorporeal Membrane Oxygenation
KW  - Extracorporeal membrane oxygenation
KW  - Female
KW  - Hemodynamics
KW  - Male
KW  - Middle Aged
KW  - Near-infrared spectroscopy
KW  - Oximetry
KW  - Retrospective Studies
KW  - Statistics, Nonparametric
KW  - Vascular Resistance
JF  - Journal of critical care
VL  - 29
IS  - 4
SP  - 690.e11
EP  - 5
DO  - 10.1016/j.jcrc.2014.02.003
UR  - http://www.ncbi.nlm.nih.gov/pubmed/24636922
N2  - PURPOSE The relationship between near-infrared spectroscopy cerebral oximetry (CrSO2), peripheral oximetry (PrSO2) and hemodynamic variables is not fully understood. METHODS The relationship between CrSO2/PrSO2 and cardiac index (CI), systemic vascular resistance index (SVRI) and mean arterial pressure (MAP) in patients experiencing cardiogenic shock and those undergoing venoarterial extracorporeal membrane oxygenation (ECMO) was retrospectively analyzed; in patients on ECMO, total circulatory index (TCI) was calculated from the sum of CI and extracorporeal blood flow index. RESULTS In patients experiencing cardiogenic shock (n=10), significant correlations between PrSO2 values and CI (Spearman r=0.81; P<.0001), SVRI (r=-0.45; P<.0001), and MAP (r=0.58; P<.0001) were found. Significant correlations between CrSO2 and CI (r=0.55; P<.0001) and SVRI (r=-0.47; P<.0001), but not MAP, were observed. Linear regression analysis revealed that CI could be calculated using the following equation: CI=PrSO2/24.0. In patients on VA ECMO (n=12), significant correlations were found between PrSO2 and TCI (r=0.68; P<.0001), SVRI (r=-0.47; P<.0001), and MAP (r=0.27; P=.025). Significant correlations were also found between CrSO2 and TCI (r=0.68; P<.0001) and SVRI (r=-0.51; P<.0001), but not MAP. CONCLUSIONS Results of the present study suggest that CrSO2 and PrSO2 in particular can be used for noninvasive estimation and monitoring of global circulatory status in patients experiencing cardiogenic shock and individuals undergoing ECMO.
ER  - 
TY  - JOUR
T1  - Cerebral and Lower Limb Near-Infrared Spectroscopy in Adults on Extracorporeal Membrane Oxygenation
A1  - Wong, Joshua K.
A1  - Smith, Thomas N.
A1  - Pitcher, Harrison T.
A1  - Hirose, Hitoshi
A1  - Cavarocchi, Nicholas C.
Y1  - 2012/08//
KW  - Adults
KW  - Cerebral oximetry
KW  - Extracorporeal membrane oxygenation
KW  - Ischemia
KW  - Lower limb oximetry
KW  - Near-infrared spectroscopy
JF  - Artificial Organs
VL  - 36
IS  - 8
SP  - 659
EP  - 667
DO  - 10.1111/j.1525-1594.2012.01496.x
UR  - http://www.ncbi.nlm.nih.gov/pubmed/22817780
UR  - http://doi.wiley.com/10.1111/j.1525-1594.2012.01496.x
N2  - Percutaneous femoral venoarterial (VA) or jugular venovenous (VV) extracorporeal membrane oxygenation (ECMO) can result in delivery of hypoxic blood to the brain, coronaries, and upper extremities. Additionally, VA-ECMO by percutaneous femoral artery cannulation may compromise perfusion to the lower limbs. Use of near-infrared spectroscopy (NIRS) detects regional ischemia and warns of impending hypoxic damage. We report the first known series with standardized monitoring of this parameter in adults on ECMO. This is an institutional review board-approved single institution retrospective review of patients with NIRS monitoring on ECMO from July 2010 until June 2011. Patients were analyzed for drops in NIRS tracings below 40 or >25% from baseline. VA-ECMO and VV-ECMO were initiated by percutaneous cannulation of the femoral vessels and the internal jugular vein, respectively. Sensors were placed on the patients' foreheads and on the lower limbs. NIRS tracings were recorded, analyzed, and correlated with clinical events. Twenty patients were analyzed (median age: 47.5 years): 17 patients were placed on VA-ECMO, and three patients on VV-ECMO. The median duration on ECMO was 7 days (range 2-26). One hundred percent of patients had a significant drop in bilateral cerebral oximetry tracings resulting in hemodynamic interventions, which involved increasing pressure, oxygenation, and/or ECMO flow. In 16 patients (80%), these interventions corrected the underlying ischemia. Four patients (20%) required further diagnostic intervention for persistent decreased bilateral and/or unilateral cerebral oximetry tracings, and were found to have a cerebrovascular accident (CVA). Six (30%) patients had persistent unilateral lower limb oximetry events, which resolved upon placement or replacement of a distal perfusion cannula. No patient was found to have either lower limb ischemia or a CVA with normal NIRS tracings. Use of NIRS with ECMO is important in detecting ischemic cerebral and peripheral vascular events. This allows for potential correction of the underlying process, thus preventing permanent ischemic damage. © 2012, the Authors. Artificial Organs © 2012, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.
ER  - 
TY  - JOUR
T1  - Prognostic value of cerebral tissue oxygen saturation during neonatal extracorporeal membrane oxygenation
A1  - Clair, Marie Philippine
A1  - Rambaud, Jérôme
A1  - Flahault, Adrien
A1  - Guedj, Romain
A1  - Guilbert, Julia
A1  - Guellec, Isabelle
A1  - Durandy, Amélie
A1  - Demoulin, Maryne
A1  - Jean, Sandrine
A1  - Mitanchez, Delphine
A1  - Chalard, François
A1  - Sileo, Chiara
A1  - Carbajal, Ricardo
A1  - Renolleau, Sylvain
A1  - Léger, Pierre Louis
ED  - Frati, Giacomo
Y1  - 2017/03//
PB  - Public Library of Science
JF  - PLoS ONE
VL  - 12
IS  - 3
SP  - e0172991
EP  - e0172991
DO  - 10.1371/journal.pone.0172991
UR  - http://dx.plos.org/10.1371/journal.pone.0172991
N2  - Objectives: Extracorporeal membrane oxygenation support is indicated in severe and refractory respiratory or circulatory failures. Neurological complications are typically represented by acute ischemic or hemorrhagic lesions, which induce higher morbidity and mortality. The primary goal of this study was to assess the prognostic value of cerebral tissue oxygen saturation (StcO2) on mortality in neonates and young infants treated with ECMO. A secondary objective was to evaluate the association between StcO2 and the occurrence of cerebral lesions. Study design: This was a prospective study in infants < 3 months of age admitted to a pediatric intensive care unit and requiring ECMO support. Measurements: The assessment of cerebral perfusion was made by continuous StcO2 monitoring using near-infrared spectroscopy (NIRS) sensors placed on the two temporo-parietal regions. Neurological lesions were identified by MRI or transfontanellar echography. Results: Thirty-four infants <3 months of age were included in the study over a period of 18 months. The ECMO duration was 10±7 days. The survival rate was 50% (17/34 patients), and the proportion of brain injuries was 20% (7/34 patients). The mean StcO2 during ECMO in the non-survivors was reduced in both hemispheres (p = 0.0008 right, p = 0.03 left) compared to the survivors. StcO2 was also reduced in deceased or brain-injured patients compared to the survivors without brain injury (p = 0.002). Conclusion: StcO2 appears to be a strong prognostic factor of survival and of the presence of cerebral lesions in young infants during ECMO.
ER  - 
TY  - JOUR
T1  - Regional cerebral oxygenation measured by multichannel near-infrared spectroscopy (optical topography) in an infant supported on venoarterial extracorporeal membrane oxygenation
A1  - Papademetriou, Maria D.
A1  - Tachtsidis, Ilias
A1  - Banaji, Murad
A1  - Elliott, Martin J.
A1  - Hoskote, Aparna
A1  - Elwell, Clare E.
Y1  - 2011///
JF  - Journal of Thoracic and Cardiovascular Surgery
VL  - 141
IS  - 5
SP  - e31
EP  - e33
DO  - 10.1016/j.jtcvs.2011.01.026
UR  - http://www.jtcvsonline.org/article/S0022-5223(11)00059-6/pdf
N2  - In the current era of advanced cardiac surgery and extracorporeal membrane oxygenation (ECMO), there are serious limitations with inadequate neuromonitoring, mis-leading neuromonitoring, or both, especially in the setting of hemodilution and nonpulsatile flow. 1 Multimodal neuro-logical monitoring is available and advocated in certain centers. 2 However, the implications of neurological moni-toring with relevance to neurodevelopmental outcome have not been clearly delineated. As a result, there is equi-poise about routine neuromonitoring, particularly with near-infrared spectroscopy (NIRS) and the relevance of data. 3 Single-or dual-channel NIRS has been used widely in car-diac theaters. 4 In a previous study we used dual-channel NIRS in patients undergoing ECMO to understand cerebral and peripheral tissue oxygenation. 5 Power spectral density analysis was performed to extract vasomotion and respiratory and cardiac oscillations. To date, most NIRS studies have used optodes placed on the forehead, which monitor only a small area of the anterior cerebrum. We have developed a novel multichannel NIRS protocol for providing regional measures of cerebral oxygenation and hemodynamics for use in cardiac theaters and intensive care units. Because ECMO in the cardiac intensive care unit could be a surrogate model similar to a patient undergoing cardiac surgery during cardiopulmonary bypass, we have carried out preliminary studies on patients undergoing ECMO during manipulations in the ECMO circuit blood flows. We present our preliminary results with our first patient undergoing ECMO in which we have identified differences in regional cerebral oxygenation with changes in ECMO flows.
ER  - 
TY  - JOUR
T1  - Clinical classification of tissue perfusion based on the central venous oxygen saturation and the peripheral perfusion index
A1  - He, Huaiwu
A1  - Long, Yun
A1  - Liu, Dawei
A1  - Wang, Xiaoting
A1  - Zhou, Xiang
Y1  - 2015/09//
PB  - BioMed Central
JF  - Critical Care
VL  - 19
IS  - 1
SP  - 330
EP  - 330
DO  - 10.1186/s13054-015-1057-8
UR  - http://www.ncbi.nlm.nih.gov/pubmed/26369784
UR  - http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC4568576
N2  - Introduction: We investigated whether combining the peripheral perfusion index (PI) and central venous oxygen saturation(ScvO<inf>2</inf>) would identify subsets of patients for assessing the tissue perfusion and predicting outcome during the resuscitation in critically ill patients. Methods: A total of 202 patients with central venous catheters for resuscitation were enrolled in this prospective observational study. The arterial, central venous blood gas and the PI were measured simultaneously at the enrollment (T0) and 8 h (T8) after early resuscitation. Based on the distribution of the PI in healthy population, a cutoff of PI ≥1.4 was defined as a normal PI. Moreover, the critical value of PI was defined as the best cutoff value related to the mortality in the study population. The PI impairment stratification is defined as follows: a normal PI(≥1.4), mild PI impairment (critical value < PI < 1.4) and critical PI impairment (PI ≤ critical value). Results: The PI at T8 was with the greatest AUC for prediction the 30-day mortality and PI is an independent risk factor for 30-day mortality. Moreover, a cutoff of PI < 0.6 is related to poor outcomes following resuscitation. So, based on cutoffs of ScvO<inf>2</inf> (70 %) and critical PI (0.6) at T8, we assigned the patients to four categories: group 1 (PI ≤ 0.6 on ScvO<inf>2</inf> < 70 %), group 2 (PI ≤ 0.6 on ScvO<inf>2</inf> ≥ 70 %), group 3 (PI > 0.6 on ScvO<inf>2</inf> < 70 %), and group 4 (PI > 0.6 on ScvO<inf>2</inf> ≥ 70 %). The combination of low ScvO<inf>2</inf>(<70 %) and PI(≤0.6) was associated with the lowest survival rates at 30 days [log rank (Mantel-Cox) = 87.518, p < 0.0001]. The sub-group patients who had high ScvO<inf>2</inf>(>80 %) at T8 were with low mortality and high PI. Moreover, the normal PI (≥1.4) did not show a better outcome than mild impaired PI (0.6-1.4) patients who had a normalized ScvO<inf>2</inf>(>70 %) after resuscitation. The PI was correlated with the lactate, P(v-a)CO<inf>2</inf>, and ScvO<inf>2</inf> in all the measurements (n = 404). These relationships are strengthened with abnormal PI (PI < 1.4) but not with normal PI (PI ≥ 1.4). Conclusion: Complementing ScvO<inf>2</inf> assessment with PI can better identify endpoints of resuscitation and adverse outcomes. Pursuing a normalized PI (≥1.4) may not result in better outcomes for a mild impaired PI after ScvO<inf>2</inf> is normalized.
ER  - 
TY  - JOUR
T1  - Central venous-to-arterial carbon dioxide partial pressure difference in early resuscitation from septic shock: A prospective observational study
A1  - Mallat, Jihad
A1  - Pepy, Florent
A1  - Lemyze, Malcolm
A1  - Gasan, Gaëlle
A1  - Vangrunderbeeck, Nicolas
A1  - Tronchon, Laurent
A1  - Vallet, Benoit
A1  - Thevenin, Didier
Y1  - 2014/07//
JF  - European Journal of Anaesthesiology
VL  - 31
IS  - 7
SP  - 371
EP  - 380
DO  - 10.1097/EJA.0000000000000064
UR  - http://www.ncbi.nlm.nih.gov/pubmed/24625464
UR  - http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00003643-201407000-00006
N2  - BACKGROUND Central venous-to-arterial carbon dioxide partial pressure difference (DPCO2) can be used as a marker for the efficacy of venous blood in removing the total CO2 produced by the tissues. To date, this role of DPCO2 has been assessed only in patients after resuscitation from septic shock with already normalised central venous oxygen saturation (ScvO2 70%). There are no reports on the behaviour of DPCO2 and its relationship to cardiac index (CI) and clinical outcome before normal ScvO2 has been achieved. OBJECTIVES To investigate the behaviour of DPCO2 and its relationship to CI, blood lactate concentration and 28- day mortality during resuscitation in the very early phase of septic shock. To examine whether patients who normalise both DPCO2 and ScvO2 during the first 6 h of resuscitation will have a greater percentage decrease in blood lactate concentration than those who only achieve normal ScvO2. DESIGN Prospective observational study. SETTING Intensive Care Unit (ICU) in a university hospital. PATIENTS Eighty patients with septic shock were consecutively recruited. INTERVENTIONS Patients were resuscitated in accordance with the recommendations of the Surviving Sepsis Campaign. MAIN OUTCOME MEASURES Blood lactate concentrations, and haemodynamic and oxygen-derived variables were obtained at ICU admission (T0) and 6 h after admission (T6). Lactate decrease was defined as the percentage decrease in lactate concentration from T0 to T6. All cause 28-day mortality was also recorded. RESULTS Data are presented asmedian (interquartile range). At T0, there were significant differences (P<0.0001) between normal (DPCO2 -0.8 kPa) and high DPCO2 groups for CI (3.9 [3.3 to 4.7] vs. 2.9 [2.3 to 3.1] l min1m2) and ScvO2 (73 [65 to 80] vs. 61 [53 to 63]%). The correlation between changes in CI and DPCO2 was r=0.62, P<0.0001. Patients who reached a normal DPCO2 at T6 had larger decreases in blood lactate concentration and Sequential Organ Failure Assessment scores on day 1. The lactate decrease was greatest in the subgroup achieving both normal ScvO2 and DPCO2 at T6. Lactate decrease, unlike DPCO2 and ScvO2, was an independent predictor of 28-day mortality. CONCLUSION Monitoring DPCO2 may be a useful tool to assess the adequacy of tissue perfusion during resuscitation. The normalisation of both DPCO2 and ScvO2 is associated with a greater decrease in blood lactate concentration than ScvO2 alone. The lactate decrease is an independent predictor of 28-day mortality. Further research is needed to confirm this hypothesis. © 2014 Copyright European Society of Anaesthesiology.
ER  - 
TY  - JOUR
T1  - Use of venous-to-arterial carbon dioxide tension difference to guide resuscitation therapy in septic shock
A1  - Mallat, Jihad
Y1  - 2016/02//
KW  - Anaerobic metabolism
KW  - Carbon dioxide production
KW  - Cardiac output
KW  - Oxygen consumption
KW  - Oxygen supply dependency
KW  - Resuscitation
KW  - Septic shock
KW  - Venous-to-arterial carbon dioxide tension differen
KW  - tissue hypoxia
JF  - World Journal of Critical Care Medicine
VL  - 5
IS  - 1
SP  - 47
EP  - 47
DO  - 10.5492/wjccm.v5.i1.47
UR  - http://www.ncbi.nlm.nih.gov/pubmed/26855893
UR  - http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC4733455
UR  - http://www.wjgnet.com/2220-3141/full/v5/i1/47.htm
N2  - The mixed venous-to-arterial carbon dioxide (CO2) tension difference [P (v-a) CO2] is the difference between carbon dioxide tension (PCO2) in mixed venous blood (sampled from a pulmonary artery catheter) and the PCO2 in arterial blood. P (v-a) CO2 depends on the cardiac output and the global CO2 production, and on the complex relationship between PCO2 and CO2 content. Experimental and clinical studies support the evidence that P (v-a) CO2 cannot serve as an indicator of tissue hypoxia, and should be regarded as an indicator of the adequacy of venous blood to wash out the total CO2 generated by the peripheral tissues. P (v-a) CO2 can be replaced by the central venous-to-arterial CO2 difference (ΔPCO2), which is calculated from simultaneous sampling of central venous blood from a central vein catheter and arterial blood and, therefore, more easy to obtain at the bedside. Determining the ΔPCO2 during the resuscitation of septic shock patients might be useful when deciding when to continue resuscitation despite a central venous oxygen saturation (ScvO2) > 70% associated with elevated blood lactate levels. Because high blood lactate levels is not a discriminatory factor in determining the source of that stress, an increased ΔPCO2 (> 6 mmHg) could be used to identify patients who still remain inadequately resuscitated. Monitoring the ΔPCO2 from the beginning of the reanimation of septic shock patients might be a valuable means to evaluate the adequacy of cardiac output in tissue perfusion and, thus, guiding the therapy. In this respect, it can aid to titrate inotropes to adjust oxygen delivery to CO2 production, or to choose between hemoglobin correction or fluid/inotrope infusion in patients with a too low ScvO2 related to metabolic demand. The combination of P (v-a) CO2 or ΔPCO2 with oxygen-derived parameters through the calculation of the P (v-a) CO2 or ΔPCO2/arteriovenous oxygen content difference ratio can detect the presence of global anaerobic metabolism.
ER  - 
TY  - JOUR
T1  - The origin of the acidosis in hyperlactataemia
A1  - Zilva, J. F.
Y1  - 1978/01//
PB  - SAGE PublicationsSage UK: London, England
JF  - Annals of Clinical Biochemistry
VL  - 15
IS  - 1
SP  - 40
EP  - 43
DO  - 10.1177/000456327801500111
UR  - http://acb.sagepub.com/lookup/doi/10.1177/000456327801500111
N2  - Anaerobic glycolysis produces lactate, ATP, and water but there is no net change in the number of hydrogen ions: it does not produce lactic acid. The acidosis usually associated with hyperlactataemia is caused by hydrolysis of the ATP, with release of hydrogen ions. By contrast, ATP turnover by aerobic mechanisms is not acidifying because the released hydrogen ion is reutilised as more ATP is formed. Gluconeogenesis from lactate does not utilise hydrogen ions directly - in fact, it produces them. The associated net H+ utilisation is caused by the aerobic generation of the ATP and GTP required to drive glycolysis in reverse. It is suggested that only by understanding these important biochemical facts can the clinician found his diagnosis and treatment on a firm, rational basis.
ER  - 
TY  - JOUR
T1  - Clinical use of lactate monitoring in critically ill patients
A1  - Bakker, Jan
A1  - Nijsten, Maarten W.N.
A1  - Jansen, Tim C.
Y1  - 2013/05//
KW  - Anesthesiology
KW  - Emergency Medicine
KW  - Intensive / Critical Care Medicine
JF  - Annals of Intensive Care
VL  - 3
IS  - 1
SP  - 1
EP  - 8
DO  - 10.1186/2110-5820-3-12
UR  - http://annalsofintensivecare.springeropen.com/articles/10.1186/2110-5820-3-12
N2  - Increased blood lactate levels (hyperlactataemia) are common in critically ill patients. Although frequently used to diagnose inadequate tissue oxygenation, other processes not related to tissue oxygenation may increase lactate levels. Especially in critically ill patients, increased glycolysis may be an important cause of hyperlactataemia. Nevertheless, the presence of increased lactate levels has important implications for the morbidity and mortality of the hyperlactataemic patients. Although the term lactic acidosis is frequently used, a significant relationship between lactate and pH only exists at higher lactate levels. The term lactate associated acidosis is therefore more appropriate. Two recent studies have underscored the importance of monitoring lactate levels and adjust treatment to the change in lactate levels in early resuscitation. As lactate levels can be measured rapidly at the bedside from various sources, structured lactate measurements should be incorporated in resuscitation protocols. © 2013 Bakker et al.; licensee Springer.
ER  - 
TY  - JOUR
T1  - Extracorporeal membrane oxygenation
A1  - Schuerer, Douglas J.E.
A1  - Kolovos, Nikoleta S.
A1  - Boyd, Kayla V.
A1  - Coopersmith, Craig M.
Y1  - 2008/07//
KW  - ARDS
KW  - Cardiac failure
KW  - Extracorporeal life support
KW  - Extracorporeal membrane oxygenation
KW  - Practice management
KW  - Respiratory failure
PB  - Elsevier
JF  - Chest
VL  - 134
IS  - 1
SP  - 179
EP  - 184
DO  - 10.1378/chest.07-2512
UR  - http://linkinghub.elsevier.com/retrieve/pii/S0012369208601646
N2  - Extracorporeal membrane oxygenation (ECMO) is a technique for providing life support for patients experiencing both pulmonary and cardiac failure by maintaining oxygenation and perfusion until native organ function is restored. ECMO is used routinely at many specialized hospitals for infants and less commonly for children with respiratory or cardiac failure from a variety of causes. Its usage is more controversial in adults, but select medical centers have reported favorable findings in patients with ARDS and other causes of severe pulmonary failure. ECMO is also rarely used as a rescue therapy in a small subset of adult patients with cardiac failure. This article will review the current uses and techniques of ECMO in the critical care setting as well as the evidence supporting its usage. In addition, current practice management related to coding and reimbursement for this intensive therapy will be discussed. Copyright © 2008 by American College of Chest Physicians.
ER  - 
TY  - JOUR
T1  - Review of ECMO (Extra Corporeal Membrane Oxygenation) Support in Critically Ill Adult Patients
A1  - Marasco, Silvana F.
A1  - Lukas, George
A1  - McDonald, Michael
A1  - McMillan, James
A1  - Ihle, Benno
Y1  - 2008/01//
KW  - ECMO
KW  - ECMO cannulation
KW  - Pulmonary or cardiac failure
JF  - Heart Lung and Circulation
VL  - 17
IS  - SUPPL. 4
SP  - S41
EP  - S47
DO  - 10.1016/j.hlc.2008.08.009
UR  - http://www.ncbi.nlm.nih.gov/pubmed/18964254
UR  - http://linkinghub.elsevier.com/retrieve/pii/S1443950608008524
N2  - Mechanical circulatory support has evolved markedly over recent years. ECMO (extra corporeal membrane oxygenation) is instituted for the management of life threatening pulmonary or cardiac failure (or both), when no other form of treatment has been or is likely to be successful. Most commonly, it is instituted in an emergency or urgent situation after failure of other treatment modalities. It is used as temporary support, usually awaiting recovery of organs, or can be used as a bridge to a more permanent device or cardiac transplantation. ECMO can be deployed in a veno-arterial configuration (either peripheral or central cannulation) for the treatment of cardiogenic shock. This is usually seen post-cardiotomy, post-heart transplant and in severe cardiac failure due to almost any other cause (e.g. cardiomyopathy, myocarditis, acute coronary syndrome with cardiogenic shock). Veno-venous ECMO is used for respiratory failure and usually involves peripheral cannulation using the femoral veins ± internal jugular vein if required. The indications for veno-venous ECMO are respiratory failure, most commonly due to adult respiratory distress syndrome (ARDS), pneumonia, trauma or primary graft failure following lung transplantation. ECMO is also used for neonatal and paediatric respiratory support. Its use in premature neonates is the mainstay of treatment for immature lungs and insufficient surfactant. In this review, the technical aspects of ECMO cannulation, maintenance and weaning are outlined. Complication rates and outcomes are reviewed and our experience at The Epworth Hospital is summarized. Crown Copyright © 2008.
ER  - 
TY  - JOUR
T1  - Cardiac extracorporeal life support: State of the art in 2007
A1  - Cooper, David S.
A1  - Jacobs, Jeffrey P.
A1  - Moore, Lisa
A1  - Stock, Arabela
A1  - Gaynor, J. William
A1  - Chancy, Thomas
A1  - Parpard, Michael
A1  - Griffin, Dee Ann
A1  - Owens, Tami
A1  - Checchia, Paul A.
A1  - Thiagarajan, Ravi R.
A1  - Spray, Thomas L.
A1  - Ravishankar, Chitra
Y1  - 2007/09//
KW  - Cardiogenic shock
KW  - Cardiopulmonary resuscitation
KW  - Extracorporeal membrane oxygenation
KW  - Low cardiac output syndrome
KW  - Ventricular assist device
PB  - Cambridge University Press
JF  - Cardiology in the Young
VL  - 17
IS  - SUPPL. 2
SP  - 104
EP  - 115
DO  - 10.1017/S1047951107001217
UR  - http://www.journals.cambridge.org/abstract_S1047951107001217
N2  - Mechanical circulatory support is an invaluable tool in the care of children with severe refractory cardiac and or pulmonary failure. Two forms of mechanical circulatory support are currently available to neonates, infants, and smaller children, namely extracorporeal membrane oxygenation and use of a ventricular assist device, with each technique having unique advantages and disadvantages. The intra-aortic balloon pump is a third form of mechanical support that has been successfully used in larger children, adolescents, and adults, but has limited applicability in smaller children. In this review, we discuss the current experiences with extracorporeal membrane oxygenation and ventricular assist devices in children with cardiac disease. A variety of forms of mechanical circulatory support are available for children with cardiopulmonary dysfunction refractory to conventional management. These devices require extensive resources, both human and economic. Extracorporeal membrane oxygenation can be effectively used in a variety of settings to provide support to critically-ill patients with cardiac disease. Careful selection of patients and timing of intervention remains challenging. Special consideration should be given to children with cardiac disease with regard to anatomy, physiology, cannulation, and circuit management. Even though exciting progress is being made in the development of ventricular assist devices for long-term mechanical support in children, extracorporeal membrane oxygenation remains the mainstay of mechanical circulatory support in children with complex anatomy, particularly those needing rapid resuscitation and those with a functionally univentricular circulation. As the familiarity and experience with extracorporeal membrane oxygenation has grown, new indications have evolved, including emergent resuscitation. This utilization has been termed extracorporeal cardiopulmonary resuscitation. The literature supporting emergent cardiopulmonary support is mounting. Reasonable survival rates have been achieved after initiation of support during active compressions of the chest following in-hospital cardiac arrest. Due to the limitations of conventional circuits for extracorporeal membrane oxygenation, some centres have developed novel systems for rapid cardiopulmonary support. Many centres previously considered a functionally univentricular circulation to be a contraindication to extracorporeal membrane oxygenation, but improved results have been achieved recently with this complex subset of patients. The registry of the Extracorporeal Life Support Organization recently reported the outcome of extracorporeal life support used in neonates for cardiac indications from 1996 to 2000. Of the 740 neonates who were placed on extracorporeal life support for cardiac indications, 118 had hypoplastic left heart syndrome. There was no significant difference in survival between these patients and those with other defects. It is now common to use extracorporeal membrane oxygenation to support patients with a functionally univentricular circulation, and reasonable survival rates are to be expected. Although extracorporeal membrane oxygenation has become a standard of care for many paediatric centres, its use is limited to those patients who require only short-term cardiopulmonary support. Mechanical ventricular assist devices have become standard therapy for adults with cardiac failure refractory to maximal medical management. Several devices are readily available in the United States of America for adults, but there are fewer options available to children. Over the last few years, substantial progress has been made in paediatric mechanical support. Ventricular assist devices are being used with increasing frequency in children with cardiac failure refractory to medical therapy for primary treatment as a long-term bridge to recovery or transplantation. The paracorporeal, pneumatic, pulsatile "Berlin Heart" ventricular assist device is being used with increasing frequency in Europe and North America to provide univentricular and biventricular support. With this device, a patient can be maintained on mechanical circulatory support while extubated, being mobilized, and feeding by mouth. Mechanical circulatory support should be anticipated, and every attempt must be made to initiate support "urgently" rather than "emergently", before the presence of dysfunction of end organs or circulatory collapse. In an emergency, these patients can be resuscitated with extracorporeal membrane oxygenation and subsequently transitioned to a long-term ventricular assist device after a period of stability. © 2007 Cambridge University Press.
ER  - 
TY  - JOUR
T1  - Delta de CO2 como factor de riesgo de muerte en choque séptico
A1  - Ocelotl Pérez, Rafaelita
A1  - Valle Ramírez, Judith
A1  - De Jesús Balcazar, Deisy
A1  - Cortés Munguía, José Alfredo
A1  - Herrera Morales, Blanca
A1  - Mendoza Rodríguez, Martín
Y1  - 2016///
KW  - choque séptico
KW  - delta CO2
KW  - delta de CO2
KW  - diferencia de CO2 venoso-arterial
KW  - septic shock
KW  - venous-arterial CO2 difference
KW  - ΔCO2
PB  - scielomx
JF  - Revista de la Asociación Mexicana de Medicina Crítica y Terapia Intensiva
VL  - 30
IS  - 1
SP  - 30
EP  - 42
SN  - 0187-8433 UL - http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0187-84332016000100006&nrm=iso
N2  - The revolutionary era's call of “tremblez tyrants” placed patriarchy under severe threat, part of a long reconfiguration from unquestioned arbitrary power and divine right to a softer and more questioned modern form. Republican wives and mothers drew on newfound moral agency. Feminists extended natural or universal rights to women. Sentimental gallants offered a third way, beyond the propriety of the domestic sphere or sexual virtue, that was articulated in its most complex form in scandal memoirs. Female memoirists such as Margaret Coghlan and Leonora Sansay exposed the workings of male tyranny. They drew on traditions of gallantry and lower-sort sexuality. They refused the patriarchal prerogative of judging and rebuking women, asserting female sentiments as the highest court of judgment and as a means of protest and self-vindication. And, in an era of transatlantic radicalism, interconnected elites, and international celebrity, they rejected the idea that figures of high politics were off-limits to female commentators. Scandal memoirs crisscrossed the revolutionary orbit. They fretted well-known political men, were handed about among radical and commercial printers, and were privately quoted. As a third and decidedly ambiguous form of antipatriarchalism, sentimental gallantry reveals a hidden genealogy of female liberty and of literary connection in the age of revolutions.
ER  - 
TY  - JOUR
T1  - Extracorporeal membrane oxygenation in adults with severe respiratory failure: A multi-center database
A1  - Brogan, Thomas V.
A1  - Thiagarajan, Ravi R.
A1  - Rycus, Peter T.
A1  - Bartlett, Robert H.
A1  - Bratton, Susan L.
Y1  - 2009/12//
KW  - Acute respiratory distress syndrome (ARDS)
KW  - Complications
KW  - Extracorporeal Life Support Organization (ELSO)
KW  - Pneumonia
KW  - Survival
JF  - Intensive Care Medicine
VL  - 35
IS  - 12
SP  - 2105
EP  - 2114
DO  - 10.1007/s00134-009-1661-7
UR  - http://link.springer.com/10.1007/s00134-009-1661-7
UR  - http://www.ncbi.nlm.nih.gov/pubmed/19768656
N2  - Objective: To evaluate clinical and treatment factors for patients recorded in the Extracorporeal Life Support Organization (ELSO) registry and survival of adult extracorporeal membrane oxygenation (ECMO) respiratory failure patients. Design and patients: Retrospective case review of the ELSO registry from 1986-2006. Data were analyzed separately for the entire time period and the most recent years (2002-2006). Results: Of 1,473 patients, 50% survived to discharge. Median age was 34 years. Most patients (78%) were supported with venovenous ECMO. In a multi-variate logistic regression model, pre-ECMO factors including increasing age, decreased weight, days on mechanical ventilation before ECMO, arterial blood pH ≤ 7.18, and Hispanic and Asian race compared to white race were associated with increased odds of death. For the most recent years (n = 600), age and PaCO2 ≥ 70 compared to PaCO2 ≤ 44 were also associated with increased odds of death. The two diagnostic categories acute respiratory failure and asthma compared to ARDS were associated with decreased odds of mortality as was venovenous compared to venoarterial mode. CPR and complications while on ECMO including circuit rupture, central nervous system infarction or hemorrhage, gastrointestinal or pulmonary hemorrhage, and arterial blood pH < 7.2 or >7.6 were associated with increased odds of death. Conclusions: Survival among this cohort of adults with severe respiratory failure supported with ECMO was 50%. Advanced patient age, increased pre-ECMO ventilation duration, diagnosis category and complications while on ECMO were associated with mortality. Prospective studies are needed to evaluate the role of this complex support mode.
ER  - 
TY  - JOUR
T1  - Acute Respiratory Distress Syndrome With and Without Extracorporeal Membrane Oxygenation: A Score Matched Study
A1  - Tsai, Hsiao Chi
A1  - Chang, Chih Hsiang
A1  - Tsai, Feng Chun
A1  - Fan, Pei Chun
A1  - Juan, Kuo Chang
A1  - Lin, Chan Yu
A1  - Yang, Huang Yu
A1  - Kao, Kuo Chin
A1  - Fang, Ji Tseng
A1  - Yang, Chih Wei
A1  - Chang, Su Wei
A1  - Chen, Yung Chang
Y1  - 2015/08//
JF  - Annals of Thoracic Surgery
VL  - 100
IS  - 2
SP  - 458
EP  - 464
DO  - 10.1016/j.athoracsur.2015.03.092
UR  - http://linkinghub.elsevier.com/retrieve/pii/S0003497515005822
UR  - http://www.ncbi.nlm.nih.gov/pubmed/26116481
N2  - Background. Acute respiratory distress syndrome (ARDS) is a life-threatening medical condition. Extracorporeal membrane oxygenation (ECMO) is a salvage therapy for patients with ARDS and refractory hypoxia. This study compared the characteristics and outcomes of ARDS patients who did or did not receive ECMO matched with Acute Physiology and Chronic Health Evaluation II (APACHE II) score and age. Methods. This retrospective, case-control study enrolled patients with ARDS admitted to the intensive care unit of a tertiary referral hospital between January 2007 and December 2012. Overall, 216 patients with ARDS - 81 receiving ECMO (ECMO group) and 135 not receiving ECMO (non-ECMO group) - were enrolled in this study. Patients were paired when the difference in their APACHE II scores was within 3 points and their age difference was 3 years. In total, 126 patients could not be matched and were thus excluded. Eventually, of the 90 patients with ARDS enrolled in this study, 45 ECMO group patients were matched with 45 non-ECMO group patients. The demographic data, reasons for intensive care unit admission, and laboratory variables were evaluated. Results. The primary etiology of ARDS was infection (72.2%). The APACHE II score and age-matched group receiving ECMO therapy had higher inhospital survival rates. Moreover, the patients receiving ECMO therapy had significantly lower 6-month mortality rates than did the non-ECMO group. Conclusions. Patients with ARDS who received ECMO treatment had higher inhospital survival rates than did those with a similar disease severity and at a similar age who did not receive ECMO.
ER  - 
TY  - JOUR
T1  - Outcome of adult respiratory failure patients receiving prolonged (≥ 14 Days) ECMO
A1  - Posluszny, Joseph
A1  - Rycus, Peter T.
A1  - Bartlett, Robert H.
A1  - Engoren, Milo
A1  - Haft, Jonathan W.
A1  - Lynch, William R.
A1  - Park, Pauline K.
A1  - Raghavendran, Krishnan
A1  - Napolitano, Lena M.
Y1  - 2016/03//
KW  - Acute respiratory distress syndrome
KW  - acute respiratory failure
KW  - extracorporeal membrane oxygenation
KW  - outcome
KW  - prolonged duration
JF  - Annals of Surgery
VL  - 263
IS  - 3
SP  - 573
EP  - 581
DO  - 10.1097/SLA.0000000000001176
UR  - http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00000658-201603000-00022
UR  - http://www.ncbi.nlm.nih.gov/pubmed/26625136
N2  - To examine the outcomes of prolonged (≥14 days) extracorporeal membrane oxygenation (P-ECMO) for adult severe respiratory failure and to assess characteristics associated with survival. Background: The use of ECMO for treatment of severe respiratory adult patients is associated with overall survival rates of 50% to 70% with median ECMO duration of 10 days. No prior multi-institutional studies have examined outcomes of P-ECMO for severe respiratory failure. Methods: Data on all adult (≥18 years) patients who required P-ECMO for severe respiratory failure from 1989 to 2013 were extracted from the Extracorporeal Life Support Organization international multi-institutional registry. We examined outcomes over 23 years and compared the 2 more recent time periods of 1989 to 2006 versus 2007 to 2013. Results: Up to 974 patients, mean age 40.2 (18-83) years, had ECMO duration of mean 25.2 days/median 21.0 days (range: 14-208 days). Venovenous ECMO support was most common (venovenous: 79.5%, venoarterial: 9.9%). Reason for ECMO discontinuation included native lung recovery (54%), organ failure (23.7%), family request (6.7%), hemorrhage (2.7%), and diagnosis incompatible with life (5.6%). Forty patients (4.1%) underwent lung transplant with 50% postoperative in-hospital mortality. Increased prevalence of P-ECMO was noted with 72% (701/974) of all cases reported since 2008. Survival to hospital discharge was 45.4% (443/974) and did not vary with ECMO duration. Multivariate logistic regression analysis confirmed that PECMO patients 2007 to 2013 had a lower risk of death [odds ratio (OR): 0.650; 95% confidence interval (CI), 0.454-0.929; P=0.010] compared with 1989 to 2006. Factors independently associated with survival were younger age (OR: 0.983; 95% CI, 0.974-0.993; P<0.001) and lower PaCO2 (OR, 0.991; 95% CI, 0.986-0.996; P<0.001). Conclusions: Prolonged ECMO use for adult respiratory failure was associated with a lower (45.4%) hospital survival rate, compared with prior reported survival rates of short duration ECMO. Prolonged ECMO survival significantly increased in recent years, and increasing ECMO duration did not alter the survival fraction in the 1989 to 2013 study cohort. Although P-ECMO survival rates are less than short ECMO runs, P-ECMO support is justified.
ER  - 
TY  - JOUR
T1  - Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis
A1  - Ouweneel, Dagmar M.
A1  - Schotborgh, Jasper V.
A1  - Limpens, Jacqueline
A1  - Sjauw, Krischan D.
A1  - Engström, A. E.
A1  - Lagrand, Wim K.
A1  - Cherpanath, Thomas G.V.
A1  - Driessen, Antoine H.G.
A1  - de Mol, Bas A.J.M.
A1  - Henriques, José P.S.
Y1  - 2016/12//
KW  - Acute myocardial infarction
KW  - Cardiac arrest
KW  - Cardiogenic shock
KW  - Cardiopulmonary resuscitation
KW  - Extracorporeal life support
KW  - Extracorporeal membrane oxygenation
KW  - Systematic review
JF  - Intensive Care Medicine
VL  - 42
IS  - 12
SP  - 1922
EP  - 1934
DO  - 10.1007/s00134-016-4536-8
UR  - http://link.springer.com/10.1007/s00134-016-4536-8
UR  - http://www.ncbi.nlm.nih.gov/pubmed/27647331
UR  - http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC5106498
N2  - Purpose: Veno-arterial extracorporeal life support (ECLS) is increasingly used in patients during cardiac arrest and cardiogenic shock, to support both cardiac and pulmonary function. We performed a systematic review and meta-analysis of cohort studies comparing mortality in patients treated with and without ECLS support in the setting of refractory cardiac arrest and cardiogenic shock complicating acute myocardial infarction. Methods: We systematically searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the publisher subset of PubMed updated to December 2015. Thirteen studies were included of which nine included cardiac arrest patients (n = 3098) and four included patients with cardiogenic shock after acute myocardial infarction (n = 235). Data were pooled by a Mantel-Haenzel random effects model and heterogeneity was examined by the I2 statistic. Results: In cardiac arrest, the use of ECLS was associated with an absolute increase of 30 days survival of 13 % compared with patients in which ECLS was not used [95 % CI 6–20 %; p < 0.001; number needed to treat (NNT) 7.7] and a higher rate of favourable neurological outcome at 30 days (absolute risk difference 14 %; 95 % CI 7–20 %; p < 0.0001; NNT 7.1). Propensity matched analysis, including 5 studies and 438 patients (219 in both groups), showed similar results. In cardiogenic shock, ECLS showed a 33 % higher 30-day survival compared with IABP (95 % CI, 14–52 %; p < 0.001; NNT 13) but no difference when compared with TandemHeart/Impella (−3 %; 95 % CI −21 to 14 %; p = 0.70; NNH 33). Conclusions: In cardiac arrest, the use of ECLS was associated with an increased survival rate as well as an increase in favourable neurological outcome. In the setting of cardiogenic shock there was an increased survival with ECLS compared with IABP.
ER  - 
TY  - JOUR
T1  - The feasibility and safety of extracorporeal carbon dioxide removal to avoid intubation in patients with COPD unresponsive to noninvasive ventilation for acute hypercapnic respiratory failure (ECLAIR study): multicentre case–control study
A1  - Braune, Stephan
A1  - Sieweke, Annekatrin
A1  - Brettner, Franz
A1  - Staudinger, Thomas
A1  - Joannidis, Michael
A1  - Verbrugge, Serge
A1  - Frings, Daniel
A1  - Nierhaus, Axel
A1  - Wegscheider, Karl
A1  - Kluge, Stefan
Y1  - 2016/09//
KW  - Acute respiratory failure
KW  - COPD
KW  - Endotracheal intubation
KW  - Extracorporeal carbon dioxide removal
KW  - Hypercapnia
KW  - Mechanical ventilation
JF  - Intensive Care Medicine
VL  - 42
IS  - 9
SP  - 1437
EP  - 1444
DO  - 10.1007/s00134-016-4452-y
UR  - http://link.springer.com/10.1007/s00134-016-4452-y
UR  - http://www.ncbi.nlm.nih.gov/pubmed/27456703
N2  - Introduction: The aim of the study was to evaluate the feasibility and safety of avoiding invasive mechanical ventilation (IMV) by using extracorporeal CO2 removal (ECCO2R) in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and acute hypercapnic respiratory failure refractory to noninvasive ventilation (NIV). Methods: Case–control study. Patients with acute hypercapnic respiratory failure refractory to NIV being treated with a pump-driven veno-venous ECCO2R system (iLA-Activve®; Novalung, Heilbronn, Germany) were prospectively observed in five European intensive care units (ICU). Inclusion criteria were respiratory acidosis (pH ≤ 7.35, PaCO2 > 45 mmHg) with predefined criteria for endotracheal intubation (ClinicalTrials.gov NCT01784367). The historical controls were patients with acute hypercapnic respiratory failure refractory to NIV who were treated with IMV. The matching criteria were main diagnosis, age, SAPS-II score and pH. Results: Twenty-five cases (48.0 % male, mean age 67.3 years) were matched with 25 controls. Intubation was avoided in 14 patients (56.0 %) in the ECCO2R group with a mean extracorporeal blood flow of 1.3 L/min. Seven patients were intubated because of progressive hypoxaemia and four owing to ventilatory failure despite ECCO2R and NIV. Relevant ECCO2R-associated adverse events were observed in 11 patients (44.0 %), of whom 9 (36.0 %) suffered major bleeding complications. The mean time on IMV, ICU stay and hospital stay in the case and control groups were 8.3 vs. 13.7, 28.9 vs. 24.0 and 36.9 vs. 37.0 days, respectively, and the 90-day mortality rates were 28.0 vs. 28.0 %. Conclusions: The use of veno-venous ECCO2R to avoid invasive mechanical ventilation was successful in just over half of the cases. However, relevant ECCO2R-associated complications occurred in over one-third of cases. Despite the shorter period of IMV in the ECCO2R group there were no significant differences in length of stay or in 28- and 90-day mortality rates between the two groups. Larger, randomised studies are warranted for further assessment of the effectiveness of ECCO2R.
ER  - 
TY  - JOUR
T1  - Hemostatic Changes during Extracorporeal Membrane Oxygenation: A Prospective Randomized Clinical Trial Comparing Three Different Extracorporeal Membrane Oxygenation Systems
A1  - Malfertheiner, Maximilian V.
A1  - Philipp, Alois
A1  - Lubnow, Matthias
A1  - Zeman, Florian
A1  - Enger, Tone Bull
A1  - Bein, Thomas
A1  - Lunz, Dirk
A1  - Schmid, Christof
A1  - Müller, Thomas
A1  - Lehle, Karla
Y1  - 2016/04//
KW  - D-dimers
KW  - coagulation
KW  - extracorporeal membrane oxygenation
KW  - hemostasis
KW  - prothrombin fragment 1.2
KW  - thrombin antithrombin complex
JF  - Critical Care Medicine
VL  - 44
IS  - 4
SP  - 747
EP  - 754
DO  - 10.1097/CCM.0000000000001482
UR  - http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00003246-900000000-97051
UR  - http://www.ncbi.nlm.nih.gov/pubmed/26646464
N2  - Objective: Extracorporeal membrane oxygenation is a rescue therapy for patients with severe lung failure. Major complications caused by extracorporeal membrane oxygenation are bleeding, thrombosis, and hemolysis. The aim of this study was to compare the impact of different extracorporeal membrane oxygenation systems on blood hemostasis in adults during veno-venous extracorporeal membrane oxygenation therapy. Design: Single center prospective randomized study. Setting: University Hospital Regensburg, Germany. Patients: Adult patients with severe acute respiratory distress syndrome requiring veno-venous extracorporeal membrane oxygenation therapy. Interventions: None. Measurements and Main Results: Three different extracorporeal membrane oxygenation systems: the Cardiohelp system (Maquet Cardiopulmonary AG), the Dideco ECC.O5 (Sorin Group), and the Deltastream system with Hilite 7000 LT + DP3 pumphead (Medos Medizintechnik AG) were compared. Therefore hemostasis, anticoagulation, hemolysis, and inflammatory parameters were monitored. Of the 54 patients included in the study, 18 patients each were randomly assigned to the three different extracorporeal membrane oxygenation systems. Exclusion criteria were acute renal failure, trauma, and surgery within 2 days. The median time on veno-venous extracorporeal membrane oxygenation support was 13.5 days (4-70 d). Median platelet count had dropped from 220.5 G/L before extracorporeal membrane oxygenation therapy to a minimum of 133 G/L by the last day of extracorporeal membrane oxygenation support. During the first 5 days of extracorporeal membrane oxygenation therapy, prothrombin fragment 1.2 (F1.2) (1.36-2.4 μM), thrombin-antithrombin complex (14.5-50 μg/L), and D-dimers (6.00-27.0 mg/L) increased, whereas fibrinogen values dropped from 5.8 to 4.1 g/L. The three different extracorporeal membrane oxygenation systems did not show any differences with regard to hemostasis, anticoagulation, hemolysis, and inflammatory parameters within the first 5 days of extracorporeal membrane oxygenation therapy. Conclusions: Over time, miniaturized veno-venous extracorporeal membrane oxygenation therapy increasingly activates coagulation. The different types of membrane oxygenators and pumps did not significantly alter hemostasis.
ER  - 
TY  - JOUR
T1  - Extracorporeal Life Support Organization Registry International Report 2016
A1  - Thiagarajan, Ravi R.
A1  - Barbaro, Ryan P.
A1  - Rycus, Peter T.
A1  - McMullan, D. Michael
A1  - Conrad, Steven A.
A1  - Fortenberry, James D.
A1  - Paden, Matthew L.
Y1  - 2017///
KW  - Extracorporeal Life Support Organization Registry
KW  - adverse events
KW  - extracorporeal life support
KW  - survival
JF  - ASAIO Journal
VL  - 63
IS  - 1
SP  - 60
EP  - 67
DO  - 10.1097/MAT.0000000000000475
UR  - http://www.ncbi.nlm.nih.gov/pubmed/27984321
UR  - http://insights.ovid.com/crossref?an=00002480-201701000-00011
N2  - Data on extracorporeal life support (ECLS) use and survival submitted to the Extracorporeal Life Support Organization's data registry from the inception of the registry in 1989 through July 1, 2016, are summarized in this report. The registry contained information on 78,397 ECLS patients with 58% survival to hospital discharge. Extracorporeal life support use and centers providing ECLS have increased worldwide. Extracorporeal life support use in the support of adults with respiratory and cardiac failure represented the largest growth in the recent time period. Extracorporeal life support indications are expanding, and it is increasingly being used to support cardiopulmonary resuscitation in children and adults. Adverse events during the course of ECLS are common and underscore the need for skilled ECLS management and appropriately trained ECLS personnel and teams.
ER  - 
TY  - JOUR
T1  - Pediatric Extracorporeal Life Support Organization Registry International Report 2016
A1  - Barbaro, Ryan P.
A1  - Paden, Matthew L.
A1  - Guner, Yigit S.
A1  - Raman, Lakshmi
A1  - Ryerson, Lindsay M.
A1  - Alexander, Peta
A1  - Nasr, Viviane G.
A1  - Bembea, Melania M.
A1  - Rycus, Peter T.
A1  - Thiagarajan, Ravi R.
Y1  - 2017///
KW  - Extracorporeal Life Support Organization
KW  - complications
KW  - extracorporeal life support
KW  - extracorporeal membrane oxygenation
KW  - neonate
KW  - outcomes
KW  - pediatric
JF  - ASAIO Journal
VL  - 63
IS  - 4
SP  - 456
EP  - 463
DO  - 10.1097/MAT.0000000000000603
UR  - http://www.ncbi.nlm.nih.gov/pubmed/28557863
UR  - http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC5626007
UR  - http://insights.ovid.com/crossref?an=00002480-201707000-00014
N2  - The purpose of this report is to describe the international growth, outcomes, complications, and technology used in pediatric extracorporeal life support (ECLS) from 2009 to 2015 as reported by participating centers in the Extracorporeal Life Support Organization (ELSO). To date, there are 59,969 children who have received ECLS in the ELSO Registry; among those, 21,907 received ECLS since 2009 with an overall survival to hospital discharge rate of 61%. In 2009, 2,409 ECLS cases were performed at 157 centers. By 2015, that number grew to 2,992 cases in 227 centers, reflecting a 24% increase in patients and 55% growth in centers. ECLS delivered to neonates (0-28 days) for respiratory support was the largest subcategory of ECLS among children <18-years old. Overall, 48% of ECLS was delivered for respiratory support and 52% was for cardiac support or extracorporeal life support to support cardiopulmonary resuscitation (ECPR). During the study period, over half of children were supported on ECLS with centrifugal pumps (51%) and polymethylpentene oxygenators (52%). Adverse events including neurologic events were common during ECLS, a fact that underscores the opportunity and need to promote quality improvement work.
ER  - 
TY  - JOUR
T1  - Venoarterial CO2 difference during regional ischemic or hypoxic hypoxia
A1  - Vallet, Benoit
A1  - Teboul, Jean Louis
A1  - Cain, Stephen
A1  - Curtis, Scott
Y1  - 2000///
KW  - Dysoxia
KW  - Oxygenation
KW  - Regional capnometry
KW  - Respiratory quotient
JF  - Journal of Applied Physiology
VL  - 89
IS  - 4
SP  - 1317
EP  - 1321
DO  - 10.1152/jappl.2000.89.4.1317
UR  - https://www.physiology.org/doi/pdf/10.1152/jappl.2000.89.4.1317
UR  - http://www.ncbi.nlm.nih.gov/pubmed/11007564
N2  - To test the role of blood flow in tissue hypoxia-related increased veno-arterial PCO2 difference (ΔPCO2), we decreased O2 delivery (DO2) by either decreasing flow [ischemic hypoxia (IH)] or arterial PO2 [hypoxic hypoxia (HH)] in an in situ, vascularly isolated, innervated dog hind-limb perfused with a pump-membrane oxygenator system. Twelve anesthetized and ventilated dogs were studied, with systemic hemodynamics maintained within normal range. In the IH group (n = 6), hindlimb DO2 was progressively lowered every 15 min by decreasing pump-controlled flow from 60 to 10 ml · kg-1 · min-1, with arterial PO2 constant at 100 Torr. In the HH group (n = 6), hindlimb DO2 was progressively lowered every 15 min by decreasing PO2 from 100 to 15 Torr, when flow was constant at 60 ml · kg-1 · min-1. Limb DO2, O2 uptake (VO2), and ΔPCO2 were obtained every 15 min. Below the critical DO2. decreased, indicating dysoxia, and O2 extraction ratio (VO2/DO2) rose continuously and similarly in both groups, reaching a maximal value of ~90%. ΔPCO2 significantly increased in IH but never differed from baseline in HH. We conclude that absence of increased ΔPCO2 does not preclude the presence of tissue dysoxia and that decreased flow is a major determinant in increased ΔPCO2.
ER  - 
TY  - JOUR
T1  - Central venous O2 saturation and venous-to-arterial CO2 difference as complementary tools for goal-directed therapy during high-risk surgery
A1  - Futier, Emmanuel
A1  - Robin, Emmanuel
A1  - Jabaudon, Matthieu
A1  - Guerin, Renaud
A1  - Petit, Antoine
A1  - Bazin, Jean-Etienne
A1  - Constantin, Jean-Michel
A1  - Vallet, Benoit
Y1  - 2010/10//
JF  - Critical Care
VL  - 14
IS  - 5
SP  - R193
EP  - R193
DO  - 10.1186/cc9310
N2  - Central venous oxygen saturation (ScvO2) is a useful therapeutic target in septic shock and high-risk surgery. We tested the hypothesis that central venous-to-arterial carbon dioxide difference (P(cv-a)CO2), a global index of tissue perfusion, could be used as a complementary tool to ScvO2 for goal-directed fluid therapy (GDT) to identify persistent low flow after optimization of preload has been achieved by fluid loading during high-risk surgery.
ER  - 
TY  - JOUR
T1  - Magnitude of arterial carbon dioxide change at initiation of extracorporeal membrane oxygenation support is associated with survival
A1  - Bembea, Melania M.
A1  - Lee, Ramon
A1  - Masten, Desiree
A1  - Kibler, Kathleen K.
A1  - Lehmann, Christoph U.
A1  - Brady, Kenneth M.
A1  - Easley, R. Blaine
Y1  - 2013/03//
KW  - ECLS
KW  - ECMO
KW  - Extracorporeal life support
KW  - Extracorporeal membrane oxygenation
KW  - Outcome
KW  - Pediatric
JF  - Journal of Extra-Corporeal Technology
VL  - 45
IS  - 1
SP  - 26
EP  - 32
UR  - http://www.ncbi.nlm.nih.gov/pubmed/23691781
UR  - http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC4557460
N2  - Many patient factors have been associated with mortality from extracorporeal membrane oxygenation (ECMO) therapy. Pre-ECMO patient pH and arterial carbon dioxide (paCO2) have been associated with poor outcome and can be significantly altered by ECMO initiation. We hypothesized that the magnitude of change in paCO2 and pH with ECMO initiation could be associated with survival. We designed a retrospective observational study from a single tertiary care center and included all pediatric patients (age younger than 18 years) undergoing ECMO between 2002 and 2010. Electronic records were queried for demographics and clinical characteristics, including the arterial blood gas (ABG) pre- and post-ECMO initiation. Bivariate analysis compared ECMO course characteristics by outcome (survivor vs. nonsurvivor). Multivariable logistic regression was performed on factors associated with the outcome in the bivariate analysis at the significance level of p <.1. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were reported. We identified 201 patients with a median age of 10 days (range, 1 day to 16 years). Indications for ECMO were: respiratory failure (51%), cardiac failure (23%), extracorporeal cardiopulmonary resuscitation (21%), and sepsis (5%). Mortality, defined by death before discharge, was 37% (74 of 201). ABG data pre- and post-ECMO initiations were available in 84% (169 of 201). Age, pH, paCO2, indication, and intracranial hemorrhage were significantly associated with mortality (p <.05). After adjusting for potential confounders (age, use of epinephrine, volume of fluid administered, year of ECMO, ECMO indication, and duration of ECMO) by multivariable logistic regression, the magnitude of paCO2 change (≥25 mmHg) was associated with mortality (adjusted OR, 2.21; 95% CI, 1.06-4.63; p =.036). The decrease in paCO2 with ECMO initiation was associated with mortality. Although this change in paCO2 is multifactorial, it represents a modifiable element of clinical management involving pre-ECMO ventilation, ECMO circuit priming, CO2 administration/removal, and may represent a future therapeutic target that could improve survival in pediatric ECMO.
ER  - 
TY  - JOUR
T1  - Central venous-to-arterial carbon dioxide difference as a prognostic tool in high-risk surgical patients
A1  - Robin, Emmanuel
A1  - Futier, Emmanuel
A1  - Pires, Oscar
A1  - Fleyfel, Maher
A1  - Tavernier, Benoit
A1  - Lebuffe, Gilles
A1  - Vallet, Benoit
Y1  - 2015///
JF  - Critical Care
VL  - 19
IS  - 1
DO  - 10.1186/s13054-015-0917-6
UR  - https://link.springer.com/content/pdf/10.1186/s13054-015-0917-6.pdf
N2  - The purpose of this study was to evaluate the clinical relevance of high values of central venous-to-arterial carbon dioxide difference (PCO2 gap) in high-risk surgical patients admitted to a postoperative ICU. We hypothesized that PCO2 gap could serve as a useful tool to identify patients still requiring hemodynamic optimization at ICU admission. Methods: One hundred and fifteen patients were included in this prospective single-center observational study during a 1-year period. High-risk surgical inclusion criteria were adapted from Schoemaker and colleagues. Demographic and biological data, PCO2 gap, central venous oxygen saturation, lactate level and postoperative complications were recorded for all patients at ICU admission, and 6 hours and 12 hours after admission. Results: A total of 78 (68%) patients developed postoperative complications, of whom 54 (47%) developed organ failure. From admission to 12 hours after admission, there was a significant difference in mean PCO2 gap (8.7 ± 2.8 mmHg versus 5.1 ± 2.6 mmHg; P = 0.001) and median lactate values (1.54 (1.1-3.2) mmol/l versus 1.06 (0.8-1.8) mmol/l; P = 0.003) between patients who developed postoperative complications and those who did not. These differences were maximal at admission to the ICU. At ICU admission, the area under the receiver operating characteristic curve for occurrence of postoperative complications was 0.86 for the PCO2 gap compared to Sequential Organ Failure Assessment score (0.82), Simplified Acute Physiology Score II score (0.67), and lactate level (0.67). The threshold value for PCO2 gap was 5.8 mmHg. Multivariate analysis showed that only a high PCO2 gap and a high Sequential Organ Failure Assessment score were independently associated with the occurrence of postoperative complications. A high PCO2 gap (≥ mmHg) was associated with more organ failure, an increase in duration of mechanical ventilation and length of hospital stay. Conclusion: A high PCO2 gap at admission in the postoperative ICU was significantly associated with increased postoperative complications in high-risk surgical patients. If the increase in PCO2 gap is secondary to tissue hypoperfusion then the PCO2 gap might be a useful tool complementary to central venous oxygen saturation as a therapeutic target.
ER  - 
TY  - JOUR
T1  - Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): A randomised controlled trial
A1  - Devereaux, P. J.
A1  - Yang, Homer
A1  - Yusuf, Salim
A1  - Guyatt, Gordon
A1  - Leslie, Kate
A1  - Villar, Juan Carlos
A1  - Xavier, Denis
A1  - Chrolavicius, Susan
A1  - Greenspan, Launi
A1  - Pogue, Janice
A1  - Pais, Prem
A1  - Liu, Lisheng
A1  - Xu, Shouchun
A1  - Málaga, German
A1  - Avezum, Alvaro
A1  - Chan, Matthew
A1  - Montori, Victor M.
A1  - Jacka, Mike
A1  - Choi, Peter
A1  - Ciapponi, A.
A1  - Garcia Dieguez, M.
A1  - Leslie, K.
A1  - Avezum, A.
A1  - Berwanger, O.
A1  - Hudson, R. J.
A1  - Jacka, M.
A1  - Schricker, T.
A1  - Warriner, B.
A1  - Liu, L.
A1  - Xu, S.
A1  - Villar, J. C.
A1  - Tristan, M.
A1  - Baidel, Y.
A1  - Salazar, A.
A1  - Espinel, M.
A1  - Carlos Zevallos, J.
A1  - Leino, K.
A1  - Keltai, M.
A1  - Faller, J.
A1  - Pais, P.
A1  - Xavier, D.
A1  - Islas Andrade, S.
A1  - Raeder, J.
A1  - Alonso-Coello, P.
A1  - Urrutia, G.
A1  - Gannedahl, P.
A1  - Phrommintikul, A.
A1  - Foëx, P.
A1  - Giles, J.
A1  - Sear, J.
A1  - Goldman, L.
A1  - Caccavo, R. A.
A1  - Ferrari, A.
A1  - Nicolosi, L. N.
A1  - Sierra, F.
A1  - Tesolin, P.
A1  - Barratt, S.
A1  - Beilby, D.
A1  - Bolsin, S.
A1  - Boyd, D.
A1  - Bugler, S.
A1  - Cope, L.
A1  - Douglas, J.
A1  - Fatovich, S.
A1  - Grant, J.
A1  - Halliwell, R.
A1  - Kerridge, R. K.
A1  - Leslie, K.
A1  - Love, J.
A1  - March, S.
A1  - McCulloch, T. J.
A1  - Myles, P. S.
A1  - Paech, M.
A1  - Peyton, P.
A1  - Poole, C.
A1  - Poustie, S.
A1  - Priestly, M.
A1  - Reeves, M.
A1  - Wallace, S.
A1  - Weitkamp, B.
A1  - Wolfers, D.
A1  - Baptista, M.
A1  - Do Amara Baruzzi, A. C.
A1  - Blacher, C.
A1  - Bodanese, L. C.
A1  - Campos De Albuquerque, D.
A1  - Esteves, J. P.
A1  - França Neto, O. R.
A1  - Guiselli Gallina, L. E.
A1  - Izukawa, N. M.
A1  - Kallas, F. C.
A1  - Kerr Saraiva, J. F.
A1  - Marin-Neto, J. A.
A1  - Nigro Maia, L.
A1  - Penha Rosateli, P. H.
A1  - Rabello, R.
A1  - Schammass Ducatti, T.
A1  - Aggarwala, R.
A1  - Argibay-Poliquin, E.
A1  - Badner, N.
A1  - Baer, C.
A1  - Beattie, W. S.
A1  - Bednarowski, M.
A1  - Bertozzi, H. A.
A1  - Boisvenu, G.
A1  - Boulton, A.
A1  - Brunet, D.
A1  - Bryson, G. L.
A1  - Burlingham, J.
A1  - Campeau, J.
A1  - Chauret, D.
A1  - Choi, P.
A1  - Cook, D.
A1  - Cook, D. R.
A1  - Cossette, P.
A1  - Crossan, M.
A1  - Davies, B.
A1  - Devereaux, P. J.
A1  - DeWolfe, J.
A1  - Doig, G.
A1  - Duffy, P.
A1  - Eng, M. S.
A1  - Finlay, S.
A1  - Finlayson, A.
A1  - Gallacher, J.
A1  - Ghali, W.
A1  - Gilbert, K.
A1  - Hughes, D.
A1  - Hunter, L.
A1  - Jacka, M. J.
A1  - Kamra, C.
A1  - Khurana, M.
A1  - Kinsella, C.
A1  - Lanthier, L.
A1  - Lee, T. W.R.
A1  - Lovell, M.
A1  - MacDonald, C.
A1  - MacDonald, P.
A1  - Marquis, M.
A1  - Marti, J.
A1  - Martinek, R.
A1  - Merchant, R. N.
A1  - Misterski, J.
A1  - Mizera, R.
A1  - Moor, R.
A1  - Morin, J.
A1  - O'Reilly, M.
A1  - Ostrander, J.
A1  - Parlow, J. L.
A1  - Paul, J.
A1  - Pettit, S.
A1  - Pilon, D.
A1  - Pruneau, G.
A1  - Rammohan, S.
A1  - Schricker, T.
A1  - Sivakumaran, S.
A1  - Sonnema, L.
A1  - Stoger, S.
A1  - Thompson, C.
A1  - Tod, D.
A1  - Toner, S.
A1  - Turabian, M.
A1  - Twist, D.
A1  - Urbanowicz, C.
A1  - Van Vlymen, J. M.
A1  - Warriner, B.
A1  - Wijeysundera, D. N.
A1  - Wong, D. T.
A1  - Yang, H.
A1  - Zarnke, K.
A1  - Chang, J.
A1  - Chen, K. K.
A1  - Chen, W.
A1  - Chen, W. Z.
A1  - Cui, J. Y.
A1  - Deng, L. L.
A1  - Ge, X. L.
A1  - Hu, W. J.
A1  - Li, H. Y.
A1  - Li, X. S.
A1  - Li, Z.
A1  - Liu, H. L.
A1  - Liu, L. H.
A1  - Liu, X.
A1  - Liu, X. Y.
A1  - Liu, Y. D.
A1  - Lv, B. N.
A1  - Ren, F. X.
A1  - Suo, X. X.
A1  - Tang, L.
A1  - Wang, H.
A1  - Wang, Q. Y.
A1  - Wei, G. W.G.
A1  - Wu, S. B.
A1  - Wu, X. M.
A1  - Wu, Z. D.
A1  - Xiao, R.
A1  - Xu, Y. F.
A1  - Xu, X.
A1  - Zan, Z. X.
A1  - Zhang, L.
A1  - Zhang, W. H.
A1  - Zhao, S. H.
A1  - Zhao, W. D.
A1  - Zou, Y. C.
A1  - Zuo, M. Z.
A1  - Agonh, R.
A1  - Alvarez, S.
A1  - Arrieta, M.
A1  - Barrera, J. G.
A1  - Cáceres, L. E.
A1  - Cañón, W.
A1  - Castellanos, H.
A1  - Chaparro, M. S.
A1  - Chaves, A.
A1  - Chona, J.
A1  - Duarte, E.
A1  - Garcia, H. F.
A1  - Guevara, C.
A1  - Ibarra, P.
A1  - Manrique, J.
A1  - Martinez, L. X.
A1  - Mateus, L.
A1  - Parra, S. B.
A1  - Pava, L. F.
A1  - Perafán, P. E.
A1  - Plata, R.
A1  - Rangel, G. W.
A1  - Rojas, M.
A1  - Romero, M. F.
A1  - Romero, T.
A1  - Ruiz, J.
A1  - Torres, G. F.
A1  - Mellada Herrera, J. A.
A1  - Palomino Cabrera, E.
A1  - Caballero, H.
A1  - Sanchez Velez, M.
A1  - Cruz, T.
A1  - Rodriguez, V.
A1  - Hynynen, M.
A1  - Leino, K.
A1  - Choi, G. Y.S.
A1  - Gin, T.
A1  - Yu, S. C.
A1  - Darvas, K.
A1  - Entz, L.
A1  - Hajdu, Z.
A1  - Keleti, G.
A1  - Nagy, A.
A1  - Peter, S.
A1  - Regoly-Merei, J.
A1  - Abraham, V.
A1  - Afzal, L.
A1  - Agarwal, S.
A1  - Babu Panwar, R.
A1  - Bharani, A.
A1  - Chidambaram, N.
A1  - Desai, S.
A1  - Girija, K. R.
A1  - Gupta, R.
A1  - Gurusan Kaur, S.
A1  - Haridas, K. K.
A1  - Jerry, N.
A1  - Kerkar, P.
A1  - Kilpadi, K.
A1  - Mohanan, P. P.
A1  - Naik, S.
A1  - Narayana Swamy, A. G.
A1  - Parakh, R.
A1  - Paul, S. K.
A1  - Pinjala, R.
A1  - Raja Panwar, V.
A1  - Rajendra Kumar, P.
A1  - Rama Raju, V. A.
A1  - Ramakrishna, P.
A1  - Ramana, P. V.
A1  - Ramanathan, M.
A1  - Ramani Devi, T.
A1  - Ramdas, E. K.
A1  - Saraf, J. K.
A1  - Sigamani, A.
A1  - Singh, R.
A1  - Srivastava, O. P.
A1  - Suresh, K. R.
A1  - Swami, A.
A1  - Varma, S.
A1  - Xavier, F.
A1  - Yadav, A.
A1  - Bahari Noor, M. Y.
A1  - Hassan, J.
A1  - Hian, N. S.
A1  - Pilus, I.
A1  - Wang, C. Y.
A1  - Islas-Andrade, S.
A1  - Mora Martinez, J. M.
A1  - Orta Flores, R.
A1  - Tamez Perez, H. E.
A1  - Chan, B.
A1  - McAllister-Sim, D.
A1  - Vinnell, T.
A1  - Walker, S.
A1  - Young, Y.
A1  - Aasbø, V.
A1  - Mellin-Olsen, J.
A1  - Raeder, J.
A1  - Aguirre, R.
A1  - Aphang-Lam, M.
A1  - Arrunategui, B.
A1  - Baca, L.
A1  - Botazzi Alvarez, R.
A1  - Calmett, D.
A1  - Coloma, E.
A1  - Malaga, G.
A1  - Ponce De Leon, D.
A1  - Rojas Pareja, J. G.E.
A1  - Sihuayro Ancco, A. M.
A1  - Soto Tarazona, A.
A1  - Tupayachi, G.
A1  - Kelly, R. P.
A1  - Alvarez Zurro, C.
A1  - Blanc Saizar, G.
A1  - Cruz Pardos, P.
A1  - De Nadal Clanchet, M.
A1  - Fernandez Riveira, C.
A1  - Martiez Borja, M.
A1  - Mases Fernández, A.
A1  - Moral Garcia, V.
A1  - Toran Garcia, L.
A1  - Unceta-Barrenechea Orue, B.
A1  - Hörnquist, R.
A1  - Malmstedt, J.
A1  - Rosell, J.
A1  - Vimláti, L.
A1  - Kuanprasert, S.
A1  - Rerkkasem, K.
A1  - Foëx, P.
A1  - Giles, J.
A1  - Howard-Alpe, G.
A1  - Sear, J.
Y1  - 2008/05//
PB  - Elsevier
JF  - The Lancet
VL  - 371
IS  - 9627
SP  - 1839
EP  - 1847
DO  - 10.1016/S0140-6736(08)60601-7
UR  - http://www.ncbi.nlm.nih.gov/pubmed/18479744
N2  - Background: Trials of β blockers in patients undergoing non-cardiac surgery have reported conflicting results. This randomised controlled trial, done in 190 hospitals in 23 countries, was designed to investigate the effects of perioperative β blockers. Methods: We randomly assigned 8351 patients with, or at risk of, atherosclerotic disease who were undergoing non-cardiac surgery to receive extended-release metoprolol succinate (n=4174) or placebo (n=4177), by a computerised randomisation phone service. Study treatment was started 2-4 h before surgery and continued for 30 days. Patients, health-care providers, data collectors, and outcome adjudicators were masked to treatment allocation. The primary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal cardiac arrest. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00182039. Findings: All 8351 patients were included in analyses; 8331 (99.8%) patients completed the 30-day follow-up. Fewer patients in the metoprolol group than in the placebo group reached the primary endpoint (94 [5.8%] patients in the metoprolol group vs 290 [6.9%] in the placebo group; hazard ratio 0.84, 95% CI 0.70-0.99; p=0.0399). Fewer patients in the metoprolol group than in the placebo group had a myocardial infarction (176 [4.2%] vs 239 [5.7%] patients; 0.73, 0.60-0.89; p=0.0017). However, there were more deaths in the metoprolol group than in the placebo group (129 [3.1%] vs 97 [2.3%] patients; 1.33, 1.03-1.74; p=0.0317). More patients in the metoprolol group than in the placebo group had a stroke (41 [1.0%] vs 19 [0.5%] patients; 2.17, 1.26-3.74; p=0.0053). Interpretation: Our results highlight the risk in assuming a perioperative β-blocker regimen has benefit without substantial harm, and the importance and need for large randomised trials in the perioperative setting. Patients are unlikely to accept the risks associated with perioperative extended-release metoprolol.
ER  - 
TY  - JOUR
T1  - Central venous-to-arterial carbon dioxide gradient as a marker of occult tissue hypoperfusion after major surgery
A1  - Silbert, B. I.
A1  - Litton, E.
A1  - Ho, Kwok Ming
Y1  - 2015///
KW  - Carbon dioxide
KW  - Cardiac output
KW  - Haemodynamics
KW  - Hyperoxia
JF  - Anaesthesia and Intensive Care
VL  - 43
IS  - 5
SP  - 628
EP  - 634
SN  - 0310-057X (Print)\r0310-057X (Linking)
DO  - 10.1177/0310057x1504300512
N2  - The central venous-arterial carbon dioxide tension gradient ('CO2 gap') has been shown to correlate with cardiac output and tissue perfusion in septic shock. Compared to central venous oxygen saturation (SCV O2), the CO2 gap is less susceptible to the effect of hyperoxia and may be particularly useful as an adjunctive haemodynamic target in the perioperative period. This study investigated whether a high CO2 gap was associated with an increased systemic oxygen extraction (O2 ER >0.3) or occult tissue hypoperfusion in 201 patients in the immediate postoperative period. The median CO2 gap of all patients was 8 mmHg (IQR 6 to 9), and a large CO2 gap was very common (>6 mmHg in 139 patients [69%], 95% CI 63 to 75; >5 mmHg in 170 patients [85%], 95% CI 79 to 89). A CO2 gap <5 mmHg had a higher sensitivity (93%) and negative predictive value (74%) than a CO2 gap <6 mmHg in excluding occult tissue hypoperfusion. Of the four variables that were predictive of an increased O2ER in the multivariate analysis-CO2 gap, arterial pH, haemoglobin and arterial lactate concentrations-the CO2 gap (odds ratio 4.41 per mmHg increment, 95% CI 1.7 to 11.2, P=0.002) was most important and explained about 34% of the variability in the risk of occult tissue hypoperfusion. In conclusion, a normal CO22 gap (<5 mmHg) had a high sensitivity and negative predictive value in excluding inadequate systemic oxygen delivery and may be useful as an adjunct to other haemodynamic targets in avoiding occult tissue hypoperfusion in the perioperative setting when high inspired oxygen concentrations are used.
ER  - 
TY  - JOUR
T1  - Cerebral tissue oxygenation during the initiation of venovenous ECMO
A1  - Kredel, Markus
A1  - Lubnow, Matthias
A1  - Westermaier, Thomas
A1  - Müller, Thomas
A1  - Philipp, Alois
A1  - Lotz, Christopher
A1  - Kilgenstein, Christian
A1  - Küstermann, Julian
A1  - Roewer, Norbert
A1  - Muellenbach, Ralf M.
Y1  - 2014///
KW  - Acute lung injury
KW  - Acute respiratory distress syndrome
KW  - Brain injury
KW  - Extracorporeal membrane oxygenation
KW  - Near-infrared spectroscopy
JF  - ASAIO Journal
VL  - 60
IS  - 6
SP  - 694
EP  - 700
SN  - 1058-2916\r1538-943X
DO  - 10.1097/MAT.0000000000000128
N2  - In an acute respiratory distress syndrome, venovenous extracorporeal membrane oxygenation (vvECMO) can rapidly normalize arterial hypoxemia and carbon dioxide tension (PaCO2). Considering the positive relationship between PaCO2 and cerebral blood flow, the aim of the current study was to evaluate cerebral regional tissue oxygen saturation (rSO2) during the implementation of vvECMO. Fifteen acute respiratory distress syndrome patients with recordings of cerebral rSO2 by near-infrared spectroscopy before vvECMO implementation until the optimization of the ECMO/ventilator settings were retrospectively studied. Results: median (interquartile range). The cerebral rSO2 increased significantly (p < 0.05) from 69(61-74) to 75(60-80)% after ECMO was started, concomitant to the arterial oxygenation. Until the end of the observation period after 83(44-132) minutes, cerebral rSO2 decreased significantly to 61(52-71)%. PaCO2 decreased from 70(61-87) to 43(38-54) mm Hg and the pH increased from 7.23(7.14-7.29) to 7.39(7.34-7.43). The baseline arterial oxygen saturation and tension as well as the actual bicarbonate concentration were negatively correlated with the absolute change in cerebral rSO2 (?rSO2). In the 11 nonhypoxemic patients (arterial oxygen saturation =90%) ?PaCO2 was significantly correlated with ?rSO2. Patients receiving vvECMO treatment are at risk for a decrease in cerebral rSO2. This decrease is more distinct in patients with normal baseline arterial oxygenation and high actual bicarbonate. ASAIO Journal 2014; 60:694-700.
ER  - 
TY  - JOUR
T1  - Extracorporeal membrane oxygenation for critically ill adults ( Review )
A1  - Tramm, R
A1  - Ilic, D
A1  - Ar, Davies
A1  - Va, Pellegrino
A1  - Romero, L
A1  - Hodgson, C
Y1  - 2019///
JF  - Curr Opin Crit Care
VL  - 19
IS  - 1
SP  - 38
EP  - 43
SN  - 0000000000
DO  - 10.1002/14651858.CD010381.pub2.www.cochranelibrary.com
N2  - PURPOSE OF REVIEW: To evaluate the last 2 years' publications for evidence supporting use of extracorporeal membrane oxygenation (ECMO) for critically ill adults with acute respiratory distress syndrome (ARDS). RECENT FINDINGS: First, there are no new prospective studies comparing ECMO and other therapy in adults with ARDS. Second, the number of review articles and case descriptions published in the last 2 years suggests increased interest in ECMO. Third, recently published retrospective cohort studies analyzing patients from the H1N1 epidemic report conflicting conclusions. SUMMARY: Intensivists may have increased their utilization of ECMO. Credible evidence for mortality benefit of ECMO is lacking. A prospective randomized controlled trial designed to evaluate the efficacy of ECMO for ARDS is overdue.
ER  - 
TY  - JOUR
T1  - Extracorporeal membrane oxygenation, an anesthesiologist′s perspective: Physiology and principles. Part 1
A1  - Chauhan, Sandeep
A1  - Subin, S.
Y1  - 2011///
KW  - Cardiopulmonary bypass
KW  - extracorporeal membrane oxygenation
KW  - hemodynamic changes
KW  - oxygenation
KW  - physiology
KW  - venous-arterial ECMO
KW  - venous-venous extracorporeal membrane oxygenation
JF  - Annals of Cardiac Anaesthesia
VL  - 14
IS  - 3
SP  - 218
EP  - 229
DO  - 10.4103/0971-9784.84030
UR  - http://www.annals.in/temp/AnnCardAnaesth143218-8099762_222957.pdf
N2  - Extracorporeal membrane oxygenation (ECMO) is an adaptation of conventional cardiopulmonary bypass techniques to provide cardiopulmonary support. ECMO provides physiologic cardiopulmonary support to aid reversible aspects of the disease process and to allow recovery. ECMO does not provide treatment of the underlying disease. The indications for ECMO support have expanded from acute respiratory failure to acute cardiac failure refractory to conventional treatments from wide patient subsets involving neonates to adults. Vascular access for ECMO support is either percutaneous through a single-site, dual-lumen bicaval cannula or transthoracic via separate cannulas. The modes of support are either veno-venous or veno-arterial ECMO. In this article, the physiologic aspects of ECMO support are outlined.
ER  - 
TY  - JOUR
T1  - Extracorporeal membrane oxygenation-An anesthesiologist's perspective-Part II: Clinical and technical consideration
A1  - Chauhan, Sandeep
A1  - Subin, S.
Y1  - 2012///
KW  - Circuits
KW  - clinical criteria
KW  - extracorporeal membrane oxygenation
KW  - indications
KW  - patient and circuit complications
KW  - patient outcome
KW  - technical aspects
JF  - Annals of Cardiac Anaesthesia
VL  - 15
IS  - 1
SP  - 69
EP  - 82
DO  - 10.4103/0971-9784.91485
UR  - http://www.annals.in/temp/AnnCardAnaesth15169-8102636_223026.pdf
N2  - Although the concept of extracorporeal membrane oxygenation (ECMO) has remained unchanged, component technology has evolved considerably over the past three decades. Presently the clinical conditions requiring ECMO support have been updated with input from the outcome data of patient registries. Modern circuit configuration has become less cumbersome, safer, and more efficient. Technological advances now allow prolonged support with fewer complications compared to the past eras and facilitate transition to a single bedside caregiver model, similar to hemofiltration or ventricular-assist devices. The clinical considerations and indicators for placing the patient on ECMO, the various circuit configurations, clinical and technical issues, and management aspects are considered in this article.
ER  - 
TY  - JOUR
T1  - Prolonged Extracorporeal Oxygenation for Acute Post-Traumatic Respiratory Failure (Shock-Lung Syndrome): Use of the Bramson Membrane Lung
A1  - Hill, J. Donald
A1  - O'brien, Thomas G.
A1  - Murray, James J.
A1  - Dontigny, Leon
A1  - Bramson, M. L.
A1  - Osborn, J. J.
A1  - Gerbode, F.
Y1  - 1972/03//
JF  - New England Journal of Medicine
VL  - 286
IS  - 12
SP  - 629
EP  - 634
DO  - 10.1056/NEJM197203232861204
UR  - http://www.ncbi.nlm.nih.gov/pubmed/5060491
UR  - http://www.nejm.org/doi/abs/10.1056/NEJM197203232861204
N2  - A 24-year-old man sustained subadventitial transection of the thoracic aorta and multiple orthopedic injuries resulting from blunt trauma. The aortic injury was repaired. Because respiratory failure occurred four days later and worsened despite maximal conventional supportive therapy, partial venoarterial perfusion with peripheral cannulation, with use of the Bramson-membrane heart-lung machine, was initiated and continued for 75 hours. At a by-pass flow of 3.0 to 3.6 liters per minute, oxygen tension increased from 38 to 75 mm of mercury, inspired oxygen concentration was reduced from 100 to 60 per cent, and peak airway pressure decreased from 60 to 35 cm of water. The shock-lung syndrome was reversed, and the patient recovered. End-stage shock lung may be reversible if the patient receives adequate gas exchange through partial extracorporeal circulation with an appropriate membrane lung. Shock lung as a clinical entity is now a well recognized phenomenon after trauma, extensive surgery, hemorrhage, burn or shock.1,2 Thus far, no single treatment has been consistently successful.3,4 In the case reported below prolonged partial venoarterial extracorporeal circulation was successfully used in the treatment of shock lung after extensive trauma. Case Report Injury and Diagnosis A 24-year-old man was admitted to the emergency room of the Santa Barbara Cottage Hospital about 30 minutes after being struck by an automobile. He had not lost consciousness. Pain was severe in the pelvis and lower extremities. The blood pressure was 74/30, the. © 1972, Massachusetts Medical Society. All rights reserved.
ER  - 
TY  - JOUR
T1  - Extracorporeal membrane oxygenation (ECMO) in patients with H1N1 influenza infection: A systematic review and meta-analysis including 8 studies and 266 patients receiving ECMO
A1  - Zangrillo, Alberto
A1  - Biondi-Zoccai, Giuseppe
A1  - Landoni, Giovanni
A1  - Frati, Giacomo
A1  - Patroniti, Nicolò
A1  - Pesenti, Antonio
A1  - Pappalardo, Federico
Y1  - 2013/02//
JF  - Critical Care
VL  - 17
IS  - 1
SP  - R30
EP  - R30
DO  - 10.1186/cc12512
UR  - http://www.ncbi.nlm.nih.gov/pubmed/23406535
UR  - http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC4057025
UR  - http://ccforum.biomedcentral.com/articles/10.1186/cc12512
N2  - Introduction: H1N1 influenza can cause severe acute lung injury (ALI). Extracorporeal membrane oxygenation (ECMO) can support gas exchange in patients failing conventional mechanical ventilation, but its role is still controversial. We conducted a systematic review and meta-analysis on ECMO for H1N1-associated ALI.Methods: CENTRAL, Google Scholar, MEDLINE/PubMed and Scopus (updated 2 January 2012) were systematically searched. Studies reporting on 10 or more patients with H1N1 infection treated with ECMO were included. Baseline, procedural, outcome and validity data were systematically appraised and pooled, when appropriate, with random-effect methods.Results: From 1,196 initial citations, 8 studies were selected, including 1,357 patients with confirmed/suspected H1N1 infection requiring intensive care unit admission, 266 (20%) of whom were treated with ECMO. Patients had a median Sequential Organ Failure Assessment (SOFA) score of 9, and had received mechanical ventilation before ECMO implementation for a median of two days. ECMO was implanted before inter-hospital patient transfer in 72% of cases and in most patients (94%) the veno-venous configuration was used. ECMO was maintained for a median of 10 days. Outcomes were highly variable among the included studies, with in-hospital or short-term mortality ranging between 8% and 65%, mainly depending on baseline patient features. Random-effect pooled estimates suggested an overall in-hospital mortality of 28% (95% confidence interval 18% to 37%; I2= 64%).Conclusions: ECMO is feasible and effective in patients with ALI due to H1N1 infection. Despite this, prolonged support (more than one week) is required in most cases, and subjects with severe comorbidities or multiorgan failure remain at high risk of in-hospital death. © 2013 Zangrillo et al.; licensee BioMed Central Ltd.
ER  - 
TY  - JOUR
T1  - Long-term outcomes of pandemic 2009 influenza A(H1N1)-associated severe ARDS
A1  - Luyt, Charles Edouard
A1  - Combes, Alain
A1  - Becquemin, Marie Heĺène
A1  - Beigelman-Aubry, Catherine
A1  - Hatem, Steṕhane
A1  - Brun, Anne Laure
A1  - Zraik, Nizar
A1  - Carrat, Fabrice
A1  - Grenier, Philippe A.
A1  - Richard, Jean Christophe M.
A1  - Mercat, Alain
A1  - Brochard, Laurent
A1  - Brun-Buisson, Christian
A1  - Chastre, Jean
Y1  - 2012/09//
JF  - Chest
VL  - 142
IS  - 3
SP  - 583
EP  - 592
DO  - 10.1378/chest.11-2196
UR  - http://www.ncbi.nlm.nih.gov/pubmed/22948576
UR  - http://linkinghub.elsevier.com/retrieve/pii/S0012369212605017
N2  - Background: No data on long-term outcomes of survivors of 2009 influenza A(H1N1) (A[H1N1])-associated ARDS are available. The objective of this study was to compare the 1-year outcomes of survivors of A(H1N1)-associated ARDS, according to use or no use of extracorporeal lung assist (ECLA), using its need as an ARDS severity surrogate. Methods: Survivors of ARDS (12 with ECLA use vs 25 without, corresponding to 75% and 54% of the eligible patients for each group, respectively) selected from the Réseau Européen de Ventilation Artificielle (REVA) registry had previously been healthy, with only pregnancy and/or moderate obesity (BMI ≤ 35 kg/m2) as known risk factors for A(H1N1) infection. Lung function and morphology, health-related quality of life (HRQoL), and psychologic impairment were evaluated. Results: At 1 year post-ICU discharge for the ECLA and no-ECLA groups, respectively, 50% and 40% reported significant exertion dyspnea, 83% and 64% had returned to work, and 75% and 64% had decreased diffusion capacity across the blood-gas barrier, despite their near-normal and similar lung function test results. For both groups, exercise test results showed diminished but comparable exercise capacities, with similar alveolar-arterial oxygen gradients at peak exercise, and CT scans showed minor abnormal findings. HRQoL assessed by the 36-Item Short-Form Health Survey was poorer for both groups than for a sex- and age-matched general population group, but without between-group differences. ECLA and no-ECLA group patients, respectively, had symptoms of anxiety (50% and 56%) and depression (28% and 28%) and were at risk for posttraumatic stress disorder (41% and 44%). Conclusions: One year post-ICU discharge, a majority of survivors of A(H1N1)-associated ARDS had minor lung disabilities with diminished diffusion capacities across the blood-gas barrier, and most had psychologic impairment and poorer HRQoL than a sex- and age-matched general population group. ECLA and no-ECLA group patients had comparable outcomes. Trial registry: ClinicalTrials.gov; No.: NCT01271842; URL: www.clinicaltrials.gov. © 2012 American College of Chest Physicians.
ER  - 
TY  - JOUR
T1  - The journey of pediatric ECMO
A1  - Mehta, Tejas
A1  - Sallehuddin, Ahmed
A1  - John, Jiju
Y1  - 2017///
JF  - Qatar Medical Journal
VL  - 2017
IS  - 1
SP  - 4
EP  - 4
DO  - 10.5339/qmj.2017.swacelso.4
UR  - http://www.qscience.com/doi/pdf/10.5339/qmj.2017.swacelso.4
N2  - Introduction: Extracorporeal membrane oxygenation (ECMO) is an adaptation of conventional cardio-pulmonary bypass techniques used for long-term support of respiratory and/or cardiac function. It provides physiologic cardiopulmonary support for patients with acute, reversible cardiac or respiratory failure. The term "extracorporeal life support" (ECLS) was proposed to describe prolonged but temporary (1–30 days) support of heart or lung function using mechanical devices. Technically, ECMO terminology is used for modalities that provide pulmonary support system involving oxygenation and carbon dioxide removal, and ECLS is used for both cardiac and pulmonary support systems, but these terminologies are still used interchangeably.
ER  - 
TY  - JOUR
T1  - Extracorporeal support for patients with acute respiratory distress syndrome
A1  - Finney, Simon J.
Y1  - 2014/09//
PB  - European Respiratory Society
JF  - European Respiratory Review
VL  - 23
IS  - 133
SP  - 379
EP  - 389
DO  - 10.1183/09059180.00005514
UR  - http://www.ncbi.nlm.nih.gov/pubmed/25176974
N2  - Extracorporeal membrane oxygen (ECMO) has been used for many years in patients with life-threatening hypoxaemia and/or hypercarbia. While early trials demonstrated that it was associated with poor outcomes and extensive haemorrhage, the technique has evolved. It now encompasses new technologies and understanding that the lung protective mechanical ventilation it can facilitate is inextricably linked to improving outcomes for patients. The positive results from the CESAR (Conventional ventilation or ECMO for Severe Adult Respiratory failure) study and excellent outcomes in patients who suffered severe influenza A (H1N1/09) infection have established ECMO in the care of patients with severe acute respiratory distress syndrome. Controversy remains as to at what point in the clinical pathway ECMO should be employed; as a rescue therapy or more pro-actively to enable and ensure high-quality lung protective mechanical ventilation. The primary aims of this article are to discuss: 1) the types of extracorporeal support available; 2) the rationale for its use; 3) the relationship with lung protective ventilation; and 4) the current evidence for its use. © ERS 2014.
ER  - 
TY  - JOUR
T1  - ELSO Pediatric Respiratory Failure Supplement to the ELSO General Guidelines Extracorporeal Life Support Organization (ELSO) Guidelines for Pediatric Respiratory Failure
Y1  - 2013///
UR  - https://www.elso.org/Portals/0/IGD/Archive/FileManager/e76ef78eabcusersshyerdocumentselsoguidelinesforadultcardiacfailure1.3.pdf
ER  - 
TY  - JOUR
T1  - Extracorporeal Life Support Organization ECLS Guidelines 2018 Guidelines for Pediatric Cardiac Failure
A1  - Brown, Georgia
A1  - Deatrick, Kristopher B
Y1  - 2017///
SP  - 1
EP  - 43
UR  - http://www.elso.org/resources/guidelines.aspx,
N2  - This guideline is a supplement to " General Guidelines for Extracorporeal Life Support " , and applies to the use of ECLS to neonates, infants and children with cardiac failure. Disclaimer This guideline describes useful and safe practice but these are not necessarily consensus recommendations for extracorporeal life support (ECLS). These guidelines are not intended as a standard of care, and are revised at regular intervals as new information, devices, medications, and techniques become available. These guidelines are intended for educational use to build the knowledge of physicians and other health professionals in assessing the conditions and managing the treatment of patients undergoing ECLS. These guidelines are not a substitute for a health care provider's professional judgment and must be interpreted with regard to specific information about the patient and in consultation with other medical authorities as appropriate. In no event will ELSO be liable for any decision made or action taken in reliance upon the information provided through these guidelines. Reference as Pediatric Cardiac Failure, Extracorporeal Life Support Organization, Ann Arbor, MI. [cited 2017 Feb 15]. Available from
ER  - 
TY  - MGZN
T1  - New perspectives on extracorporeal membrane oxygenation
A1  - Santacruz, Carlos Miguel
Y1  - 2015///
JF  - Revista Colombiana de Cardiologia
VL  - 22
IS  - 1
SP  - 66
EP  - 67
DO  - 10.1016/j.rccar.2015.03.003
UR  - www.elsevier.es/revcolcar
N2  - En enero del año en curso, la Extracorporeal life support organization (ELSO), la más grande entidad que recoge y divulga información acerca de soporte vital extracorpóreo en el mundo, emitió el último reporte de estadísticas lle-vadas a cabo desde 1990 hasta 2014, en el que se observa una tendencia clara: el aumento del número de pacientes y de centros en los cuales se realiza oxigenación por mem-brana extracorpórea (ECMO) desde el inicio del registro, llegándose a 251 centros inscritos y 5.037 pacientes con una supervivencia general del 71% 1 . El 2014 fue el primer año en el que se reportó una disminución en el número de pacien-tes en comparación con el 2013 (5.626 casos). Una de las razones que pueden explicar este comportamiento particu-lar es la posible estabilización de la cantidad de pacientes en una cifra cercana a este número ya que se calcula que debe existir un centro de ECMO por cada 2 a 3 millones de habitantes, y cada uno de estos centros debe llevar en pro-medio 12 pacientes anuales, datos que, aproximadamente, equivalen a la población total del número de países en los cuales está disponible esta terapia. Tampoco se debe obviar un importante subregistro de pacientes de centros no ins-critos en la ELSO, dentro de los que se cuentan casi todos los centros de Colombia. Es posible que muchos centros no registrados estén utilizando cada vez más esta terapia, pero que este incremento no se refleje en las estadísticas del ente verificador. Por lo pronto, la ECMO continúa siendo una terapia no probada, como bien lo demuestra la literatura, que viene tratando, con algún éxito, de unificar indicaciones, crite-rios y formas de manejo 2,3 . Paradójicamente, el aumento de centros y pacientes indica que la falta de evidencia no ha disminuido el crecimiento de las instituciones donde se lleva a cabo. Colombia no ha sido inmune a esta tendencia y cada año se incrementa el uso de esta terapia en diferentes centros, en especial en aquellos dedicados a enfermedades cardio-vasculares, así como en diferentes unidades de cuidados intensivos. Es evidente el aumento de cursos, talleres etc., que han logrado expandir el conocimiento y las habilidades básicas a prácticamente todas las grandes ciudades del país. La inclusión de nuevas tecnologías siempre ha traído retos para los médicos e implica una responsabilidad en su administración. Mientras la ELSO y prácticamente toda la literatura son claras en afirmar que el éxito de la ECMO está estrictamente relacionado con el número de casos que atiende cada centro, así como con el manejo multidiscipli-nario y el entrenamiento continuo, en Colombia aumentan exponencialmente dichos centros pese a que pocos reúnen el número de pacientes recomendados (alrededor de 12 por año) para poder ser reconocido como centro de ECMO en el ámbito internacional. Entre tanto, la presión de la industria es indudable y la necesidad de innovación a cualquier costo también es responsable de este crecimiento. Este hecho se demuestra en que es casi imposible saber la cantidad de centros o pacientes sometidos a esta terapia en los últimos años, si bien, tomando como base reportes anecdóticos, se cuentan cerca de 5 centros en Bogotá y alrededor de 10 en el resto del país. Por su parte, las sociedades científicas deben empezar a observar este fenómeno con cuidado, llevar un control y, de ser posible, regular esta explosión para no repetir los errores de los países que ya recorrieron este camino. Ante la claridad de las recomendaciones, lo ideal es incrementar el número de pacientes por centro, como se ha hecho en EE. UU. y en algunos países de Europa, con el fin de que se garantice a los pacientes una mejoría en la supervivencia y a los médicos y a las instituciones se les ofrezca el beneficio de contar con centros más especializados y efectivos.
ER  - 
TY  - JOUR
T1  - ECMO veno-arterial en pacientes adultos con choque cardiogénico refractario. Características clínicas y supervivencia en una serie de casos
A1  - Cohen Ruiz, Arnaldo
Y1  - 2017/03//
KW  - 617.96
KW  - Anestesiología
KW  - Análisis de supervivencia
KW  - Características clínicas
KW  - Cardiopatías
KW  - Choque cardiogénico refractario
KW  - Circulación asistida
KW  - Circulación sanguínea
KW  - Clinical characteristics
KW  - ECMO veno
KW  - Refractory cardiogenic shock
KW  - Survival analysis
KW  - arterial
KW  - arterial ECMO
KW  - veno
PB  - Universidad del Rosario
JF  - Repositorio Institucional Universidad del Rosario
UR  - http://repository.urosario.edu.co//handle/10336/13287%0Ahttp://repository.urosario.edu.co/handle/10336/13287?show=full
N2  - Objetivo: describir las características clínicas y determinar probabilidad de supervivencia de los pacientes llevados a ECMO veno-arterial (ECMO VA) por indicación cardiaca en la Fundación Cardioinfantil (FCI-IC). Materiales y métodos: se realizó un análisis retrospectivo de una serie de 17 pacientes que fueron llevados a ECMO VA tras presentar choque cardiogénico refractario por múltiples causas: síndrome postcardiotomía (SPC), infarto agudo del miocardio, falla cardiaca crónica agudizada (FCCA), disfunción primaria de corazón trasplantado, entre otras. Se realizó descripción de las características demográficas y clínicas con medidas de tendencia central. Se realizó un análisis para determinar la probabilidad de sobrevivir a la terapia ECMO. Resultados: 12 pacientes fueron separados con vida del soporte con ECMO (71%) y 9 sobrevivieron al alta hospitalaria (53%). 50% de los fallecidos era mayor de 61 años y 100% de ellos tenía más de 50 años. Diabetes mellitus, hipertensión arterial, EPOC e hipertensión pulmonar fueron más frecuentes en los pacientes que murieron durante la ECMO VA. Las dos causas más frecuentes de choque cardiogénico fueron la FCCA y el SPC. La mediana de duración de la ECMO fue de 3 días. La probabilidad de supervivencia se redujo a 66% al quinto día de tratamiento. Conclusiones: la mortalidad intraterapia de la ECMO VA por indicación cardiaca en la FCI-IC es similar a la registrada a nivel mundial, observándose una disminución significativa de la probabilidad de sobrevida después del quinto día de tratamiento con soporte extracorpóreo.
ER  - 
TY  - JOUR
T1  - Capítulo 12. Dispositivos de asistencia ventricular: una realidad en Colombia
A1  - Echeverría, Luis E.
A1  - Salazar, Leonardo
A1  - Torres, Ángela
A1  - Figueredo, Antonio
Y1  - 2015/03//
KW  - Cardiogenic shock
KW  - Heart assist devices
KW  - Heart failure
KW  - Heart transplantation
PB  - Elsevier
JF  - Revista Colombiana de Cardiologia
VL  - 23
SP  - 49
EP  - 54
DO  - 10.1016/j.rccar.2016.01.014
UR  - https://www.sciencedirect.com/science/article/pii/S0120563316000188
N2  - Introduction Heart failure is one of the most prevalent causes of morbidity and mortality in the world. Despite improvements in medical therapy and cardiac stimulation devices, there are a number of patients who progress to refractory heart failure and their options are reduced to inotropes, heart transplantation and ventricular assist devices. Objective To present the current ventricular assist devices which are available to patients with advanced heart failure. Methodology Narrative review of the literature. Conclusion Mechanical ventricular assistance has become a viable option as a bridge to heart transplantation or as definitive long-term therapy, because it has a favourable impact on mortality and quality of life. In Colombia, the placing of ventricular assist devices has considerably increased in recent years and despite the constraints due to their high cost, the country is the first in South America to implant a HeartMate II device for assistance as destination therapy. This article describes the benefits of ventricular assist devices, its indications and availability in Colombia.
ER  - 
TY  - JOUR
T1  - Central venous oxygenation: When physiology explains apparent discrepancies
A1  - Squara, Pierre
Y1  - 2014/12//
KW  - Emergency Medicine
KW  - Intensive / Critical Care Medicine
PB  - BioMed Central
JF  - Critical Care
VL  - 18
IS  - 6
SP  - 579
EP  - 579
DO  - 10.1186/s13054-014-0579-9
UR  - http://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0579-9
N2  - Central venous oxygen saturation (ScvO2) >70% or mixed venous oxygen saturation (SvO2) >65% is recommended for both septic and non-septic patients. Although it is the task of experts to suggest clear and simple guidelines, there is a risk of reducing critical care to these simple recommendations. This article reviews the basic physiological and pathological features as well as the metrological issues that provide clear evidence that SvO2 and ScvO2 are adaptative variables with large inter-patient variability. This variability is exemplified in a modeled population of 1,000 standard ICU patients and in a real population of 100 patients including 15,860 measurements. In these populations, it can be seen how optimizing one to three of the four S(c)vO2 components homogenized the patients and yields a clear dependency with the fourth one. This explains the discordant results observed in large studies where cardiac output was increased up to predetermined S(c)vO2 thresholds following arterial oxygen hemoglobin saturation, total body oxygen consumption needs and hemoglobin optimization. Although a systematic S(c)vO2 goal-oriented protocol can be statistically profitable before ICU admission, appropriate intensive care mandates determination of the best compromise between S(c)vO2 and its four components, taking into account the specific constraints of each individual patient.
ER  - 
TY  - JOUR
T1  - Ratios of central venous-to-arterial carbon dioxide content or tension to arteriovenous oxygen content are better markers of global anaerobic metabolism than lactate in septic shock patients
A1  - Mallat, Jihad
A1  - Lemyze, Malcolm
A1  - Meddour, Mehdi
A1  - Pepy, Florent
A1  - Gasan, Gaelle
A1  - Barrailler, Stephanie
A1  - Durville, Emmanuelle
A1  - Temime, Johanna
A1  - Vangrunderbeeck, Nicolas
A1  - Tronchon, Laurent
A1  - Vallet, Benoît
A1  - Thevenin, Didier
Y1  - 2016/12//
KW  - Acute circulatory failure
KW  - Anaerobic metabolism
KW  - Lactate
KW  - Oxygen consumption
KW  - Septic shock
KW  - Tissue hypoxia
KW  - Venous oxygen saturation
KW  - Venous-to-arterial carbon dioxide difference
JF  - Annals of Intensive Care
VL  - 6
IS  - 1
SP  - 1
EP  - 9
DO  - 10.1186/s13613-016-0110-3
UR  - http://www.annalsofintensivecare.com/content/6/1/10
N2  - Background: To evaluate the ability of the central venous-to-arterial CO2 content and tension differences to arteriovenous oxygen content difference ratios (∆ContCO2/∆ContO2 and ∆PCO2/∆ContO2, respectively), blood lactate concentration, and central venous oxygen saturation (ScvO2) to detect the presence of global anaerobic metabolism through the increase in oxygen consumption (VO2) after an acute increase in oxygen supply (DO2) induced by volume expansion (VO2/DO2 dependence). Methods: We prospectively studied 98 critically ill mechanically ventilated patients in whom a fluid challenge was decided due to acute circulatory failure related to septic shock. Before and after volume expansion (500 mL of colloid solution), we measured cardiac index, VO2, DO2, ∆ContCO2/∆ContO2 and ∆PCO2/∆ContO2 ratios, lactate, and ScvO2. Fluid-responders were defined as a ≥15 % increase in cardiac index. Areas under the receiver operating characteristic curves (AUC) were determined for these variables. Results: Fifty-one patients were fluid-responders (52 %). DO2 increased significantly (31 ± 12 %) in these patients. An increase in VO2 ≥ 15 % (“VO2-responders”) concurrently occurred in 57 % of the 51 fluid-responders (45 ± 16 %). Compared with VO2-non-responders, VO2-responders were characterized by higher lactate levels and higher ∆ContCO2/∆ContO2 and ∆PCO2/∆ContO2 ratios. At baseline, lactate predicted a fluid-induced increase in VO2 ≥ 15 % with AUC of 0.745. Baseline ∆ContCO2/∆ContO2 and ∆PCO2/∆ContO2 ratios predicted an increase of VO2 ≥ 15 % with AUCs of 0.965 and 0.962, respectively. Baseline ScvO2 was not able to predict an increase of VO2 ≥ 15 % (AUC = 0.624). Conclusions: ∆ContCO2/∆ContO2 and ∆PCO2/∆ContO2 ratios are more reliable markers of global anaerobic metabolism than lactate. ScvO2 failed to predict the presence of global tissue hypoxia.
ER  - 
TY  - JOUR
T1  - Gas exchange theory and the lactic acidosis (anaerobic) threshold
A1  - Wasserman, K.
A1  - Beaver, W. L.
A1  - Whipp, B. J.
Y1  - 1990/01//
KW  - Buffering of metabolic acid
KW  - CO2 production
KW  - Cell redox state
KW  - Exercise
KW  - O2 consumption
KW  - O2 transport
JF  - Circulation
VL  - 81
IS  - 1 SUPPL. II
SP  - II14
EP  - I30
SN  - 0009-7322 (Print)\r0009-7322 (Linking)
UR  - http://www.ncbi.nlm.nih.gov/pubmed/2403868
N2  - The physiological requirements of performing exercise above the anaerobic threshold are considerably more demanding than for lower work rates. Lactic acidosis develops at a metabolic rate that is specific to the individual and the task being performed. Although numerous pyruvate-dependent mechanisms can lead to an elevated blood lactate, the increase in lactate during muscular exercise is accompanied by an increase in lactate-pyruvate ratio (i.e., increased NADH/NAD ratio). This is typically caused by an inadequate O2 supply to the mitochondria. Thus, the anaerobic threshold can be considered to be an important assessment of the ability of the cardiovascular system to supply O2 at a rate adequate to prevent muscle anaerobiosis during exercise testing. In this paper, we demonstrate, with statistical justification, that the pattern of arterial lactate and lactate/pyruvate ratio increase during exercise evidences threshold dynamics rather than the continuous exponential increase proposed by some investigators. The pattern of change in arterial bicarbonate (HCO3-) and pulmonary gas exchange supports this threshold concept. To estimate the anaerobic threshold by gas exchange methods, we measure CO2 output (V̇CO2) as a continuous function of O2 uptake (VO2) (V-slope analysis) as work rate is increased. The break-point in this plot reflects the obligate buffering of increasing lactic acid production by HCO3-. The anaerobic threshold measured by the V-slope analysis appears to be a sensitive index of the development of metabolic acidosis even in subjects in whom other gas exchange indexes are insensitive, owing to irregular breathing, reduced chemoreceptor sensitivity, impaired respiratory mechanics, or all of these occurrences.
ER  - 
TY  - JOUR
T1  - The use of the ratio between the veno-arterial carbon dioxide difference and the arterial-venous oxygen difference to guide resuscitation in cardiac surgery patients with hyperlactatemia and normal central venous oxygen saturation
A1  - Du, Wei
A1  - Long, Yun
A1  - Wang, Xiao Ting
A1  - Liu, Da Wei
Y1  - 2015/05//
KW  - Cardiac Surgical Procedures
KW  - Lactic Acid
KW  - Physiologic Monitoring
KW  - Resuscitation
PB  - Wolters Kluwer -- Medknow Publications
JF  - Chinese Medical Journal
VL  - 128
IS  - 10
SP  - 1306
EP  - 1313
DO  - 10.4103/0366-6999.156770
UR  - http://www.ncbi.nlm.nih.gov/pubmed/25963349
UR  - http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC4830308
N2  - Background: After cardiac surgery, central venous oxygen saturation (ScvO<inf>2</inf>) and serum lactate concentration are often used to guide resuscitation; however, neither are completely reliable indicators of global tissue hypoxia. This observational study aimed to establish whether the ratio between the veno‑arterial carbon dioxide and the arterial‑venous oxygen differences (P(v−a)CO<inf>2</inf>/C(a−v)O<inf>2</inf>) could predict whether patients would respond to resuscitation by increasing oxygen delivery (DO<inf>2</inf>). Methods: We selected 72 patients from a cohort of 290 who had undergone cardiac surgery in our institution between January 2012 and August 2014. The selected patients were managed postoperatively on the Intensive Care Unit, had a normal ScvO<inf>2</inf>, elevated serum lactate concentration, and responded to resuscitation by increasing DO<inf>2</inf> by >10%. As a consequence, 48 patients responded with an increase in oxygen consumption (VO<inf>2</inf>) while VO<inf>2</inf> was static or fell in 24. Results: At baseline and before resuscitative intervention in postoperative cardiac surgery patients, a P(v−a)CO<inf>2</inf>/C(a−v)O<inf>2</inf> ratio ≥1.6 mmHg/ml predicted a positive VO<inf>2</inf> response to an increase in DO<inf>2</inf> of >10% with a sensitivity of 68.8% and a specificity of 87.5%. Conclusions: P(v−a)CO<inf>2</inf>/C(a−v)O<inf>2</inf> ratio appears to be a reliable marker of global anaerobic metabolism and predicts response to DO<inf>2</inf> challenge. Thus, patients likely to benefit from resuscitation can be identified promptly, the P(v−a)CO<inf>2</inf>/C(a−v)O<inf>2</inf> ratio may, therefore, be a useful resuscitation target.
ER  - 
TY  - JOUR
T1  - Hemodynamic management of cardiovascular failure by using PCO2 venous-arterial difference
A1  - Dres, Martin
A1  - Monnet, Xavier
A1  - Teboul, Jean Louis
Y1  - 2012/10//
KW  - Carbon dioxide tension
KW  - Carbone dioxide production
KW  - Tissue hypoxia
KW  - Veno-arterial carbon dioxide tension difference
JF  - Journal of Clinical Monitoring and Computing
VL  - 26
IS  - 5
SP  - 367
EP  - 374
DO  - 10.1007/s10877-012-9381-x
UR  - http://www.ncbi.nlm.nih.gov/pubmed/22828858
UR  - http://link.springer.com/10.1007/s10877-012-9381-x
N2  - The difference between mixed venous blood carbon dioxide tension (PvCO2) and arterial carbon dioxide tension (PaCO2) called DPCO2 has been proposed to better characterize the hemodynamic status. It depends on the global carbon dioxide (CO2) production, on cardiac output and on the complex relation between CO2 tension and CO2 content. The aim of this review is to detail the physiological background allowing adequate interpretation of DPCO2 at the bedside. Clinical and experimental data support the use of DPCO2 as a valuable help in the decision-making process in patients with hemodynamic instability. The difference between central venous CO2 tension and arterial CO2 tension, which is easy to obtain can substitute for DPCO2 to assess the adequacy of cardiac output. Differences between local tissue CO2 tension and arterial CO2 tension can also be obtained and provide data on the adequacy of local blood flow to the local metabolic conditions. © Springer Science+Business Media, LLC 2012.
ER  - 
TY  - JOUR
T1  - Central Venous-to-Arterial Carbon Dioxide Partial Pressure Difference in Patients Undergoing Cardiac Surgery is Not Related to Postoperative Outcomes
A1  - Guinot, Pierre Grégoire
A1  - Badoux, Louise
A1  - Bernard, Eugénie
A1  - Abou-Arab, Osama
A1  - Lorne, Emmanuel
A1  - Dupont, Hervé
Y1  - 2017/08//
KW  - cardiac surgery
KW  - cardiopulmonary bypass
KW  - central venous oxygen saturation
KW  - central venous-to-arterial carbon dioxide differen
KW  - postoperative complications
PB  - W.B. Saunders
JF  - Journal of Cardiothoracic and Vascular Anesthesia
VL  - 31
IS  - 4
SP  - 1190
EP  - 1196
DO  - 10.1053/j.jvca.2017.02.015
UR  - https://www.sciencedirect.com/science/article/pii/S1053077017300654
N2  - Objective The objective of this study was to assess the association between increased central venous-to-arterial carbon dioxide difference (ΔPCO2) following cardiac surgery with cardiopulmonary bypass and postoperative morbidity and mortality. Design A prospective, observational, non-interventional study. Patients Three hundred ninety-three patients undergoing cardiac surgery with cardiopulmonary bypass. Interventions The primary endpoint was the occurrence of one or more major postoperative complications. A ΔPCO2 ≥ 6 mmHg was considered to be abnormal. Data were first analyzed globally, and then according to 4 subgroups based on time course of ΔPCO2 during the study period: [(1) persistently normal ΔPCO2; (2) increasing ΔPCO2; (3) decreasing ΔPCO2; and (4) persistently high ΔPCO2]. Results A total of 238 of the 393 (61%) patients developed complications. The major postoperative complication rate did not differ among the 4 groups: 64% (n = 9) in group 1, 62% (n = 21) in group 2, 53% (n = 32) in group 3, and 62% (n = 176) in group 4 (p = 0.568). Mortality rates did not differ among the 4 groups (p > 0.05). ΔPCO2 was correlated weakly with perfusion parameters. Conclusions These results suggested that ΔPCO2 is not predictive of postoperative complications or mortality.
ER  - 
TY  - RPRT
T1  - Guía de hemorragia posparto Código Rojo Periodo de investigación y desarrollo de la Guía (2013)
A1  - Petro, Gustavo Francisco
A1  - Alcalde Mayor De Bogotá, Urrego
A1  - Mauricio, D C
A1  - Bustamante García, Alberto
A1  - García, Giovanni Rubiano
A1  - Graciela, Elsa
A1  - Echeverri, Martínez
A1  - Aponte, Consuelo Peña
A1  - Cabrera, Tatiana Valentina
A1  - Profesional Especializada Grupo, Sierra
A1  - Perinatal, Materno
A1  - Caro, Jorge Eduardo Caro
A1  - Galindo, Augusto González
A1  - Ii, Alvinzy
A1  - Becerra, Velázquez
A1  - Alba, Reinaldo Niño
A1  - Romero, Mauricio Jiménez
A1  - Marcela, Claudia
A1  - Becerra, Villacis
A1  - Alberto, Jesús
A1  - Baquero, Echevarría
A1  - Orozco, Oriana Obagi
A1  - Díaz, Gustavo Patiño
A1  - Carlos, Juan
A1  - Garzón, Vera
A1  - Enrique, Aldo
A1  - Rojas, Cadena
A1  - Echeverry, Martínez
A1  - Lucía, Martha
A1  - Moreno Profesional Especializada, Mora
A1  - Perinatal, Grupo Materno
Y1  - 2014///
UR  - http://www.saludcapital.gov.co/DDS/Publicaciones/Guia Maternidad-Codigo Rojo_7A.pdf
ER  - 
TY  - JOUR
T1  - New technology for noninvasive brain monitoring: continuous cerebral oximetry.
A1  - Casati, A
A1  - Spreafico, E
A1  - Putzu, M
A1  - Fanelli, G
Y1  - 2006///
KW  - Brain Chemistry
KW  - Humans
KW  - Intraoperative
KW  - Monitoring
KW  - Oximetry
KW  - Oxygen
JF  - Minerva anestesiologica
VL  - 72
IS  - 7-8
SP  - 605
EP  - 25
SN  - 0375-9393 (Print)\r0375-9393 (Linking)
UR  - http://www.ncbi.nlm.nih.gov/pubmed/16865080
N2  - Although the central nervous system is the primary endpoint of most general anesthetics, it is still the least monitored organ in clinical anesthesiology. In the last decade, technological research has expanded the application of near-infrared spectroscopy to allow continuous, non-invasive, and bedside monitoring of cerebral oxygen saturation (rSO(2)) through the scalp and skull, providing accurate information on the balance between brain oxygen supply and demand. The aim of this review is to provide an overview on relevant technological issues of cerebral oximetry, describe a systematic approach to its use, and summarize current information on its possible impact on our daily practice. We reviewed studies published on peer-reviewed journals about technological development and clinical application of rSO(2) monitoring in different fields of application to clinical practice. Due to the wide patient-to-patient variability of baseline rSO(2) values in each patient the baseline value should be determined before inducing general anesthesia, and cerebral ischemia is related more to the changes from baseline than to the absolute value: a reduction of 20% from baseline is usually accepted as clinical threshold of cerebral ischemia. If baseline rSO(2) is lower than 50% the critical threshold should be reduced to 15%. Routine use of rSO(2) monitoring in patients undergoing cardiac surgery to guide the anesthesia plan has been demonstrated to improve patient outcome and shorten hospital stay. However, rSO(2) monitoring does not seem to provide information accurate enough to indicate the placement of a Javid's shunt during carotid endarterectomy. In patients with neurological pathology or head trauma rSO(2) monitoring has been reported accurate enough in detecting early changes in cerebral blood flow that might result in cerebral ischemia. In aged patients undergoing major abdominal surgery rSO(2) monitoring to guide the anesthesia plan has been reported to reduce the exposition to cerebral ischemia with less effects on cognitive decline and shorter hospital stay. In conclusion several clinical conditions routinely encountered in our daily practice have the potential to disrupt the balance between the brain oxygen supply and demand, exposing to the risk of intraoperative cerebral ischemia. These alterations in brain oxygen balance remain totally undiagnosed if we do not specifically monitor it; while the possibility of monitoring regional cerebral oxygen saturation through a simple and totally non-invasive device has the potential for optimizing our anesthesia plan to the real needs of our main targeted organ: the brain.
ER  - 
TY  - JOUR
T1  - Simulation of near-infrared light absorption considering individual head and prefrontal cortex anatomy: Implications for optical neuroimaging
A1  - Haeussinger, Florian B.
A1  - Heinzel, Sebastian
A1  - Hahn, Tim
A1  - Schecklmann, Martin
A1  - Ehlis, Ann Christine
A1  - Fallgatter, Andreas J.
Y1  - 2011///
JF  - PLoS ONE
VL  - 6
IS  - 10
SN  - 1932-6203
DO  - 10.1371/journal.pone.0026377
UR  - https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0026377&type=printable
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Haeussinger et al. - Unknown - Simulation of near-infrared light absorption considering individual head and prefrontal cortex anatomy im.pdf
N2  - Functional near-infrared spectroscopy (fNIRS) is an established optical neuroimaging method for measuring functional hemodynamic responses to infer neural activation. However, the impact of individual anatomy on the sensitivity of fNIRS measuring hemodynamics within cortical gray matter is still unknown. By means of Monte Carlo simulations and structural MRI of 23 healthy subjects (mean age: (25.0 ± 2.8) years), we characterized the individual distribution of tissue-specific NIR-light absorption underneath 24 prefrontal fNIRS channels. We, thereby, investigated the impact of scalp-cortex distance (SCD), frontal sinus volume as well as sulcal morphology on gray matter volumes (V gray) traversed by NIR-light, i.e. anatomy-dependent fNIRS sensitivity. The NIR-light absorption between optodes was distributed describing a rotational ellipsoid with a mean penetration depth of (23.6 ± 0.7)mm considering the deepest 5% of light. Of the detected photon packages scalp and bone absorbed (96.4 ± 9.7)% and V gray absorbed (3.1 ± 1.8)% of the energy. The mean V gray volume (1.1 ± 0.4)cm 3 was negatively correlated (r= -.76) with the SCD and frontal sinus volume (r= -.57) and was reduced by 41.5% in subjects with relatively large compared to small frontal sinus. Head circumference was significantly positively correlated with the mean SCD (r=.46) and the traversed frontal sinus volume (r=.43). Sulcal morphology had no significant impact on V gray. Our findings suggest to consider individual SCD and frontal sinus volume as anatomical factors impacting fNIRS sensitivity. Head circumference may represent a practical measure to partly control for these sources of error variance. © 2011 Haeussinger et al.
ER  - 
TY  - GEN
T1  - What is microcirculatory shock?
A1  - Kanoore Edul, Vanina S.
A1  - Ince, Can
A1  - Dubin, Arnaldo
Y1  - 2015/06//
KW  - microcirculation
KW  - resuscitation
KW  - septic shock
KW  - tissue perfusion
JF  - Current Opinion in Critical Care
VL  - 21
IS  - 3
SP  - 245
EP  - 252
SN  - 0000000000000
DO  - 10.1097/MCC.0000000000000196
UR  - http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00075198-201506000-00013
N2  - Purpose of review Microcirculatory shock is a condition defined by the presence of tissue hypoperfusion despite the normalization of systemic and regional blood flow. In this article, we discuss the characteristics of the microcirculation in septic shock, the main form of microcirculatory shock, along with its interaction with systemic hemodynamics, and the response to different therapies. Recent findings In septic shock, microcirculatory abnormalities are common, and more severe in nonsurvivors. In addition, the microcirculation shows a behavior that is frequently dissociated from that of systemic hemodynamics. Therefore, microcirculatory alterations may persist despite correction of systemic hemodynamic variables. Sublingual and intestinal microcirculation might also display divergent behaviors. Moreover, microvascular alterations may improve in response to hemodynamic resuscitation, but the response might depend on the underlying microcirculatory alterations. Particularly, the response to fluids seems to be related to both its basal state and the magnitude of the increase in cardiac output. Summary The optimal treatment of microcirculatory shock might require monitoring and therapeutic goals targeted on the microcirculation, more than in systemic variables. The clinical benefits of this approach should be demonstrated in clinical trials.
ER  - 
TY  - JOUR
T1  - Use of central venous oxygen saturation to guide therapy
A1  - Walley, Keith R.
Y1  - 2011/09//
KW  - Cardiac output
KW  - Early goal directed therapy
KW  - Fick equation
KW  - Oxygen extraction ratio
KW  - Shunt fraction
JF  - American Journal of Respiratory and Critical Care Medicine
VL  - 184
IS  - 5
SP  - 514
EP  - 520
DO  - 10.1164/rccm.201010-1584CI
UR  - http://www.atsjournals.org/doi/abs/10.1164/rccm.201010-1584CI
UR  - http://www.ncbi.nlm.nih.gov/pubmed/21177882
N2  - The use of pulmonary artery catheters has diminished, so that other technologies are emerging. Central venous oxygen saturation measurement (ScvO2) as a surrogate for mixed venous oxygen saturation measurement (Sv̄O2) is simple and clinically accessible. To maximize the clinical utility of ScvO2 (or Sv̄O2) measurement, it is useful to reviewwhatthemeasurementmeansin a physiologic context,howthe measurement is made, important limitations, andhowthis measurement may be helpful in common clinical scenarios. Compared with cardiac output measurement, Sv̄O2 is more directly related to tissue oxygenation. Furthermore,whentissue oxygenation is a clinical concern, Sv̄O2 is less prone to error compared with cardiac output, where small measurement errors may lead to larger errors in interpreting adequacy of oxygen delivery. ScvO2 should be measured from the tip of a central venous catheter placed close to, or within, the right atrium to reduce measurement error. Correct clinical interpretation of Sv̄O2, or its properly measured ScvO2 surrogate, can be used to (1) estimate cardiac output using the Fick equation, (2) better understand whether a patient's oxygen delivery is adequate to meet their oxygen demands, (3) help guide clinical practice, particularly when resuscitating patients using validated early goal directed therapy treatment protocols, (4) understand and treat arterial hypoxemia, and (5) rapidly estimate shunt fraction (venous admixture).
ER  - 
TY  - CHAP
T1  - Venous oximetry
A1  - Bloos, Frank
A1  - Reinhart, Konrad
Y1  - 2012/06//
JF  - Applied Physiology in Intensive Care Medicine 1: Physiological Notes - Technical Notes - Seminal Studies in Intensive Care, Third Edition
VL  - 12
IS  - 3
SP  - 59
EP  - 61
SN  - 9783642282706
DO  - 10.1007/978-3-642-28270-6_14
UR  - http://www.ncbi.nlm.nih.gov/pubmed/16672787
UR  - https://insights.ovid.com/crossref?an=00075198-200606000-00015
N2  - The primary physiological task of the cardiovascular system is to deliver enough oxygen (O2) to meet the metabolic demands of the body. Shock and tissue hypoxia occur when the cardiorespiratory system is unable to cover metabolic demand adequately. Sustained tissue hypoxia is one of the most important cofactors in the pathophysiology of organ dysfunction [1].
ER  - 
TY  - JOUR
T1  - Changes in central venous saturation after major surgery, and association with outcome.
A1  - Pearse, Rupert
A1  - Dawson, Deborah
A1  - Fawcett, Jayne
A1  - Rhodes, Andrew
A1  - Grounds, R. Michael
A1  - Bennett, E. David
Y1  - 2005///
KW  - Aged
KW  - Female
KW  - Humans
KW  - London
KW  - London: epidemiology
KW  - Male
KW  - Multivariate Analysis
KW  - Outcome Assessment (Health Care)
KW  - Oxygen
KW  - Oxygen: blood
KW  - Postoperative Complications
KW  - Postoperative Complications: blood
KW  - Postoperative Complications: epidemiology
KW  - Prospective Studies
KW  - Reference Values
KW  - Sensitivity and Specificity
KW  - Survival Analysis
KW  - Veins
JF  - Critical care (London, England)
VL  - 9
IS  - 6
SP  - R694
EP  - 9
DO  - 10.1186/cc3888
UR  - http://ccforum.com/content/9/6/R694Thisarticleisonlineat:http://ccforum.com/content/9/6/R694
UR  - http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1414025&tool=pmcentrez&rendertype=abstract
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Pearse et al. - 2005 - Open Access R694 Changes in central venous saturation after major surgery, and association with outcome.pdf
N2  - INTRODUCTION: Despite recent interest in measurement of central venous oxygen saturation (ScvO2), there are no published data describing the pattern of ScvO2 changes after major general surgery or any relationship with outcome. METHODS: ScvO2 and other biochemical, physiological and demographic data were prospectively measured for 8 hours after major surgery. Complications and deaths occurring within 28 days of enrollment were included in the data analysis. Independent predictors of complications were identified with the use of logistic regression analysis. Optimum cutoffs for ScvO2 were identified by receiver operator characteristic analysis. RESULTS: Data from 118 patients was analysed; 123 morbidity episodes occurred in 64 these patients. There were 12 deaths (10.2%). The mean +/- SD age was 66.8 +/- 11.4 years. Twenty patients (17%) underwent emergency surgery and 77 patients (66%) were male. The mean +/- SD P-POSSUM (Portsmouth Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity) score was 38.6 +/- 7.7, with a predicted mortality of 16.7 +/- 17.6%. After multivariate analysis, the lowest cardiac index value (odds ratio (OR) 0.58 (95% confidence intervals 0.37 to 0.9); p = 0.018), lowest ScvO2 value (OR 0.94 (0.89 to 0.98); p = 0.007) and P-POSSUM score (OR 1.09 (1.02 to 1.15); p = 0.008) were independently associated with post-operative complications. The optimal ScvO2 cutoff value for morbidity prediction was 64.4%. In the first hour after surgery, significant reductions in ScvO2 were observed, but there were no significant changes in CI or oxygen delivery index during the same period. CONCLUSION: Significant fluctuations in ScvO2 occur in the immediate post-operative period. These fluctuations are not always associated with changes in oxygen delivery, suggesting that oxygen consumption is also an important determinant of ScvO2. Reductions in ScvO2 are independently associated with post-operative complications.
ER  - 
TY  - GEN
T1  - Is this child dehydrated?
A1  - Steiner, Michael J.
A1  - DeWalt, Darren A.
A1  - Byerley, Julie S.
Y1  - 2004/06//
JF  - Journal of the American Medical Association
VL  - 291
IS  - 22
SP  - 2746
EP  - 2754
DO  - 10.1001/jama.291.22.2746
UR  - http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.291.22.2746
N2  - Context: The ability to assess the degree of dehydration quickly and accurately in infants and young children often determines patient treatment and disposition. Objective: To systematically review the precision and accuracy of symptoms, signs, and basic laboratory tests for evaluating dehydration in infants and children. Data Sources: We identified 1561 potential articles by multiple search strategies of the MEDLINE database through PubMed. Searches of bibliographies of retrieved articles, the Cochrane Library, textbooks, and private collections of experts in the field yielded an additional 42 articles. Study Selection: Twenty-six of 1603 reviewed studies contained original data on the precision or accuracy of findings for the diagnosis of dehydration in young children (1 month to 5 years). Data Extraction: Two of the 3 authors independently reviewed and abstracted data for estimating the likelihood ratios (LRs) of diagnostic tests. We eliminated 13 of the 26 studies because of the lack of an accepted diagnostic standard or other limitation in study design. The other 13 studies were included in the review. Data Synthesis: The most useful individual signs for predicting 5% dehydration in children are an abnormal capillary refill time (LR, 4.1; 95% confidence interval [CI], 1.7-9.8), abnormal skin turgor (LR, 2.5; 95% CI, 1.5-4.2), and abnormal respiratory pattern (LR, 2.0; 95% CI, 1.5-2.7). Combinations of examination signs perform markedly better than any individual sign in predicting dehydration. Historical points and laboratory tests have only modest utility for assessing dehydration. Conclusions: The initial assessment of dehydration in young children should focus on estimating capillary refill time, skin turgor, and respiratory pattern and using combinations of other signs. The relative imprecision and inaccuracy of available tests limit the ability of clinicians to estimate the exact degree of dehydration.
ER  - 
TY  - JOUR
T1  - Capillary refill and core-peripheral temperature gap as indicators of haemodynamic status in paediatric intensive care patients
A1  - Tibby, Shane M.
A1  - Hatherill, Mark
A1  - Murdoch, Ian A.
Y1  - 1999///
KW  - Capillary refill
KW  - Cardiac output
KW  - Hypovolaemia
KW  - Septic shock
KW  - Stroke volume
JF  - Archives of Disease in Childhood
VL  - 80
IS  - 2
SP  - 163
EP  - 166
DO  - 10.1136/adc.80.2.163
UR  - http://adc.bmj.com/
N2  - Objectives - Capillary refill time is an important diagnostic adjunct in the acute resuscitation phase of the shocked child. This study assesses its relation to commonly measured haemodynamic parameters in the postresuscitation phase when the child has reached the intensive care unit, and compares this with core-peripheral temperature gap. Methods - Ninety standardised measurements of capillary refill time were made on 55 patients, who were divided into postcardiac surgery (n = 27), and general (n = 28), most of whom had septic shock (n = 24). A normal capillary refill time was defined as ≤ 2 seconds. Measured haemodynamic variables included: cardiac index, central venous pressure, systemic vascular resistance index, stroke volume index (SVI), and blood lactate. Seventy measurements were made on patients while being treated with inotropes or vasodilators. Results - Capillary refill time and temperature gap both correlated poorly with all haemodynamic variables among postcardiac surgery children. For general patients, capillary refill time was related to SVI and lactate; temperature gap correlated poorly with all variables. General patients with a prolonged capillary refill time had a lower median SVI (28 v 38 ml/m2) but not a higher lactate (1.7 v 1.1 mmol/l). A capillary refill time of ≥ 6 seconds had the best predictive value for a reduced SVI. Conclusion - Among ventilated, general intensive care patients, capillary refill time is related weakly to blood lactate and SVI. A normal value for capillary refill time of ≤ 2 seconds has little predictive value and might be too conservative for this population; septic shock.
ER  - 
TY  - JOUR
T1  - Capillary refill time: Is it still a useful clinical sign?
A1  - Pickard, Amelia
A1  - Karlen, Walter
A1  - Ansermino, J. Mark
Y1  - 2011/07//
JF  - Anesthesia and Analgesia
VL  - 113
IS  - 1
SP  - 120
EP  - 123
DO  - 10.1213/ANE.0b013e31821569f9
UR  - https://insights.ovid.com/crossref?an=00000539-201107000-00021
N2  - Capillary refill time (CRT) is widely used by health care workers as part of the rapid, structured cardiopulmonary assessment of critically ill patients. Measurement involves the visual inspection of blood returning to distal capillaries after they have been emptied by pressure. It is hypothesized that CRT is a simple measure of alterations in peripheral perfusion. Evidence for the use of CRT in anesthesia is lacking and further research is required, but understanding may be gained from evidence in other fields. In this report, we examine this evidence and factors affecting CRT measurement. Novel approaches to the assessment of CRT are under investigation. In the future, CRT measurement may be achieved using new technologies such as digital videography or modified oxygen saturation probes; these new methods would remove the limitations associated with clinical CRT measurement and may even be able to provide an automated CRT measurement. © 2011 International Anesthesia Research Society.
ER  - 
TY  - JOUR
T1  - Regional Cerebral Oxygen Saturation Level Predicts 30-Day Mortality Rate After Left Ventricular Assist Device Surgery
A1  - Ghosal, Soutik
A1  - Trivedi, Jaimin
A1  - Chen, James
A1  - Rogers, Michael P.
A1  - Cheng, Allen
A1  - Slaughter, Mark S.
A1  - Kong, Maiying
A1  - Huang, Jiapeng
Y1  - 2018/06//
KW  - cerebral oxygen saturation
KW  - clinical outcome
KW  - left ventricular assist device
JF  - Journal of Cardiothoracic and Vascular Anesthesia
VL  - 32
IS  - 3
SP  - 1185
EP  - 1190
DO  - 10.1053/j.jvca.2017.08.029
UR  - https://linkinghub.elsevier.com/retrieve/pii/S1053077017307115
N2  - Objective: Left ventricular assist device (LVAD) surgery is complex, high risk, and expensive. The authors’ hypothesis is baseline regional cerebral oxygen saturation (rSO2) might be a predictor of postoperative clinical outcomes. Design: Retrospective review of 210 consecutive continuous flow LVAD patients between 2008 and 2014. The primary measure is 30-day mortality rate and secondary measures include modified major adverse cardiocerebral events (MACE), length of stay (LOS), and intensive care unit (ICU) stay. Multiple logistic regression models were applied to examine if a binary outcome variable, such as 30-day mortality and MACE, is associated with rSO2 at baseline. Log-linear model was used to examine whether LOS or ICU stay hours is associated with rSO2 at baseline. Setting: Single institution, academic hospital. Participants: Patients who received LVAD surgery ​at Jewish Hospital, Louisville, KY. Interventions: All patients received LVAD surgery. Cerebral oximetry monitoring was used in both the preoperative and intraoperative periods. Measurements and Main Results: The authors found that higher rSO2 at baseline is associated with lower 30-day mortality with an odds ratio of 0.94 and 95% confidence interval (0.888, 0.995) for every 1% increase of rSO2. For secondary outcomes, baseline rSO2 was not significantly associated with MACE, requirement for postoperative renal failure/dialysis, reoperation for bleeding, and LOS or ICU hours. Conclusions: Regional cerebral oxygen saturation levels at baseline are significantly associated with 30-day mortality after LVAD surgeries.
ER  - 
TY  - GEN
T1  - The Value of Near-Infrared Spectroscopy Measured Cerebral Oximetry During Carotid Endarterectomy in Perioperative Stroke Prevention. A Review
A1  - Pennekamp, C. W.A.
A1  - Bots, M. L.
A1  - Kappelle, L. J.
A1  - Moll, F. L.
A1  - de Borst, G. J.
Y1  - 2009/11//
KW  - Carotid endarterectomy (CEA)
KW  - Cerebral hyperperfusion syndrome (CHS)
KW  - Cerebral oximetry
KW  - Near-infrared spectroscopy (NIRS)
KW  - Perioperative stroke prevention
KW  - Transcranial Doppler (TCD)
PB  - Elsevier
JF  - European Journal of Vascular and Endovascular Surgery
VL  - 38
IS  - 5
SP  - 539
EP  - 545
SN  - 1532-2165 (Electronic)\n1078-5884 (Linking)
DO  - 10.1016/j.ejvs.2009.07.008
UR  - https://linkinghub.elsevier.com/retrieve/pii/S1078588409003839
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Pennekamp et al. - 2009 - The Value of Near-Infrared Spectroscopy Measured Cerebral Oximetry During Carotid Endarterectomy in Perioperat.pdf
N2  - Background: Transcranial Doppler (TCD) for identification of patients at risk for cerebral hyperperfusion syndrome (CHS) following carotid endarterectomy (CEA) cannot be performed in 10-15% of patients because of the absence of a temporal bone window. Near-infrared spectroscopy (NIRS) may be of additional value in these patients. We aimed to (1) compare the value of NIRS related to existing cerebral monitoring techniques in prediction of perioperative cerebral ischaemia and (2) compare the relation between NIRS and the occurrence of CHS. Methods: A systematic literature search relating to NIRS and CEA was conducted in PubMed and EMBASE databases. Those included were: (1) prospective studies; (2) on NIRS for brain monitoring during CEA; (3) including comparison of NIRS to any other intra-operative cerebral monitoring systems; and (4) on either symptomatic or asymptomatic patients. Results: We identified 16 studies, of which 14 focussed on the prediction of intra-operative cerebral ischaemia and shunt indication. Only two studies discussed the ability of NIRS in predicting CHS. NIRS values correlated well with TCD and electroencephalography (EEG) values indicating ischaemia. However, a threshold for postoperative cerebral ischaemia could not be determined. Neither could a threshold for selective shunting be determined since shunting criteria varied considerably across studies. The evidence suggesting that NIRS is useful in predicting CHS is modest. Conclusion: NIRS seems a promising monitoring technique in patients undergoing CEA. Yet the evidence to define clear cut-off points for the presence of perioperative cerebral ischaemia or identification of patients at high risk of CHS is limited. A large prospective cohort study addressing these issues is urgently needed. © 2009 European Society for Vascular Surgery.
ER  - 
TY  - JOUR
T1  - Cerebral near-infrared spectroscopy (NIRS) for perioperative monitoring of brain oxygenation in children and adults
A1  - Yu, Yun
A1  - Zhang, Kaiying
A1  - Zhang, Ling
A1  - Zong, Huantao
A1  - Meng, Lingzhong
A1  - Han, Ruquan
Y1  - 2018/01//
KW  - *Spectroscopy
KW  - Abdomen [surgery]
KW  - Arthroplasty
KW  - Brain [*diagnosis]
KW  - Brain [*metabolism]
KW  - Cognition Disorders [prevention & control]
KW  - Hip
KW  - Hypoxia‐Ischemia
KW  - Intraoperative
KW  - Knee
KW  - Lumbar Vertebrae [surgery]
KW  - Monitoring
KW  - Near‐Infrared
KW  - Oxygen Consumption [*physiology]
KW  - Postoperative Complications [prevention & control]
KW  - Randomized Controlled Trials as Topic
KW  - Replacement
PB  - John Wiley & Sons, Ltd
JF  - Cochrane Database of Systematic Reviews
VL  - 2018
IS  - 1
DO  - 10.1002/14651858.CD010947.pub2
UR  - http://doi.wiley.com/10.1002/14651858.CD010947.pub2
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Yu et al. - 2018 - Cerebral near-infrared spectroscopy (NIRS) for perioperative monitoring of brain oxygenation in children and adults.pdf
N2  - Background: Various techniques have been employed for the early detection of perioperative cerebral ischaemia and hypoxia. Cerebral near-infrared spectroscopy (NIRS) is increasingly used in this clinical scenario to monitor brain oxygenation. However, it is unknown whether perioperative cerebral NIRS monitoring and the subsequent treatment strategies are of benefit to patients. Objectives: To assess the effects of perioperative cerebral NIRS monitoring and corresponding treatment strategies in adults and children, compared with blinded or no cerebral oxygenation monitoring, or cerebral oxygenation monitoring based on non-NIRS technologies, on the detection of cerebral oxygen desaturation events (CDEs), neurological outcomes, non-neurological outcomes and socioeconomic impact (including cost of hospitalization and length of hospital stay). Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 12), Embase (1974 to 20 December 2016) and MEDLINE (PubMed) (1975 to 20 December 2016). We also searched the World Health Organization (WHO) International Clinical Trials Registry Platform for ongoing studies on 20 December 2016. We updated this search in November 2017, but these results have not yet been incorporated in the review. We imposed no language restriction. Selection criteria: We included all relevant randomized controlled trials (RCTs) dealing with the use of cerebral NIRS in the perioperative setting (during the operation and within 72 hours after the operation), including the operating room, the postanaesthesia care unit and the intensive care unit. Data collection and analysis: Two authors independently selected studies, assessed risk of bias and extracted data. For binary outcomes, we calculated the risk ratio (RR) and its 95% confidence interval (CI). For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. As we expected clinical and methodological heterogeneity between studies, we employed a random-effects model for analyses and we examined the data for heterogeneity (I2 statistic). We created a 'Summary of findings' table using GRADEpro. Main results: We included 15 studies in the review, comprising a total of 1822 adult participants. There are 12 studies awaiting classification, and eight ongoing studies. None of the 15 included studies considered the paediatric population. Four studies were conducted in the abdominal and orthopaedic surgery setting (lumbar spine, or knee and hip replacement), one study in the carotid endarterectomy setting, and the remaining 10 studies in the aortic or cardiac surgery setting. The main sources of bias in the included studies related to potential conflict of interest from industry sponsorship, unclear blinding status or missing participant data. Two studies with 312 participants considered postoperative neurological injury, however no pooled effect estimate could be calculated due to discordant direction of effect between studies (low-quality evidence). One study (N = 126) in participants undergoing major abdominal surgery reported that 4/66 participants experienced neurological injury with blinded monitoring versus 0/56 in the active monitoring group. A second study (N = 195) in participants having coronary artery bypass surgery reported that 1/96 participants experienced neurological injury in the blinded monitoring group compared with 4/94 participants in the active monitoring group. We are uncertain whether active cerebral NIRS monitoring has an important effect on the risk of postoperative stroke because of the low number of events and wide confidence interval (RR 0.25, 95% CI 0.03 to 2.20; 2 studies, 240 participants; low-quality evidence). We are uncertain whether active cerebral NIRS monitoring has an important effect on postoperative delirium because of the wide confidence interval (RR 0.63, 95% CI 0.27 to 1.45; 1 study, 190 participants; low-quality evidence). Two studies with 126 participants showed that active cerebral NIRS monitoring may reduce the incidence of mild postoperative cognitive dysfunction (POCD) as defined by the original studies at one week after surgery (RR 0.53, 95% CI 0.30 to 0.95, I2 = 49%, low-quality evidence). Based on six studies with 962 participants, there was moderate-quality evidence that active cerebral oxygenation monitoring probably does not decrease the occurrence of POCD (decline in cognitive function) at one week after surgery (RR 0.62, 95% CI 0.37 to 1.04, I2 = 80%). The different type of monitoring equipment in one study could potentially be the cause of the heterogeneity. We are uncertain whether active cerebral NIRS monitoring has an important effect on intraoperative mortality or postoperative mortality because of the low number of events and wide confidence interval (RR 0.63, 95% CI 0.08 to 5.03, I2= 0%; 3 studies, 390 participants; low-quality evidence). There was no evidence to determine whether routine use of NIRS-based cerebral oxygenation monitoring causes adverse effects. Authors' conclusions: The effects of perioperative active cerebral NIRS monitoring of brain oxygenation in adults for reducing the occurrence of short-term, mild POCD are uncertain due to the low quality of the evidence. There is uncertainty as to whether active cerebral NIRS monitoring has an important effect on postoperative stroke, delirium or death because of the low number of events and wide confidence intervals. The conclusions of this review may change when the eight ongoing studies are published and the 12 studies awaiting assessment are classified. More RCTs performed in the paediatric population and high-risk patients undergoing non-cardiac surgery (e.g. neurosurgery, carotid endarterectomy and other surgery) are needed.
ER  - 
TY  - JOUR
T1  - Near-infrared spectroscopy as an index of brain and tissue oxygenation
A1  - Murkin, J. M.
A1  - Arango, M.
Y1  - 2009///
KW  - Brain, ischaemia
KW  - Brain, oxygen consumption
KW  - Measurement techniques, oximeters
KW  - Monitoring, oxygen
KW  - Oxygen, saturation
JF  - British Journal of Anaesthesia
VL  - 103
IS  - SUPPL.1
SN  - 0007091214716771
DO  - 10.1093/bja/aep299
UR  - https://bjanaesthesia.org/article/S0007-0912(17)33859-X/pdf
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Murkin, Arango - 1997 - CARDIOVASCULAR Near-infrared spectroscopy as an index of brain and tissue oxygenation.pdf
N2  - Continuous real-time monitoring of the adequacy of cerebral perfusion can provide important therapeutic information in a variety of clinical settings. The current clinical availability of several non-invasive near-infrared spectroscopy (NIRS)-based cerebral oximetry devices represents a potentially important development for the detection of cerebral ischaemia. In addition, a number of preliminary studies have reported on the application of cerebral oximetry sensors to other tissue beds including splanchnic, renal, and spinal cord. This review provides a synopsis of the mode of operation, current limitations and confounders, clinical applications, and potential future uses of such NIRS devices. © The Author [2009].
ER  - 
TY  - GEN
T1  - Cerebral and tissue oximetry
A1  - Steppan, Jochen
A1  - Hogue, Charles W.
Y1  - 2014/12//
KW  - Anesthesia
KW  - Cardiac surgery
KW  - Cerebral autoregulation
KW  - Monitor
KW  - NIRS
KW  - Near-infrared spectroscopy
JF  - Best Practice and Research: Clinical Anaesthesiology
VL  - 28
IS  - 4
SP  - 429
EP  - 439
SN  - 1521-6896
DO  - 10.1016/j.bpa.2014.09.002
UR  - https://linkinghub.elsevier.com/retrieve/pii/S1521689614000779
N2  - The use of near-infrared spectroscopy (NIRS) has been increasingly adopted in cardiac surgery to measure regional cerebral oxygen saturation. This method takes advantage of the fact that light in the near-infrared spectrum penetrates tissue, including bone and muscle. Sensors are placed at fixed distances from a light emitter, and algorithms subtract superficial light absorption from deep absorption to provide an index of tissue oxygenation. Although the popularity of NIRS monitoring is growing, definitive data that prove outcome benefits with its use remain sparse. Therefore, widespread, routine use of NIRS as a standard-of-care monitor cannot be recommended at present. Recent investigations have focused on the use of NIRS in subgroups that may benefit from NIRS monitoring, such as pediatric patients. Furthermore, a novel application of processed NIRS information for monitoring cerebral autoregulation and tissue oxygenation (e.g., kidneys and the gut) is promising.
ER  - 
TY  - JOUR
T1  - Early lactate-guided therapy in intensive care unit patients: A multicenter, open-label, randomized controlled trial
A1  - Jansen, Tim C.
A1  - Van Bommel, Jasper
A1  - Schoonderbeek, F. Jeanette
A1  - Sleeswijk Visser, Steven J.
A1  - Van Der Klooster, Johan M.
A1  - Lima, Alex P.
A1  - Willemsen, Sten P.
A1  - Bakker, Jan
Y1  - 2010/09//
KW  - Central venous oxygenation
KW  - Early goal directed therapy
KW  - Lactate
KW  - Oxygen delivery
KW  - Shock
JF  - American Journal of Respiratory and Critical Care Medicine
VL  - 182
IS  - 6
SP  - 752
EP  - 761
DO  - 10.1164/rccm.200912-1918OC
UR  - http://www.ncbi.nlm.nih.gov/pubmed/20463176
UR  - http://www.atsjournals.org/doi/abs/10.1164/rccm.200912-1918OC
N2  - Rationale: It is unknown whether lactate monitoring aimed to decrease levels during initial treatment in critically ill patients improves outcome. Objectives: To assess the effect of lactate monitoring and resuscitation directed at decreasing lactate levels in intensive care unit (ICU) patients admitted with a lactate level of greater than or equal to 3.0 mEq/L. Methods: Patients were randomly allocated to two groups. In the lactate group, treatment was guided by lactate levels with the objective to decrease lactate by 20% or more per 2 hours for the initial 8 hours of ICU stay. In the control group, the treatment team had no knowledge of lactate levels (except for the admission value) during this period. The primary outcome measure was hospital mortality. Measurements and Main Results: The lactate group received more fluids and vasodilators. However, there were no significant differences in lactate levels between the groups. In the intention-to-treat population (348 patients), hospital mortality in the control group was 43.5% (77/177) compared with 33.9% (58/171) in the lactate group (P = 0.067). When adjusted for predefined risk factors, hospital mortality was lower in the lactate group (hazard ratio, 0.61; 95% confidence interval, 0.43-0.87; P = 0.006). In the lactate group, Sequential Organ Failure Assessment scores were lower between 9 and 72 hours, inotropes could be stopped earlier, and patients could be weaned from mechanical ventilation and discharged from the ICU earlier. Conclusions: In patients with hyperlactatemia on ICU admission, lactate-guided therapy significantly reduced hospital mortality when adjusting for predefined risk factors. As this was consistent with important secondary endpoints, this study suggests that initial lactate monitoring has clinical benefit. Clinical trial registered with www.clinicaltrials.gov (NCT00270673).
ER  - 
TY  - JOUR
T1  - Goal-directed fluid management based on the pulse oximeter-derived pleth variability index reduces lactate levels and improves fluid management
A1  - Forget, Patrice
A1  - Lois, Fernande
A1  - De Kock, Marc
Y1  - 2010/08//
JF  - Anesthesia and Analgesia
VL  - 111
IS  - 4
SP  - 910
EP  - 914
DO  - 10.1213/ANE.0b013e3181eb624f
UR  - http://www.ncbi.nlm.nih.gov/pubmed/20705785
UR  - https://insights.ovid.com/crossref?an=00000539-900000000-99662
N2  - BACKGROUND: Dynamic variables predict fluid responsiveness and may improve fluid management during surgery. We investigated whether displaying the variability in the pulse oximeter plethysmogram (pleth variability index; PVI) would guide intraoperative fluid management and improve circulation as assessed by lactate levels. METHODS: Eighty-two patients scheduled for major abdominal surgery were randomized into 2 groups to compare intraoperative PVI-directed fluid management (PVI group) versus standard care (control group). After the induction of general anesthesia, the PVI group received a 500-mL crystalloid bolus and a crystalloid infusion of 2 mL · kg-1 · h-1. Colloids of 250 mL were administered if the PVI was >13% Vasoactive drug support was given to maintain the mean arterial blood pressure above 65 mm Hg. In the control group, an infusion of 500 mL of crystalloids was followed by fluid management on the basis of fluid challenges and their effects on mean arterial blood and central venous pressure. Perioperative lactate levels, hemodynamic data, and postoperative complications were recorded prospectively. RESULTS: Intraoperative crystalloids and total volume infused were significantly lower in the goal-directed PVI group. Lactate levels were significantly lower in the PVI group during surgery and 48 hours after surgery (P < 0.05). CONCLUSIONS: PVI-based goal-directed fluid management reduced the volume of intraoperative fluid infused and reduced intraoperative and postoperative lactate levels. Copyright © 2010 International Anesthesia Research Society.
ER  - 
TY  - JOUR
T1  - Relation between respiratory variations in pulse oximetry plethysmographic waveform amplitude and arterial pulse pressure in ventilated patients.
A1  - Cannesson, Maxime
A1  - Besnard, Cyril
A1  - Durand, Pierre G.
A1  - Bohé, Julien
A1  - Jacques, Didier
Y1  - 2005///
JF  - Critical care (London, England)
VL  - 9
IS  - 5
SP  - R562
EP  - -R568
SN  - 1466-609X (Electronic)$\$r1364-8535 (Linking)
DO  - 10.1186/cc3799
UR  - http://ccforum.com/content/9/5/R562Thisarticleisonlineat:http://ccforum.com/content/9/5/R562
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Cannesson et al. - 2005 - Open Access Relation between respiratory variations in pulse oximetry plethysmographic waveform amplitude and.pdf
N2  - INTRODUCTION: Respiratory variation in arterial pulse pressure is a reliable predictor of fluid responsiveness in mechanically ventilated patients with circulatory failure. The main limitation of this method is that it requires an invasive arterial catheter. Both arterial and pulse oximetry plethysmographic waveforms depend on stroke volume. We conducted a prospective study to evaluate the relationship between respiratory variation in arterial pulse pressure and respiratory variation in pulse oximetry plethysmographic (POP) waveform amplitude. METHOD: This prospective clinical investigation was conducted in 22 mechanically ventilated patients. Respiratory variation in arterial pulse pressure and respiratory variation in POP waveform amplitude were recorded simultaneously in a beat-to-beat evaluation, and were compared using a Spearman correlation test and a Bland-Altman analysis. RESULTS: There was a strong correlation (r2 = 0.83; P < 0.001) and a good agreement (bias = 0.8 +/- 3.5%) between respiratory variation in arterial pulse pressure and respiratory variation in POP waveform amplitude. A respiratory variation in POP waveform amplitude value above 15% allowed discrimination between patients with respiratory variation in arterial pulse pressure above 13% and those with variation of 13% or less (positive predictive value 100%). CONCLUSION: Respiratory variation in arterial pulse pressure above 13% can be accurately predicted by a respiratory variation in POP waveform amplitude above 15%. This index has potential applications in patients who are not instrumented with an intra-arterial catheter.
ER  - 
TY  - BOOK
T1  - Monitoring tissue perfusion in shock: From physiology to the bedside
A1  - Pinto Lima, Alexandre Augusto
A1  - Silva, Eliézer
Y1  - 2018///
JF  - Monitoring Tissue Perfusion in Shock: From Physiology to the Bedside
SP  - 1
EP  - 206
SN  - 9783319431307
DO  - 10.1007/978-3-319-43130-7
N2  - This book describes various aspects of the basic physiological processes critical to tissue perfusion and cellular oxygenation, including the roles of the circulatory system, respiratory system, blood flow distribution and microcirculation. In the context of monitoring critically ill patients in the early hours of circulatory shock, it is essential to recognize changes in traditional parameters such as mean arterial pressure and cardiac output, and to assess the need for active intervention. However, even if global macrocirculatory variables are restored, abnormalities in tissue oxygenation may persist. Tissue hypoperfusion is connected to the development of organ failure and, if it goes unrecognized, may worsen the prognosis. As a result, there is a growing interest in methods for monitoring regional perfusion in peripheral tissues to predict or diagnose ongoing hypoperfusion. In this work, eminent experts from a range of disciplines convey a working knowledge of how regional monitoring in shock can complement the conventional global parameters of oxygen transport, and demonstrate that real-time bedside assessment of tissue oxygenation is readily achievable using noninvasive monitoring techniques. Accordingly, the book offers a valuable, easy-to-use guide for the entire ICU team and other clinicians.
ER  - 
TY  - JOUR
T1  - Can venous-to-arterial carbon dioxide differences reflect microcirculatory alterations in patients with septic shock?
A1  - Ospina-Tascón, Gustavo A.
A1  - Umaña, Mauricio
A1  - Bermúdez, William F.
A1  - Bautista-Rincón, Diego F.
A1  - Valencia, Juan D.
A1  - Madriñán, Humberto J.
A1  - Hernandez, Glenn
A1  - Bruhn, Alejandro
A1  - Arango-Dávila, César
A1  - De Backer, Daniel
Y1  - 2016///
KW  - Microcirculation
KW  - Microcirculatory blood flow
KW  - Septic shock
KW  - Venous-to-arterial carbon dioxide difference
JF  - Intensive Care Medicine
VL  - 42
IS  - 2
SP  - 211
EP  - 221
DO  - 10.1007/s00134-015-4133-2
UR  - https://link.springer.com/content/pdf/10.1007%2Fs00134-015-4133-2.pdf
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Ospina-Tascón et al. - 2015 - Can venous-to-arterial carbon dioxide differences reflect microcirculatory alterations in patients with s.pdf
N2  - Purpose: Septic shock has been associated with microvascular alterations and these in turn with the development of organ dysfunction. Despite advances in video microscopic techniques, evaluation of microcirculation at the bedside is still limited. Venous-to-arterial carbon dioxide difference (Pv-aCO2) may be increased even when venous O2 saturation (SvO2) and cardiac output look normal, which could suggests microvascular derangements. We sought to evaluate whether Pv-aCO2 can reflect the adequacy of microvascular perfusion during the early stages of resuscitation of septic shock. Methods: Prospective observational study including 75 patients with septic shock in a 60-bed mixed ICU. Arterial and mixed-venous blood gases and hemodynamic variables were obtained at catheter insertion (T0) and 6 h after (T6). Using a sidestream dark-field device, we simultaneously acquired sublingual microcirculatory images for blinded semiquantitative analysis. Pv-aCO2 was defined as the difference between mixed-venous and arterial CO2 partial pressures. Results: Progressively lower percentages of small perfused vessels (PPV), lower functional capillary density, and higher heterogeneity of microvascular blood flow were observed at higher Pv-aCO2 values at both T0 and T6. Pv-aCO2 was significantly correlated to PPV (T0: coefficient −5.35, 95 % CI −6.41 to −4.29, p < 0.001; T6: coefficient, −3.49, 95 % CI −4.43 to −2.55, p < 0.001) and changes in Pv-aCO2 between T0 and T6 were significantly related to changes in PPV (R2 = 0.42, p < 0.001). Absolute values and changes in Pv-aCO2 were not related to global hemodynamic variables. Good agreement between venous-to-arterial CO2 and PPV was maintained even after corrections for the Haldane effect. Conclusions: During early phases of resuscitation of septic shock, Pv-aCO2 could reflect the adequacy of microvascular blood flow.
ER  - 
TY  - JOUR
T1  - Quality of Life and Lung Function in Survivors of Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome
A1  - Grasselli, Giacomo
A1  - Scaravilli, Vittorio
A1  - Tubiolo, Daniela
A1  - Russo, Riccarda
A1  - Crimella, Francesco
A1  - Bichi, Francesca
A1  - Corinna Morlacchi, Letizia
A1  - Scotti, Eleonora
A1  - Patrini, Lorenzo
A1  - Gattinoni, Luciano
A1  - Pesenti, Antonio
A1  - Chiumello, Davide
Y1  - 2019///
JF  - Anesthesiology
VL  - 130
IS  - 4
SP  - 572
EP  - 580
SN  - 0000000000
DO  - 10.1097/ALN.0000000000002624
N2  - Background: Survivors of acute respiratory distress syndrome (ARDS) have long-term impairment of pulmonary function and health-related quality of life, but little is known of outcomes of ARDS survivors treated with extracorporeal membrane oxygenation. The aim of this study was to compare long-term outcomes of ARDS patients treated with or without extracorporeal membrane oxygenation. Methods: A prospective, observational study of adults with ARDS (January 2013 to December 2015) was conducted at a single center. One year after discharge, survivors underwent pulmonary function tests, computed tomography of the chest, and health-related quality-of-life questionnaires. Results: Eighty-four patients (34 extracorporeal membrane oxygenation, 50 non-extracorporeal membrane oxygenation) were studied; both groups had similar characteristics at baseline, but comorbidity was more common in non-extracorporeal membrane oxygenation (23 of 50 vs. 4 of 34, 46% vs. 12%, P < 0.001), and severity of hypoxemia was greater in extracorporeal membrane oxygenation (median Pao2/Fio2 72 [interquartile range, 50 to 103] vs. 114 [87 to 133] mm Hg, P < 0.001) and respiratory compliance worse. At 1 yr, survival was similar (22/33 vs. 28/47, 66% vs. 59%; P = 0.52), and pulmonary function and computed tomography were almost normal in both groups. Non-extracorporeal membrane oxygenation patients had lower health-related quality-of-life scores and higher rates of posttraumatic stress disorder. Conclusions: Despite more severe respiratory failure at admission, 1-yr survival of extracorporeal membrane oxygenation patients was not different from that of non-extracorporeal membrane oxygenation patients; each group had almost full recovery of lung function, but non-extracorporeal membrane oxygenation patients had greater impairment of health-related quality of life.
ER  - 
TY  - BOOK
T1  - Interventional procedure overview of extracorporeal carbon dioxide removal for acute respiratory failure
A1  - Liu, Zulian
A1  - Bramley, George
A1  - Duarte, Rui
A1  - Bayliss, Sue
A1  - Cummins, Carole
Y1  - 2016/04//
ER  - 
TY  - CHAP
T1  - Trigeminocardiac Reflex in Neurosurgery - Current Knowledge and Prospects
A1  - Abdulazim, Amr
A1  - N., Martin
A1  - Sadr-Eshkevari, Pooyan
A1  - Prochnow, Nora
A1  - Sandu, Nora
A1  - Bohluli, Benham
A1  - Schaller, Bernhard
Y1  - 2012/05//
PB  - InTech
JF  - Explicative Cases of Controversial Issues in Neurosurgery
DO  - 10.5772/29607
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Abdulazim et al. - 2012 - Trigeminocardiac Reflex in Neurosurgery - Current Knowledge and Prospects.pdf
ER  - 
TY  - BOOK
T1  - Cottrell and Patel's Neuroanesthesia
A1  - Patel, James, Cottrell Piyush
Y1  - 2016///
SP  - 520
EP  - 520
SN  - 9780323359443
N2  - Sixth edition. Revised edition of: Cottrell and Young's neuroanesthesia / [edited by] James E. Cottrell, William L. Young. 5th ed. c2010. Brain metabolism, the pathophysiology of brain injury, and potential beneficial agents and techniques -- Cerebral and spinal cord blood flow -- Cerebrospinal fluid -- Effects of anesthetic agents and other drugs on cerebral blood flow, metabolism, and intracranial pressure -- Modern neuroradiology relevant to anesthetic and perioperative management -- Evoked potentials -- Transcranial Doppler ultrasonography in anesthesia and neurosurgery -- Multi-modality neurologic monitoring -- Fluid management during craniotomy -- Care of the acutely unstable patient -- Supratentorial masses : anesthetic considerations -- Anesthetic management for posterior fossa surgery -- Anesthetic management of cerebral aneurysm surgery -- Interventional neuroradiology anesthetic management -- Anesthetic considerations for surgical resection of brain arteriovenous malformations -- Occlusive cerebrovascular disease : anesthetic considerations -- Awake craniotomy, epilepsy, minimally invasive and robotic surgery -- Stereotactic surgery, deep brain stimulation, brain biopsy, and gene therapies -- Perioperative management of adult patients with severe head injury -- Pediatric neuroanesthesia and critical care -- Neurosurgical diseases and trauma of the spine and spinal cord : anesthetic considerations -- Neurologic disease and anesthesia -- Postoperative and intensive care including head injury and multisystem sequelae -- Chronic pain management -- Anesthesia for neurosurgery in the pregnant patient -- Ethical considerations in the care of patients with neurosurgical disease -- The pituitary gland and associated pathologic states -- Information management and technology -- Future advances in neuroanesthesia.
ER  - 
TY  - RPRT
T1  - ECLS Registry Report International Summary
A1  - Drive, Jones
A1  - Arbor, Ann
Y1  - 2003/01//
JF  - Organization
VL  - 2121
IS  - C
SP  - 1
EP  - 15
UR  - https://www.elso.org/Portals/0/Files/Reports/2020_January/InternationalReport January-New-Page1.pdf
N2  - : ECLS Registry Report. International Summary, Ann Arbor.2016.
ER  - 
TY  - JOUR
T1  - The ten pitfalls of lactate clearance in sepsis
A1  - Hernandez, Glenn
A1  - Bellomo, Rinaldo
A1  - Bakker, Jan
Y1  - 2019/01//
PB  - Springer Verlag
JF  - Intensive Care Medicine
VL  - 45
IS  - 1
SP  - 82
EP  - 85
DO  - 10.1007/s00134-018-5213-x
UR  - http://link.springer.com/10.1007/s00134-018-5213-x
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Hernandez, Bellomo, Bakker - 2019 - The ten pitfalls of lactate clearance in sepsis.pdf
ER  - 
TY  - JOUR
T1  - Arterial versus venous lactate: a measure of sepsis in children
A1  - Samaraweera, Sahan Asela
A1  - Gibbons, Berwyck
A1  - Gour, Anami
A1  - Sedgwick, Philip
Y1  - 2017/08//
KW  - Arterial blood lactate
KW  - Blood gas
KW  - Paediatric sepsis
KW  - Venous blood lactate
PB  - Springer Verlag
JF  - European Journal of Pediatrics
VL  - 176
IS  - 8
SP  - 1055
EP  - 1060
DO  - 10.1007/s00431-017-2925-9
UR  - http://link.springer.com/10.1007/s00431-017-2925-9
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Samaraweera et al. - 2017 - Arterial versus venous lactate a measure of sepsis in children.pdf
N2  - This study assessed the agreement between arterial and venous blood lactate and pH levels in children with sepsis. This retrospective, three-year study involved 60 PICU patients, with data collected from electronic or paper patient records. The inclusion criteria comprised of children (≤17 years old) with sepsis and those who had a venous blood gas taken first with an arterial blood gas taken after within one hour. The lactate and pH values measured through each method were analysed. There is close agreement between venous and arterial lactate up to 2 mmol/L. As this value increases, this agreement becomes poor. The limits of agreement (LOA) are too large (±1.90 mmol/L) to allow venous and arterial lactate to be used interchangeably. The mean difference and LOA between both methods would be much smaller if derived using lactate values under 2.0 mmol/L. There is close agreement between arterial and venous pH (MD = −0.056, LOA ± 0.121). However, due to extreme variations in pH readings during sepsis, pH alone is an inadequate marker. Conclusion: A venous lactate ≤2 mmol/L can be used as a surrogate for arterial lactate during early management of sepsis in children. However, if the value exceeds 2 mmol/L, an arterial sample must confirm the venous result.What is known:• In children with septic shock, a blood gas is an important test to show the presence of acidosis and high lactic acid. Hyperlactataemia on admission is an early predictor of outcome and is associated with a greater mortality risk.• An arterial sample is the standard for lactate measurement, however getting a sample may be challenging in the emergency department or a general paediatric ward. Venous samples are quicker and easier to obtain. Adult studies generally advise caution in replacing venous lactate values for the arterial standard, whilst paediatric studies are limited in this area.What is new:• This is the first study assessing the agreement between arterial and peripheral venous lactate in children with sepsis, with a significant sample of patients.• This study shows that a venous sample with a lactate of ≤ 2 mmol/L can be used as a surrogate measurement for arterial lactate during early management of sepsis in children. However, if the venous lactate is above 2 mmol/L, an arterial sample must be taken to confirm the result.
ER  - 
TY  - JOUR
T1  - Extracorporeal cardiopulmonary resuscitation in children after open heart surgery
A1  - Guo, Zheng
A1  - Yang, Yinyu
A1  - Zhang, Wei
A1  - Shen, Jia
A1  - Jiang, Lei
A1  - Yu, Xindi
A1  - Wang, Wei
Y1  - 2019/07//
KW  - children
KW  - congenital heart disease
KW  - extracorporeal cardiopulmonary resuscitation
KW  - extracorporeal membrane oxygenation
PB  - Blackwell Publishing Inc.
JF  - Artificial Organs
VL  - 43
IS  - 7
SP  - 633
EP  - 640
DO  - 10.1111/aor.13408
UR  - https://onlinelibrary.wiley.com/doi/abs/10.1111/aor.13408
N2  - Extracorporeal membrane oxygenation (ECMO) provides cardiorespiratory support during cardiopulmonary resuscitation unresponsive to conventional methods. Here, we analyzed the extracorporeal cardiopulmonary resuscitation (ECPR) results of children in a cardiac arrest setting after cardiac surgery. Of 3119 cases of pediatric open-heart surgery, 31 required postoperative ECMO. Among the 31 patients, 11 experienced cardiac arrest and ECPR in the early postoperative period. These 11 patients’ median age is 1.5 [range, 0.1-19] months and median weight is 3.9 [range, 2.9-10.3] kg. The medical records of ECPR cases were analyzed. The median ECMO-assisted time was 68 (range, 13-456) hours and 4 cases (36.4%) survived. The ECMO-assisted times were ≤2 days in 4 patients (all eventually died), ≥6 days in 3 patients (all also died), and all 4 cases supported for 2-6 days were discharged successfully (P = 0.006). In the survivors and nonsurvivors, peak lactate levels were 10.8 ± 7.04 and 22.8 ± 6.98 mmol/L (P = 0.023) and peak creatinine levels were 47.50 ± 25.9 and 153.7 ± 73.9 mg/dL (P = 0.035), respectively. In these 11 ECPR cases, the most common complications were bleeding requiring re-exploration (n = 6, 54.5%) and renal failure (n = 6, 54.5%). The incidence of renal failure was significantly correlated with hypoperfusion time (P = 0.015). ECPR is valuable in children with postoperative cardiac arrest. The higher peak lactate level, higher peak creatinine level, and prolonged ECMO duration were associated with higher mortality. Early diagnosis and intervention of residual anatomical problems could improve survival. Bleeding and renal failure were the most common complications and the incidence of renal failure may be correlated with longer hypoperfusion duration.
ER  - 
TY  - JOUR
T1  - Importance of the sampling site for measurement of mixed venous oxygen saturation in shock
A1  - Edwards, J. Denis
A1  - Mayall, Ruth M.
Y1  - 1998///
KW  - Mixed venous oxyhemoglobin saturation
KW  - Pulmonary artery flotation catheter
KW  - Right atrium
KW  - Sampling site
KW  - Shock
KW  - Superior vena cava
PB  - Lippincott Williams and Wilkins
JF  - Critical Care Medicine
VL  - 26
IS  - 8
SP  - 1356
EP  - 1360
DO  - 10.1097/00003246-199808000-00020
UR  - https://pubmed.ncbi.nlm.nih.gov/9710094/
N2  - Objectives: To determine if oxyhemoglobin saturation in blood samples taken from the superior vena cava or right atrium can be substituted for oxyhemoglobin saturation in blood taken from the proximal pulmonary artery (Sv̄(O2)) in patients in shock. Design: Prospective clinical investigation. Setting: Mixed surgical/medical intensive care unit in a university hospital. Patients: Thirty consecutive patients in severe circulatory shock who required insertion of a pulmonary artery flotation catheter (PAFC) immediately on intensive care unit admission. All patients fulfilled the criteria described below which were established in advance. Measurements and Main Results: Oxyhemoglobin saturation in the superior vena cava, right atrium, and pulmonary artery (Sv̄(O2)) was measured by cooximetry in consecutive blood samples from each site during initial insertion of the PAFC. The mean standard deviation of values from these sites was similar: 74 ± 12.5%, 70.6 ± 13%, and 71.3 ± 12.7%, respectively. However, when superior vena cava and right atrial oxyhemoglobin saturations and Sv̄(O2) were compared, the ranges and 95% confidence limits were found to be clinically unacceptable. The ranges were -19.3 to 23.1% and -19.7 to 16.7%, respectively, and the 95% confidence limits were -18.4 to 24.2% and -18.6 to +17.3%, respectively. Conclusions: These wide range differences and confidence limits would lead to large errors if superior vena cava or right atrial oxyhemoglobin saturations were substituted for true mixed venous blood in oxygen transport or pulmonary venous admixture calculations, or if clinical decision making was based on individual results. In patients in shock in whom clinical decisions may be based on the value of mixed venous oxyhemoglobin, oxyhemoglobin saturation is only reliably measured in samples taken from the pulmonary artery.
ER  - 
TY  - JOUR
T1  - Comparison of central venous oxygen saturation and mixed venous oxygen saturation during liver transplantation
A1  - El Masry, Ashraf
A1  - Mukhtar, A. M.
A1  - El Sherbeny, A. M.
A1  - Fathy, M.
A1  - El-Meteini, M.
Y1  - 2009/04//
KW  - A M Mukhtar
KW  - A el-Masry
KW  - Adult
KW  - Blood Specimen Collection / methods*
KW  - Catheterization
KW  - Central Venous
KW  - Comparative Study
KW  - Female
KW  - Hemodynamics
KW  - Humans
KW  - Intraoperative Care / methods
KW  - Liver Transplantation*
KW  - M el-Meteini
KW  - MEDLINE
KW  - Male
KW  - Middle Aged
KW  - NCBI
KW  - NIH
KW  - NLM
KW  - National Center for Biotechnology Information
KW  - National Institutes of Health
KW  - National Library of Medicine
KW  - Oxygen / blood*
KW  - Prospective Studies
KW  - PubMed Abstract
KW  - Reproducibility of Results
KW  - Swan-Ganz
KW  - doi:10.1111/j.1365-2044.2008.05793.x
KW  - pmid:19317701
PB  - Anaesthesia
JF  - Anaesthesia
VL  - 64
IS  - 4
SP  - 378
EP  - 382
DO  - 10.1111/j.1365-2044.2008.05793.x
UR  - https://pubmed.ncbi.nlm.nih.gov/19317701/
N2  - Central venous catheterisation is commonly performed during major surgery and intensive care, and it would be useful if central venous oxygen saturation could function as a surrogate for mixed venous oxygen saturation. We studied 50 patients undergoing living related liver transplantation. Blood samples were taken simultaneously from central venous and pulmonary artery catheters at nine time points during the pre-anhepatic, anhepatic, and postanhepatic phases. Four hundred and fifty sets of measurement were obtained. There was a good correlation between central venous oxygen saturation and mixed venous oxygen saturation. The mean (SD) difference (95% limit of agreement) was lowest at the first time point (1.06 (0.65)%, -1.94% to 2.7%) and then increased throughout the study but remained acceptable. The change in mixed venous oxygen and central venous oxygen saturations occurred mostly in parallel and as a result changes in mixed venous oxygen saturation were reflected adequately in the change in central venous oxygen saturation. The correlation between mixed venous oxygen saturation and cardiac output was poor. © 2009 The Authors.
ER  - 
TY  - JOUR
T1  - Central venous versus mixed venous oxygen content
A1  - FABER, T.
Y1  - 1995///
KW  - Blood carbon dioxide content
KW  - central venous oxygen content
KW  - mixed venous oxygen content
KW  - oxygen transport monitoring
PB  - Acta Anaesthesiol Scand Suppl
JF  - Acta Anaesthesiologica Scandinavica
VL  - 39
SP  - 33
EP  - 36
DO  - 10.1111/j.1399-6576.1995.tb04327.x
UR  - https://pubmed.ncbi.nlm.nih.gov/8599294/
UR  - https://pubmed.ncbi.nlm.nih.gov/8599294/?from_single_result=83.+Faber+T.+Central+venous+versus+mixed+venous+oxygen+content.+Acta+Anaesthesiol+Scand+Suppl.+1995%3B107%3A33–6.
N2  - Mixed venous oxygen content (commonly measured as oxygen saturation) is a highly relevant parameter in the monitoring of critically ill patients; unfortunately, its measurement requires catheterization of the pulmonary artery. Though less invasive, the central venous oxygen saturation is an unsatisfactory substitute, due to fluctuations in perfusion distribution and regional oxygen extraction in the course of illness. The present study examined the relation of oxygen contents in simultaneously withdrawn central venous and mixed venous blood samples from critically ill patients, in order to validate a hypothetical algorithm for the estimation of mixed venous oxygen content from a central venous sample: Although the proposed algorithm had a fairly high power of prediction, its merits in comparison to assuming simple proportionality between central venous and mixed venous oxygen content seemed marginal. However, as it is likely that the results so far are mathematically coupled, further prospective studies are necessary. Copyright © 1995 Acta Anaesthesiol Scand
ER  - 
TY  - GEN
T1  - Continuous monitoring of the central venous oxygen saturation in surgical patients: Comparison to the monitoring of the mixed venous saturation [2]
A1  - Cohendy, R.
A1  - Peries, C.
A1  - Lefrant, J. Y.
A1  - Doucot, P. Y.
A1  - Saissi, G.
A1  - Eledjam, J. J.
Y1  - 1996/09//
PB  - Blackwell Munksgaard
JF  - Acta Anaesthesiologica Scandinavica
VL  - 40
IS  - 8 I
SP  - 956
EP  - 956
DO  - 10.1111/j.1399-6576.1996.tb04568.x
UR  - http://www.ncbi.nlm.nih.gov/pubmed/8908236
ER  - 
TY  - JOUR
T1  - Diagnostic accuracy of central venous saturation in estimating mixed venous saturation is proportional to cardiac performance among cardiac surgical patients
A1  - Gasparovic, Hrvoje
A1  - Gabelica, Rajka
A1  - Ostojic, Zvonimir
A1  - Kopjar, Tomislav
A1  - Petricevic, Mate
A1  - Ivancan, Visnja
A1  - Biocina, Bojan
Y1  - 2014///
KW  - Cardiac surgery
KW  - Central venous saturation
KW  - Mixed venous saturation
KW  - Pulmonary artery catheter
PB  - W.B. Saunders
JF  - Journal of Critical Care
VL  - 29
IS  - 5
SP  - 828
EP  - 834
DO  - 10.1016/j.jcrc.2014.04.012
UR  - https://pubmed.ncbi.nlm.nih.gov/24857639/
UR  - https://pubmed.ncbi.nlm.nih.gov/24857639/?from_single_result=84.+Gasparovic+H%2C+Gabelica+R%2C+Ostojic+Z%2C+et+al.+Diagnostic+accuracy+of+central+venous+saturation+in+estimating+mixed+venous+saturation+is+proporti
N2  - Purpose: Advanced hemodynamic monitoring in cardiac surgery translates into improvement in outcomes. We evaluated the relationship between central venous (ScvO2) and mixed venous (SvO2) saturations over the early postoperative period. The adequacy of their interchangeability was tested in patients with varying degrees of cardiac performance. Methods: In this prospective observational study, we evaluated 156 consecutive cardiac surgical patients in an academic center. The ScvO2 and SvO2 data were harvested from 468 paired samples taken preoperatively (T0), after weaning from cardiopulmonary bypass (T1) and on postoperative day 1 (T2). Results: The relationship between ScvO2 and SvO2 was inconsistent, with inferior correlations in patients with lower cardiac indices (CI) (Pearson r2 = 0.37 if CI ≤2.0 L/min per square meter vs r2 = 0.73 if CI >2.0 L/min per square meter, both P < .01). Patients with lower CI also had wider 95% limits of agreement between SvO2 and ScvO2. The proportion of patients with a negative SvO2-ScvO2 gradient increased over time (48/156 [31%] at T0 to 73/156 [47%] at T2; P < .01). This subgroup more frequently required inotropes at T2 than patients with a positive SvO2-ScvO2 gradient (odds ratio, 6.46 [95% confidence interval, 0.81-51.87], P = .06) and also had higher serum lactate levels (1.5 ± 0.8 vs 1.0 ± 0.4; P < .01). Conclusions: The diagnostic accuracy of ScvO2 for estimating SvO2 is proportional to cardiac performance. A negative SvO2-ScvO2 gradient at T2 correlated with inotropic support requirement, higher operative risk score, age, lactate level, and duration of cardiopulmonary bypass. © 2014 Elsevier Inc.
ER  - 
TY  - JOUR
T1  - The use of central venous oxygen sturation measurements in a coronary care unit.
A1  - Goldman, R. H.
A1  - Braniff, B.
A1  - Harrison, D. C.
A1  - Spivack, A. P.
Y1  - 1968///
KW  - A P Spivack
KW  - Aged
KW  - B Braniff
KW  - Blood Pressure Determination
KW  - Cardiac Catheterization
KW  - Heart Arrest / diagnosis
KW  - Heart Failure / complications
KW  - Humans
KW  - Intensive Care Units*
KW  - MEDLINE
KW  - Male
KW  - Methods
KW  - Middle Aged
KW  - Myocardial Infarction / complications
KW  - Myocardial Infarction / diagnosis*
KW  - NCBI
KW  - NIH
KW  - NLM
KW  - National Center for Biotechnology Information
KW  - National Institutes of Health
KW  - National Library of Medicine
KW  - Oximetry*
KW  - PubMed Abstract
KW  - Pulmonary Artery
KW  - R H Goldman
KW  - Shock / complications
KW  - Superior
KW  - Veins*
KW  - Vena Cava
KW  - doi:10.7326/0003-4819-68-6-1280
KW  - pmid:5653623
PB  - Ann Intern Med
JF  - Annals of internal medicine
VL  - 68
IS  - 6
SP  - 1280
EP  - 1287
DO  - 10.7326/0003-4819-68-6-1280
UR  - https://pubmed.ncbi.nlm.nih.gov/5653623/
UR  - https://pubmed.ncbi.nlm.nih.gov/5653623/?from_single_result=85.+Goldman+RH%2C+Braniff+B%2C+Harrison+DC%2C+et+al.+The+use+of+central+venous+oxygen+saturation+measurements+in+a+coronary+care+unit.+Ann+Intern+Med.+196
ER  - 
TY  - JOUR
T1  - The concentration of oxygen, lactate and glucose in the central veins, right heart, and pulmonary artery: A study in patients with pulmonary hypertension
A1  - Gutierrez, Guillermo
A1  - Venbrux, Anthony
A1  - Ignacio, Elizabeth
A1  - Reiner, Jonathan
A1  - Chawla, Lakhmir
A1  - Desai, Anish
Y1  - 2007/04//
KW  - Adult
KW  - Analysis of Variance
KW  - Anish Desai
KW  - Anthony Venbrux
KW  - Blood Glucose / metabolism*
KW  - Catheterization
KW  - Central Venous
KW  - Female
KW  - Guillermo Gutierrez
KW  - Heart
KW  - Humans
KW  - Hypertension
KW  - Inferior
KW  - Lactates / blood*
KW  - MEDLINE
KW  - Male
KW  - NCBI
KW  - NIH
KW  - NLM
KW  - National Center for Biotechnology Information
KW  - National Institutes of Health
KW  - National Library of Medicine
KW  - Oxygen / blood*
KW  - PMC2206472
KW  - Prospective Studies
KW  - PubMed Abstract
KW  - Pulmonary / blood*
KW  - Pulmonary Artery
KW  - Superior
KW  - Vena Cava
KW  - doi:10.1186/cc5739
KW  - pmid:17428338
PB  - Crit Care
JF  - Critical Care
VL  - 11
IS  - 2
DO  - 10.1186/cc5739
UR  - https://pubmed.ncbi.nlm.nih.gov/17428338/
UR  - https://pubmed.ncbi.nlm.nih.gov/17428338/?from_single_result=86.+Gutierrez+G%2C+Venbrux+A%2C+Ignacio+E%2C+et+al.+The+concentration+of+oxygen%2C+lactate+and+glucose+in+the+central+veins%2C+right+heart%2C+and+pulmon
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Gutierrez et al. - 2007 - The concentration of oxygen, lactate and glucose in the central veins, right heart, and pulmonary artery A stu.pdf
N2  - Introduction: Decreases in oxygen saturation (SO2) and lactate concentration [Lac] from superior vena cava (SVC) to pulmonary artery have been reported. These gradients (ΔSO2 and Δ[Lac]) are probably created by diluting SVC blood with blood of lower SO2 and [Lac]. We tested the hypothesis that ΔSO2 and Δ[Lac] result from mixing SVC and inferior vena cava (IVC) blood streams. Methods: This was a prospective, sequential, observational study of hemodynamically stable individuals with pulmonary artery hypertension (n = 9) who were about to undergo right heart catheterization. Catheters were advanced under fluoroscopic guidance into the IVC, SVC, right atrium, right ventricle, and pulmonary artery. Samples were obtained at each site and analyzed for SO2, [Lac], and glucose concentration ([Glu]). Analysis of variance with Tukey HSD test was used to compare metabolite concentrations at each site. Results: There were no differences in SO2 or [Lac] between IVC and SVC, both being greater than their respective pulmonary artery measurements (P < 0.01 for SO2 and P < 0.05 for [Lac]). SO2 and [Lac] in right atrium, right ventricle, and pulmonary artery were similar. ΔSO2 was 4.4 ± 1.4% (mean ± standard deviation) and Δ[Lac] was 0.16 ± 0.11 mmol/l (both > 0; P < 0.001). Δ[Glu] was -0.19 ± 0.31 mmol/l, which was not significantly different from zero, with SVC [Glu] being less than IVC [Glu]. Conclusion: Mixing of SVC with IVC blood does not account for the development of ΔSO2 and Δ[Lac] in hemodynamically stable individuals with pulmonary artery hypertension. An alternate mechanism is mixing with coronary sinus blood, implying that ΔSO2 and Δ[Lac] may reflect changes in coronary sinus SO2 and [Lac] in this patient population. © 2007 Gutierrez et al.; licensee BioMed Central Ltd.
ER  - 
TY  - JOUR
T1  - Lactate concentration gradient from right atrium to pulmonary artery.
A1  - Gutierrez, Guillermo
A1  - Chawla, Lakhmir S.
A1  - Seneff, Michael G.
A1  - Katz, Nevin M.
A1  - Zia, Hasan
Y1  - 2005///
KW  - Catheterization
KW  - Comparative Study
KW  - Coronary Circulation*
KW  - Female
KW  - Guillermo Gutierrez
KW  - Hasan Zia
KW  - Heart Atria / metabolism*
KW  - Humans
KW  - Lactic Acid / blood*
KW  - Lakhmir S Chawla
KW  - MEDLINE
KW  - Male
KW  - Middle Aged
KW  - NCBI
KW  - NIH
KW  - NLM
KW  - National Center for Biotechnology Information
KW  - National Institutes of Health
KW  - National Library of Medicine
KW  - Non-U.S. Gov't
KW  - Oxygen / blood
KW  - PMC1269463
KW  - Prospective Studies
KW  - PubMed Abstract
KW  - Pulmonary Artery / metabolism*
KW  - Randomized Controlled Trial
KW  - Research Support
KW  - Swan-Ganz
KW  - doi:10.1186/cc3741
KW  - pmid:16137356
PB  - Crit Care
JF  - Critical care (London, England)
VL  - 9
IS  - 4
DO  - 10.1186/cc3741
UR  - https://pubmed.ncbi.nlm.nih.gov/16137356/
UR  - https://pubmed.ncbi.nlm.nih.gov/16137356/?from_single_result=87.+Gutierrez+G%2C+Chawla+LS%2C+Seneff+MG%2C+et+al.+Lactate+concentration+gradient+from+right+atrium+to+pulmonary+artery.+Crit+Care.+2005%3B9%3AR425–9.
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Gutierrez et al. - 2005 - Lactate concentration gradient from right atrium to pulmonary artery.pdf
N2  - INTRODUCTION: We compared simultaneous measurements of blood lactate concentration ([Lac]) in the right atrium (RA) and in the pulmonary artery (PA). Our aim was to determine if the mixing of right atrial with coronary venous blood, having substantially lower [Lac], results in detectable decreases in [Lac] from the RA to the PA. METHODS: A prospective, sequential, observational study was conducted in a medical-surgical intensive care unit. We enrolled 45 critically ill adult individuals of either sex requiring pulmonary artery catheters (PACs) to guide fluid therapy. Immediately following the insertion of the PAC, one paired set of blood samples per patient was drawn in random order from the PAC's proximal and distal ports for measurement of hemoglobin concentration, O2 saturation (SO2) and [Lac]. We defined Delta[Lac] as ([Lac]ra - [Lac]pa), DeltaSO2 as (SraO2 - SpaO2) and the change in O2 consumption (DeltaVO2) as the difference in systemic VO2 calculated using Fick's equation with either SraO2 or SpaO2 in place of mixed venous SO2. Data were compared by paired Student's t-test, Spearman's correlation analysis and by the method of Bland and Altman. RESULTS: We found SraO2 > SpaO2 (74.2 +/- 9.1 versus 69.0 +/- 10.4%; p < 0.001) and [Lac]ra > [Lac]pa (3.9 +/- 3.0 versus 3.7 +/- 3.0 mmol x l-1; p < 0.001). Delta[Lac] correlated with DeltaVO2 (r2 = 0.34; p < 0.001). CONCLUSION: We found decreases in [Lac] from the RA to PA in this sample of critically ill individuals. We conclude that parallel decreases in SO2 and [Lac] from the RA to PA support the hypothesis that these gradients are produced by mixing RA with coronary venous blood of lower SO2 and [Lac]. The present study is a preliminary observation of this phenomenon and further work is needed to define the physiological and clinical significance of Delta[Lac].
ER  - 
TY  - JOUR
T1  - A Comparison of Central and Mixed Venous Oxygen Saturation in Circulatory Failure
A1  - Ho, Kwok M.
A1  - Harding, Richard
A1  - Chamberlain, Jenny
A1  - Bulsara, Max
Y1  - 2010///
KW  - low cardiac output state
KW  - mixed venous oxygen saturation
KW  - monitoring
KW  - shock
PB  - J Cardiothorac Vasc Anesth
JF  - Journal of Cardiothoracic and Vascular Anesthesia
VL  - 24
IS  - 3
SP  - 434
EP  - 439
DO  - 10.1053/j.jvca.2007.10.011
UR  - https://pubmed.ncbi.nlm.nih.gov/18834813/
UR  - https://pubmed.ncbi.nlm.nih.gov/18834813/?from_single_result=88.+Ho+KM%2C+Harding+R%2C+Chamberlain+J%2C+et+al.+A+comparison+of+central+and+mixed+venous+oxygen+saturation+in+circulatory+failure.+J+Cardiothorac+Vasc
N2  - Objective: The purpose of this study was to evaluate whether central venous oxygen saturation can be used as an alternative to mixed venous oxygen saturation in patients with cardiogenic and septic shock. Design: Prospective clinical study. Setting: A tertiary intensive care unit in a university hospital. Participants: Twenty patients with cardiogenic or septic shock requiring a pulmonary artery catheter and inotropic support. Interventions: None. Measurements and Main Results: The central venous oxygen saturation overestimated the mixed venous oxygen saturation by a mean bias (or an absolute difference) of 6.9%, and the 95% limits of agreement were large (-5.0% to 18.8%). The difference between central and mixed venous oxygen saturation appeared to be more significant when mixed venous oxygen saturation was <70%. The changes in central and mixed venous oxygen saturation did not follow the line of perfect agreement closely in different clinical conditions. The central or mixed venous oxygen saturation had a significant ability to predict the status of cardiac output state, but this ability was reduced when the effect of hyperoxia was not considered. Conclusion: Central and mixed venous oxygen saturation measurements are not interchangeable numerically. © 2010 Elsevier Inc. All rights reserved.
ER  - 
TY  - JOUR
T1  - Venous oxygen saturation and lactate gradient from superior vena cava to pulmonary artery in patients with septic shock
A1  - Kopterides, Petros
A1  - Bonovas, Stefanos
A1  - Mavrou, Irini
A1  - Kostadima, Eleni
A1  - Zakynthinos, Epaminondas
A1  - Armaganidis, Apostolos
Y1  - 2009/06//
KW  - Catheter
KW  - Lactate
KW  - Septic shock
KW  - Venous oxygen saturation
PB  - Shock
JF  - Shock
VL  - 31
IS  - 6
SP  - 561
EP  - 567
DO  - 10.1097/SHK.0b013e31818bb8d8
UR  - https://pubmed.ncbi.nlm.nih.gov/18838939/
UR  - https://pubmed.ncbi.nlm.nih.gov/18838939/?from_single_result=89.+Kopterides+P%2C+Bonovas+S%2C+Mavrou+I%2C+et+al.+Venous+oxygen+saturation+and+lactate+gradient+from+superior+vena+cava+to+pulmonary+artery+in+patient
N2  - Monitoring of central venous oxygen saturation (ScvO2) is considered comparable with mixed venous oxygen saturation (SvO2) in the initial resuscitation phase of septic shock. Our aim was to assess their agreement in septic shock in the intensive care unit setting and the effect of a potential difference in a computed parameter, namely, oxygen consumption (VO2). In addition, we sought for a central venous to pulmonary artery (PA) lactate gradient. We enrolled 37 patients with septic shock who were receiving noradrenaline infusions, and their attending physicians had placed a PA catheter for fluid management. Blood samples were drawn in succession from the superior vena cava, right atrium (RA), right ventricle, and PA. Hemodynamic and treatment parameters were monitored, and data were compared by correlation and Bland-Altman analysis. Mixed venous oxygen saturation was lower than ScvO2 (70.2% ± 11.4% vs. 78.6% ± 10.2%; P < 0.001), with a bias of -8.45% and 95% limits of agreement ranging from -20.23% to 3.33%. This difference correlated significantly to the noradrenaline infusion rate and the oxygen consumption and extraction ratio. These lower SvO2 values resulted in computed VO2v higher than the VO2cv (P < 0.001), with a bias of 104.97 mL min and 95% limits of agreement from -4.12 to 214.07 mL min. Finally, lactate concentration was higher in the superior vena cava and RA than in the PA (2.42 ± 3.15 and 2.35 ± 3.16 vs. 2.17 ± 3.19 mM; P < 0.01 for both comparisons). Thus, our data suggest that ScvO2 and SvO2 are not equivalent in intensive care unit patients with septic shock. Additionally, the substitution of ScvO2 for SvO2 in the calculation of VO2 produces unacceptably large errors. Finally, the decrease in lactate between RA and PA may support the hypothesis that the mixing of RA and coronary sinus blood is at least partially responsible for the difference between ScvO2 and SvO2. © 2009 The Shock Society.
ER  - 
TY  - JOUR
T1  - Central venous and mixed venous oxygen saturation in critically ill patients
A1  - Ladakis, Charalambos
A1  - Myrianthefs, Pavlos
A1  - Karabinis, Andreas
A1  - Karatzas, Gabriel
A1  - Dosios, Theodosios
A1  - Fildissis, George
A1  - Gogas, John
A1  - Baltopoulos, George
Y1  - 2001///
KW  - Cardiac index
KW  - Central venous oxygen saturation
KW  - Critical illness
KW  - Mixed venous oxygen saturation
KW  - Pulmonary artery catheter
PB  - Respiration
JF  - Respiration
VL  - 68
IS  - 3
SP  - 279
EP  - 285
DO  - 10.1159/000050511
UR  - https://pubmed.ncbi.nlm.nih.gov/11416249/
UR  - https://pubmed.ncbi.nlm.nih.gov/11416249/?from_single_result=90.+Ladakis+C%2C+Myrianthefs+P%2C+Karabinis+A%2C+et+al.+Central+venous+and+mixed+venous+oxygen+satu-+ration+in+critically+ill+patients.+Respiration.+200
N2  - Background: Although mixed venous (O2 saturation (SvO2) accurately indicates the balance of O2 supply/demand and provides an index of tissue oxygenation, the use of a pulmonary artery (PA) catheter is associated with significant costs, risks and complications. Central venous O2 saturation (ScvO2), obtained in a less risky and costly manner, can be an attractive alternative to SvO2. Objectives: To investigate whether the values of ScvO2 and SvO2 are well correlated and interchangeable in the evaluation of critically ill ICU patients and to create an equation that could estimate SvO2 from ScvO2. Methods: Sixty-one mechanically ventilated patients were catheterized upon admission and ScvO2 and SvO2 values were simultaneously measured in the lower part of the superior vena cava and PA respectively. Results: SvO2 was 68.6 ± 1.2% (mean ± SEM) and ScvO2 was 69.4 ± 1.1%. The difference is statistically significant (p < 0.03). The correlation coefficient r is 0.945 for the total population, 0.937 and 0.950 in surgical and medical patients, respectively. In 90.2% of patients the difference was <5%. When regression analysis was performed, among 11 models tested, power model ([SvO2 (= b0(ScvO2)b1] best described the relationship between the two parameters (R2 = 0.917). Conclusions: ScvO2 and SvO2 are closely related and are interchangeable for the initial evaluation of critically ill patients even if cardiac indices are different. SvO2 can be estimated with great accuracy by ScvO2 in 92% of the patients using a power model. Copyright © 2001 S. Karger AG, Basel.
ER  - 
TY  - JOUR
T1  - Central venous oxygen saturation in shock: a study in man.
A1  - Lee, J.
A1  - Wright, F.
A1  - Barber, R.
A1  - Stanley, L.
Y1  - 1972///
KW  - Adult
KW  - Aged
KW  - Blood Pressure
KW  - Cardiac Output*
KW  - Clinical Trial
KW  - Clinical Trials as Topic
KW  - F Wright
KW  - Heart Atria
KW  - Heart Ventricles
KW  - Hemorrhagic / physiopathology
KW  - Humans
KW  - Inferior
KW  - J Lee
KW  - L Stanley
KW  - MEDLINE
KW  - Middle Aged
KW  - NCBI
KW  - NIH
KW  - NLM
KW  - National Center for Biotechnology Information
KW  - National Institutes of Health
KW  - National Library of Medicine
KW  - Oxygen / blood*
KW  - PubMed Abstract
KW  - Pulmonary Artery
KW  - Septic / physiopathology
KW  - Shock
KW  - Shock / physiopathology*
KW  - Superior
KW  - Traumatic / physiopathology
KW  - Vena Cava
KW  - doi:10.1097/00000542-197205000-00012
KW  - pmid:4553795
PB  - Anesthesiology
JF  - Anesthesiology
VL  - 36
IS  - 5
SP  - 472
EP  - 478
DO  - 10.1097/00000542-197205000-00012
UR  - https://pubmed.ncbi.nlm.nih.gov/4553795/
UR  - https://pubmed.ncbi.nlm.nih.gov/4553795/?from_single_result=91.+Lee+J%2C+Wright+F%2C+Barber+R%2C+et+al.+Central+venous+oxygen+saturation+in+shock%3A+a+study+in+man.+Anesthesiology.+1972%3B36%285%29%3A472–8.
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Lee et al. - 1972 - Central venous oxygen saturation in shock a study in man.pdf
ER  - 
TY  - JOUR
T1  - Continuous mixed venous and central venous oxygen saturation in cardiac surgery with cardiopulmonary bypass
A1  - Lequeux, Pierre Yves
A1  - Bouckaert, Yves
A1  - Sekkat, Hicham
A1  - Van Der Linden, Philippe
A1  - Stefanidis, Constantin
A1  - Huynh, Chi Hoang
A1  - Bejjani, Gilbert
A1  - Bredas, Philippe
Y1  - 2010/03//
KW  - Cardiac
KW  - Central venous oxygen saturation
KW  - Mixed venous oxygen saturation
KW  - Oximetry
KW  - Surgery
PB  - Eur J Anaesthesiol
JF  - European Journal of Anaesthesiology
VL  - 27
IS  - 3
SP  - 295
EP  - 299
DO  - 10.1097/EJA.0b013e3283315ad0
UR  - https://pubmed.ncbi.nlm.nih.gov/19935073/
UR  - https://pubmed.ncbi.nlm.nih.gov/19935073/?from_single_result=92.+Lequeux+PY%2C+Bouckaert+Y%2C+Sekkat+H%2C+et+al.+Continuous+mixed+venous+and+central+venous+oxygen+saturation+in+ardiac+surgery+with+cardiopulmonary+
N2  - Background and objective Replacing mixed venous oxygen saturation (SvO 2) monitoring by central venous oxygen saturation (ScvO2) monitoring in order to avoid the use of a pulmonary artery catheter and its related complications is still controversial in the setting of cardiac surgery. The influence of surgery, cardiopulmonary bypass and anaesthesia drugs on the relationship between SvO2 and ScvO2 has never been studied. Methods Fifteen patients scheduled for cardiac surgery with cardiopulmonary bypass were included in the study. SvO2 (from the pulmonary artery) and ScvO2 (from the superior vena cava) were continuously measured with fibre-optic catheters frominduction of anaesthesia to 24 h postoperatively. Results A total of 9267 pairs of measurements were recorded. Mean bias between SvO2 and ScvO2 was 4.4% with limits of agreement of 13.6 and R22.5%, respectively. Trends of SvO2 and ScvO2 values followed very different patterns for some patients. Surgery, cardiopulmonary bypass and anaesthesia drugs did not influence the relationship between the two methods. Conclusion Because of the large interindividual variability in the difference between SvO2 and ScvO2, the measure of ScvO2 should not replace the measure of SvO2 with a pulmonary artery catheter for the management of patients undergoing cardiac surgery with cardiopulmonary bypass. © 2010 Copyright European Society of Anaesthesiology.
ER  - 
TY  - JOUR
T1  - Central Venous Oxygen Saturation Cannot Replace Mixed Venous Saturation in Patients Undergoing Cardiac Surgery
A1  - Lorentzen, Anne Grethe
A1  - Lindskov, Christian
A1  - Sloth, Erik
A1  - Jakobsen, Carl Johan
Y1  - 2008/12//
KW  - cardiac output
KW  - cardiac surgery
KW  - mixed venous oxygenation
KW  - venous oxygenation
PB  - J Cardiothorac Vasc Anesth
JF  - Journal of Cardiothoracic and Vascular Anesthesia
VL  - 22
IS  - 6
SP  - 853
EP  - 857
DO  - 10.1053/j.jvca.2008.04.004
UR  - https://pubmed.ncbi.nlm.nih.gov/18834841/
UR  - https://pubmed.ncbi.nlm.nih.gov/18834841/?from_single_result=93.+Lorentzen+AG%2C+Lindskov+C%2C+Sloth+E%2C+et+al.+Central+venous+oxygen+saturation+cannot+replace+mixed+venous+saturation+in+patients+undergoing+cardi
N2  - Objective: It has been argued that venous oxygen saturation from a central venous catheter (ScvO2) could be an inexpensive alternative to mixed venous oxygen saturation (SvO2). The aim was to evaluate whether ScvO2 measurements could replace SvO2 readings after cardiac surgery and to analyze factors influencing any differences found. Design: A prospective observational study. Setting: A university hospital. Participants: Twenty patients scheduled for elective cardiac surgery. Interventions: Patients were followed postoperatively with corresponding ScvO2/SvO2 measurements. Measurements and Main Results: The overall bias between ScvO2 and SvO2 was 1.9. In coronary artery bypass graft (CABG) patients, the bias was 0.6 compared with 6.4 in procedures involving aortic valve replacement. In situations with peripheral saturation (SAT) <92%, the bias was 10.7 compared with 0.8 when SAT was ≥99%. In 25.5% of measurements, the ScvO2 was more than 10% different from SvO2, and in only 50% the difference was less than 5%. Conclusions: The ScvO2 and SvO2 measurements are not interchangeable, and, especially in patients undergoing aortic valve surgery, this lack of agreement is crucial. However, the present data indicate that ScvO2 may be used in CABG patients, although it is not completely accurate in terms of absolute venous saturations. A low SAT, low hemoglobin, or low cardiac index increased the venous gap. © 2008 Elsevier Inc. All rights reserved.
ER  - 
TY  - JOUR
T1  - Monitoring of central venous oxygen saturation versus mixed venous oxygen saturation in critically ill patients
A1  - Martin, C.
A1  - Auffray, J. P.
A1  - Badetti, C.
A1  - Perrin, G.
A1  - Papazian, L.
A1  - Gouin, F.
Y1  - 1992/02//
KW  - Central venous catheter
KW  - Central venous oxygen saturation
KW  - Mixed venous oxygen saturation
KW  - Pulmonary artery catheter
PB  - Springer-Verlag
JF  - Intensive Care Medicine
VL  - 18
IS  - 2
SP  - 101
EP  - 104
DO  - 10.1007/BF01705041
UR  - https://pubmed.ncbi.nlm.nih.gov/1613187/
UR  - https://pubmed.ncbi.nlm.nih.gov/1613187/?from_single_result=94.+Martin+C%2C+Auffray+JP%2C+Badetti+C%2C+et+al.+Monitoring+of+central+venous+oxygen+saturation+versus+mixed+venous+oxygen+saturation+in+critically+ill+p
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Martin et al. - 1992 - Monitoring of central venous oxygen saturation versus mixed venous oxygen saturation in critically ill patients.pdf
N2  - Continous monitoring of mixed venous (SvO2) and central venous (ScO2) oxygen saturation was compared in 7 critically-ill patients (Apache II score: 19±2.1) to determine whether or not information derived from ScO2 were reliable in clinical practice. Patients were catheterized with both a pulmonary artery (PA) and a central venous (CV) catheter, each of them mounted with fiberoptic sensors (Opticath PA Catheter P7110 and Opticath CV Catheter U440, Abbott). A total of 580 comparative measurements were obtained during periods without and with therapeutic interventions (drug-titration, bronchial suction, use of PEEP, changes in FiO2...). The systematic error between the 2 measurement techniques was 0.6% and 0.3% in periods with and without therapeutic interventions, respectively. The variability between the 2 techniques was 10% for both periods. Differences between the values were ≧5% in 49% of values during periods of stability and in 50% of values during periods with therapeutic interventions. There were poor correlations between the values during periods without (r=0.48) and with therapeutic interventions (r=0.62). Better, but still less than ideal, correlations were obtained with changes in SvO2 and ScO2 during periods without (r=0.70) and with therapeutic interventions (r=0.77). Although there is a need to develop a simple technique to monitor mixed venous oxygen saturation, the present study indicates that ScO2 monitoring was not reliable in the study patients. © 1992 Springer-Verlag.
ER  - 
TY  - JOUR
T1  - Continuous central venous and pulmonary artery oxygen saturation monitoring in the critically ill
A1  - Reinhart, Konrad
A1  - Kuhn, Hans Jörg
A1  - Hartog, Christiane
A1  - Bredle, Donald L.
Y1  - 2004///
KW  - Central venous oxygen saturation
KW  - Fiberoptic oximetry
KW  - Mixed venous oxygen saturation
PB  - Springer Verlag
JF  - Intensive Care Medicine
VL  - 30
IS  - 8
SP  - 1572
EP  - 1578
DO  - 10.1007/s00134-004-2337-y
UR  - https://pubmed.ncbi.nlm.nih.gov/15197435/
UR  - https://pubmed.ncbi.nlm.nih.gov/15197435/?from_single_result=95.+Reinhart+K%2C+Kuhn+HJ%2C+Hartog+C.+Continuous+central+venous+and+pulmonary+artery+oxygen+saturation+monitoring+in+the+critically+ill.+Intensive+Care
N2  - Objective: To compare the course of continuously measured mixed and central venous O2 saturations in high-risk patients and to evaluate the impact of various factors that might interfere with reflection spectrophotometry. Design and setting: Prospective, descriptive study in the interdisciplinary ICU of a university hospital. Patients: 32 critically ill patients with triple-lumen central vein catheters, including 29 patients requiring pulmonary artery catheterization. Interventions: The accuracy of fiberoptic measurements was assessed by comparison to reference co-oximeter results at regular intervals. We examined the effect on measurement accuracy of physiological variables including hematocrit, hemoglobin, pH, temperature, and the administration of various solutions via central venous catheter. Continuous parallel measurements of SvO2 and ScvO2 were performed in patients with each type of catheters over a total observation time of 1097 h. Results: ScvO2 values were more accurate and stable than in vitro oximeter measurements (r=0.96 from 150 samples, mean difference 0.15%, average drift 0.10%/day) and was not significantly affected by synchronous infusion therapy or by changes in hematocrit, hemoglobin, pH, or temperature. ScvO 2 values closely paralleled SvO2, whether measured in vitro (r=0.88 from 150 samples) or in vivo (r=0.81 from 395,128 samples) but averaged about 7±4 saturation percentage higher. ScvO2 changed in parallel in 90% of the 1,498 instances in which SvO2 changed more than 5% (over an average of 43 min). Conclusions: Continuous fiberoptic measurement of central vein O2 saturation has potential to be a reliable and convenient tool which could rapidly warn of acute change in the oxygen supply/demand ratio of critically ill patients. © Springer-Verlag 2004.
ER  - 
TY  - JOUR
T1  - Agreement of central venous saturation and mixed venous saturation in cardiac surgery patients
A1  - Sander, Michael
A1  - Spies, Claudia D.
A1  - Foer, Achim
A1  - Weymann, Lisa
A1  - Braun, Jan
A1  - Volk, Thomas
A1  - Grubitzsch, Herko
A1  - Von Heymann, Christian
Y1  - 2007/10//
KW  - Coronary artery bypass graft surgery
KW  - Haemodynamic monitoring
KW  - Venous saturation
PB  - Intensive Care Med
JF  - Intensive Care Medicine
VL  - 33
IS  - 10
SP  - 1719
EP  - 1725
DO  - 10.1007/s00134-007-0684-1
UR  - https://pubmed.ncbi.nlm.nih.gov/17525841/
N2  - Objective: Comparison of the bias and the limits of agreement (LOA; 2 SD) of the central venous saturation (ScvO2) before, during and after coronary artery bypass graft surgery with a simultaneous measurement of the mixed venous saturation (SvO2). Design and setting: Prospective controlled study in a university hospital department of anaesthesiology. Patients: 60 patients with coronary artery bypass surgery, 300 paired measurements of SvO2 and ScvO 2. Measurements and results: ScvO2 and S vO2 were analysed after induction of anaesthesia 15 min after cardiopulmonary bypass and 1, 6 and 18 h after admission to the intensive care unit. Regression analysis for the pooled measurements of S cvO2 and SvO2 showed a correlation R 2 = 0.52. After induction of anaesthesia 15 min after weaning from cardiopulmonary bypass and 6 h after admission to the intensive care unit the correlation coefficient was R 2 = 0.46, on admission to the intensive care unit it was R 2 = 0.42, and at 18 h it was R 2 = 0.38. Bland-Altman analysis for the measurements of ScvO2 and SvO2 showed a mean bias and LOA of 0.3% and -11.9 to +12.4%. In patients with a low ScvO2 there was a trend to overestimate the SvO2 by using the ScvO 2. The only factor that influenced the ΔSvO 2 - ScvO2 was the oxygen extraction rate (R 2 = 0.16). In patients with ScvO2 below 70% this association was more pronounced (R 2 = 0.60). Conclusions: Our findings demonstrate that oxygen extraction rate is the major factor in the difference between SvO2 and ScvO2. Under certain circumstances ScvO2 differed substantially from SvO2. Therefore in selected patients both parameters should be monitored to exclude general or focal hypoperfusion. © 2007 Springer-Verlag.
ER  - 
TY  - JOUR
T1  - Critical assessment of use of central venous oxygen saturation as a mirror of mixed venous oxygen in severely ill cardiac patients.
A1  - Scheinman, M. M.
A1  - Brown, M. A.
A1  - Rapaport, E.
Y1  - 1969///
KW  - Blood Gas Analysis / statistics & numerical data
KW  - Blood Pressure
KW  - Cardiac Catheterization
KW  - Cardiac Output
KW  - E Rapaport
KW  - Female
KW  - Heart Atria
KW  - Heart Failure / blood
KW  - Heart Failure / physiopathology*
KW  - Heart Ventricles
KW  - Humans
KW  - M A Brown
KW  - M M Scheinman
KW  - MEDLINE
KW  - Male
KW  - Methods
KW  - Myocardial Infarction / blood
KW  - Myocardial Infarction / physiopathology*
KW  - NCBI
KW  - NIH
KW  - NLM
KW  - National Center for Biotechnology Information
KW  - National Institutes of Health
KW  - National Library of Medicine
KW  - Oxygen / blood*
KW  - PubMed Abstract
KW  - Pulmonary Artery
KW  - Shock / blood
KW  - Shock / physiopathology*
KW  - Veins
KW  - doi:10.1161/01.cir.40.2.165
KW  - pmid:5796787
PB  - Circulation
JF  - Circulation
VL  - 40
IS  - 2
SP  - 165
EP  - 172
DO  - 10.1161/01.CIR.40.2.165
UR  - https://pubmed.ncbi.nlm.nih.gov/5796787/
UR  - https://pubmed.ncbi.nlm.nih.gov/5796787/?from_single_result=Scheinman+MM%2C+Brown+MA%2C+Rapaport+E.+Critical+assessment+of+use+of+central+venous+oxy-+gen+saturation+as+a+mirror+of+mixed+venous+oxygen+in+severely+il
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Scheinman, Brown, Rapaport - 1969 - Critical assessment of use of central venous oxygen saturation as a mirror of mixed venous oxygen in.pdf
ER  - 
TY  - JOUR
T1  - Can central venous blood replace mixed venous blood samples?
A1  - Tahvanainen, J.
A1  - Meretoja, O.
A1  - Nikki, P.
Y1  - 1982///
KW  - Blood Gas Analysis
KW  - Blood Specimen Collection / methods*
KW  - Humans
KW  - J Tahvanainen
KW  - MEDLINE
KW  - NCBI
KW  - NIH
KW  - NLM
KW  - National Center for Biotechnology Information
KW  - National Institutes of Health
KW  - National Library of Medicine
KW  - Non-U.S. Gov't
KW  - O Meretoja
KW  - Oxygen / blood
KW  - P Nikki
KW  - PubMed Abstract
KW  - Research Support
KW  - Veins
KW  - doi:10.1097/00003246-198211000-00012
KW  - pmid:7140317
PB  - Crit Care Med
JF  - Critical care medicine
VL  - 10
IS  - 11
SP  - 758
EP  - 761
DO  - 10.1097/00003246-198211000-00012
UR  - https://pubmed.ncbi.nlm.nih.gov/7140317/
UR  - https://pubmed.ncbi.nlm.nih.gov/7140317/?from_single_result=Tahvanainen+J%2C+Meretoja+O%2C+Nikki+P.+Can+central+venous+blood+replace+mixed+venous+blood+samples%3F+Crit+Care+Med.+1982%3B10%3A758–61.
N2  - To estimate the value of central venous blood as representative of real changes in pulmonary shunt (Qsp/Qt), mixed venous oxygen saturation and arteriovenous oxygen content difference [C(a-v)O2] during active phases of adult intensive care therapy, 86 blood samples were withdrawn from 42 patients as quadruple simultaneous collections from systemic artery, pulmonary artery (PA), superior caval vein (CV) and right atrium (RA). We found a significant positive correlation of the measured variables and especially of the subsequent changes of these variables in individual patients between PA blood samples and both CV and RA blood samples (p less than 0.001). We, therefore, conclude that a central venous catheter can replace the PA catheter to collect blood representative of mixed venous blood samples for the above purposes. However, the exact numerical value of mixed venous blood samples can only be measured from blood collected from the PA itself.
ER  - 
TY  - JOUR
T1  - No agreement of mixed venous and central venous saturation in sepsis, independent of sepsis origin
A1  - Van Beest, Paul A.
A1  - Van Ingen, Jan
A1  - Boerma, E. Christiaan
A1  - Holman, Nicole D.
A1  - Groen, Henk
A1  - Koopmans, Matty
A1  - Spronk, Peter E.
A1  - Kuiper, Michael A.
Y1  - 2010/11//
KW  - Aged
KW  - Catheterization
KW  - Central Venous / methods
KW  - Central Venous / standards*
KW  - Comparative Study
KW  - Female
KW  - Humans
KW  - Intensive Care Units / standards
KW  - Jan van Ingen
KW  - MEDLINE
KW  - Male
KW  - Michael A Kuiper
KW  - Middle Aged
KW  - Multicenter Study
KW  - NCBI
KW  - NIH
KW  - NLM
KW  - National Center for Biotechnology Information
KW  - National Institutes of Health
KW  - National Library of Medicine
KW  - Oximetry / methods
KW  - Oximetry / standards
KW  - Oxygen Consumption / physiology*
KW  - PMC3219992
KW  - Paul A van Beest
KW  - Predictive Value of Tests
KW  - Prospective Studies
KW  - PubMed Abstract
KW  - Sepsis / diagnosis*
KW  - Sepsis / physiopathology*
KW  - doi:10.1186/cc9348
KW  - pmid:21114844
PB  - Crit Care
JF  - Critical Care
VL  - 14
IS  - 6
DO  - 10.1186/cc9348
UR  - https://pubmed.ncbi.nlm.nih.gov/21114844/
UR  - https://pubmed.ncbi.nlm.nih.gov/21114844/?from_single_result=an+Beest+PA%2C+van+Ingen+J%2C+Boerma+EC%2C+et+al.+No+agreement+of+mixed+venous+and+central+venous+saturation+in+sepsis%2C+independent+of+sepsis+origin.+
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Van Beest et al. - 2010 - No agreement of mixed venous and central venous saturation in sepsis, independent of sepsis origin.pdf
N2  - Introduction: Controversy remains regarding the relationship between central venous saturation (ScvO2) and mixed venous saturation (SvO2) and their use and interchangeability in patients with sepsis or septic shock. We tested the hypothesis that ScvO2does not reliably predict SvO2in sepsis. Additionally we looked at the influence of the source (splanchnic or non-splanchnic) of sepsis on this relationship.Methods: In this prospective observational two-center study we concurrently determined ScvO2and SvO2in a group of 53 patients with severe sepsis during the first 24 hours after admission to the intensive care units in 2 Dutch hospitals. We assessed correlation and agreement of ScvO2and SvO2, including the difference, i.e. the gradient, between ScvO2and SvO2(ScvO2- SvO2). Additionally, we compared the mean differences between ScvO2and SvO2of both splanchnic and non-splanchnic group.Results: A total of 265 paired blood samples were obtained. ScvO2overestimated SvO2by less than 5% with wide limits of agreement. For changes in ScvO2and SvO2results were similar. The distribution of the (ScvO2- SvO2) (< 0 or ≥ 0) was similar in survivors and nonsurvivors. The mean (ScvO2- SvO2) in the splanchnic group was similar to the mean (ScvO2- SvO2) in the non-splanchnic group (0.8 ± 3.9% vs. 2.5 ± 6.2%; P = 0.30). O2ER (P = 0.23) and its predictive value for outcome (P = 0.20) were similar in both groups.Conclusions: ScvO2does not reliably predict SvO2in patients with severe sepsis. The trend of ScvO2is not superior to the absolute value in this context. A positive difference (ScvO2- SvO2) is not associated with improved outcome. © 2010 van Beest et al.; licensee BioMed Central Ltd.
ER  - 
TY  - JOUR
T1  - Mixed venous oxygen saturation cannot be estimated by central venous oxygen saturation in septic shock
A1  - Varpula, Marjut
A1  - Karlsson, Sari
A1  - Ruokonen, Esko
A1  - Pettilä, Ville
Y1  - 2006/09//
KW  - Hemodynamic monitoring
KW  - Outcome
KW  - Sepsis
KW  - Septic shock
PB  - Intensive Care Med
JF  - Intensive Care Medicine
VL  - 32
IS  - 9
SP  - 1336
EP  - 1343
DO  - 10.1007/s00134-006-0270-y
UR  - https://pubmed.ncbi.nlm.nih.gov/16826387/
UR  - https://pubmed.ncbi.nlm.nih.gov/16826387/?from_single_result=Varpula+M%2C+Karlsson+S%2C+Ruokonen+E%2C+et+al.+Mixed+venous+oxygen+saturation+cannot+be+estimated+by+central+venous+oxygen+saturation+in+septic+shock.+
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Varpula et al. - 2006 - Mixed venous oxygen saturation cannot be estimated by central venous oxygen saturation in septic shock.pdf
N2  - Objective: Central venous oxygen saturation (ScvO2) in initial resuscitation is included in the Surviving Sepsis Campaign guidelines. ScvO 2 monitoring has also been suggested to be comparable to mixed venous oxygen saturation (SvO2) for clinical purposes. The aim of our study was to assess the correlation and agreement of ScvO2 and SvO 2 and compare ScvO2-SvO2 difference to lactate, oxygen-derived and hemodynamic parameters in early septic shock in ICU after initial resuscitation. Design and setting: Prospective clinical study with 16 patients with septic shock at two university hospital ICUs. A dose of norepinephrine over 0.1 μg/kg/min was required for inclusion. Measurements and results: Five paired ScvO2 and SvO2 samples at 6-h intervals, altogether 72 samples, were collected during 24 h. The mean SvO 2 was below the mean ScvO2 at all time points. Bias of difference was 4.2% and 95% limits of agreement ranged from -8.1% to 16.5%. The difference correlated significantly to CI and DO2. Conclusions: The difference between paired ScvO2 and SvO2 varies highly. Therefore, SvO2 may not be estimated on the basis of ScvO2 in treatment of septic shock after resuscitation period in ICU. © Springer-Verlag 2006.
ER  - 
TY  - JOUR
T1  - Correlation between central venous oxygen saturation and oxygen delivery changes following fluid therapy
A1  - Yazigi, A.
A1  - Abou-Zeid, H.
A1  - Madi-Jebara, S.
A1  - Haddad, F.
A1  - Hayek, G.
A1  - Jabbour, K.
Y1  - 2008/10//
KW  - A Yazigi
KW  - Female
KW  - Fluid Therapy*
KW  - H Abou-Zeid
KW  - Humans
KW  - K Jabbour
KW  - MEDLINE
KW  - Male
KW  - NCBI
KW  - NIH
KW  - NLM
KW  - National Center for Biotechnology Information
KW  - National Institutes of Health
KW  - National Library of Medicine
KW  - Oxygen / blood*
KW  - PubMed Abstract
KW  - Veins / metabolism
KW  - doi:10.1111/j.1399-6576.2008.01761.x
KW  - pmid:18823459
PB  - Acta Anaesthesiol Scand
JF  - Acta Anaesthesiologica Scandinavica
VL  - 52
IS  - 9
SP  - 1213
EP  - 1217
DO  - 10.1111/j.1399-6576.2008.01761.x
UR  - https://pubmed.ncbi.nlm.nih.gov/18823459/
UR  - https://pubmed.ncbi.nlm.nih.gov/18823459/?from_single_result=Correlation+between+central+venous+oxygen+saturation+and+oxygen+delivery+changes+following+fluid+therapy.+Acta+Anaesthesiol+Scand.+2008
N2  - Background: The rationale for using central venous oxygen saturation (ScvO2) in various clinical scenarios is that it reflects the balance between oxygen delivery (DO2) and demands. In this study, we evaluated the correlation between ScvO2 and DO2 changes (ΔDo2, ΔScvO2) in patients receiving fluid therapy following coronary surgery. We also correlated the changes of mean arterial pressure (ΔMAP) and central venous pressure (ΔCVP), with ΔDO2. Methods: Sixty consecutive sedated and mechanically ventilated adult patients, with cardiac index ≤2.3 L/min/m2 and a pulmonary artery occlusion pressure ≤12 mmHg following coronary surgery, were included. Concomitant hemodynamic parameters, arterial and venous blood gases were measured before (T0) and after (T1) administration of a 500 ml bolus of an isotonic crystalloid solution over 30 min. The correlations between ΔDO2 and ΔScvO2, ΔMAP or ΔCVP were evaluated by linear regression analysis and Pearson test. Results: Cardiac index (1.9±0.2 vs 2.3±0.5 ml/min/m2), MAP (83±11 vs 94±13mmHg) and CVP (5.7±3 vs 7.1±3 mmHg) were significantly higher at T1 compared with T0. The correlation of ΔDO 2 with ΔScvO2 was positive, significant (r=0.41; P=0.004) and superior to its correlation with ΔMAP (r=0.30; P=0.01) or ΔCVP (r=0.03; P=0.78). Conclusion: A significant correlation between ScvO2 and DO2 changes was found in patients receiving fluid therapy following coronary surgery. ScvO2 could be used as an indicator to track DO2 and to guide volume loading. © 2008 The Authors.
ER  - 
TY  - JOUR
T1  - Estimation of mixed venous oxygen saturation
A1  - French, William J.
A1  - Chang, Potter
A1  - Forsythe, Sarah
A1  - Criley, J. Michael
Y1  - 1983///
KW  - mixed venous oxygen saturation
KW  - shunt
JF  - Catheterization and Cardiovascular Diagnosis
VL  - 9
IS  - 1
SP  - 25
EP  - 31
DO  - 10.1002/ccd.1810090105
N2  - Pulmonary artery oxygen saturation (PA) was measured directly and estimated from venal cavae samples in 175 adults without intracardiac shunts to ascertain which of four formulas (MV1, MV2, MV3, or MV4) best estimated mixed venous oxygen saturation. Because the formula MV1, which favored IVC samples, most closely approximated pulmonary artery saturation, we recommend its use to estimate systemic flow in patients with left‐to‐right shunts. In addition, a difference between directly measured PA and calculated MV1 of 6% or greater indicates the presence of a left‐to‐right shunt in 97% of cases. Copyright © 1983 John Wiley & Sons, Ltd.
ER  - 
TY  - JOUR
T1  - Monitoring of the adult patient on venoarterial extracorporeal membrane oxygenation
A1  - Chung, Mabel
A1  - Shiloh, Ariel L.
A1  - Carlese, Anthony
Y1  - 2014///
PB  - Hindawi Limited
JF  - The Scientific World Journal
VL  - 2014
DO  - 10.1155/2014/393258
UR  - /pmc/articles/PMC3998007/?report=abstract
UR  - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3998007/
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Chung, Shiloh, Carlese - 2014 - Monitoring of the Adult Patient on Venoarterial Extracorporeal Membrane Oxygenation.pdf
N2  - Venoarterial extracorporeal membrane oxygenation (VA ECMO) provides mechanical support to the patient with cardiac or cardiopulmonary failure. This paper reviews the physiology of VA ECMO including the determinants of ECMO flow and gas exchange. The efficacy of this therapy may be determined by assessing patient hemodynamics and device flow, overall gas exchange support, markers of adequate oxygen delivery, and pulsatility of the arterial blood pressure waveform. © 2014 Mabel Chung et al.
ER  - 
TY  - JOUR
T1  - Elevated Central Venous to Arterial C o 2 Difference Is Not Associated with Poor Clinical Outcomes after Cardiac Surgery with Cardiopulmonary Bypass in Children
A1  - Akamatsu, Takaaki
A1  - Inata, Yu
A1  - Tachibana, Kazuya
A1  - Hatachi, Takeshi
A1  - Takeuchi, Muneyuki
Y1  - 2017/09//
KW  - cardiac surgery
KW  - cardiopulmonary bypass
KW  - children
KW  - venoarterial Co2 difference
PB  - Lippincott Williams and Wilkins
JF  - Pediatric Critical Care Medicine
VL  - 18
IS  - 9
SP  - 859
EP  - 862
DO  - 10.1097/PCC.0000000000001229
UR  - http://journals.lww.com/00130478-201709000-00005
N2  - Objective: To investigate whether elevated central venous to arterial Co2 difference is associated with delayed extubation and prolonged ICU stay in children after cardiac surgery with cardiopulmonary bypass. Design: Retrospective review of medical records. Setting: PICU in a tertiary children's hospital. Patients: Pediatric patients younger than 18 years old who underwent cardiac surgery with cardiopulmonary bypass between January 2014 and December 2014. Interventions: None. Measurements and Main Results: In total, 114 patients were included in this study. On ICU admission, blood samples were obtained simultaneously from an arterial line and a central venous line. There were no strong correlations between central venous to arterial Co2 difference (median, 11.1 [8.4-13] mm Hg) and other commonly used variables for the assessment of oxygen delivery including arteriovenous oxyhemoglobin saturation difference (R2 = 0.16) and blood lactate concentration (R2 = 0.02). When the patients were divided into two groups, based on the Co2 difference, the high group (difference ≥ 6 mm Hg; n = 103 [90%]) and the low group (difference < 6 mm Hg; n = 11 [10%]) showed no difference in the time to extubation (6 vs 5 hr, respectively; p = 0.80) or in the time to discharge from ICU (4 vs 5 d, respectively; p = 0.49). There was no mortality within 30 days of surgery. Conclusions: Elevation of central venous to arterial Co2 difference on ICU admission in children after cardiac surgery with cardiopulmonary bypass does not appear to be associated with delayed extubation or prolonged ICU stay.
ER  - 
TY  - JOUR
T1  - Neurological injury in adults treated with extracorporeal membrane oxygenation
A1  - Mateen, Farrah J.
A1  - Muralidharan, Rajanandini
A1  - Shinohara, Russell T.
A1  - Parisi, Joseph E.
A1  - Schears, Gregory J.
A1  - Wijdicks, Eelco F.M.
Y1  - 2011/12//
JF  - Archives of Neurology
VL  - 68
IS  - 12
SP  - 1543
EP  - 1549
DO  - 10.1001/archneurol.2011.209
UR  - http://archneur.jamanetwork.com/article.aspx?doi=10.1001/archneurol.2011.209
N2  - Background: Extracorporeal membrane oxygenation (ECMO) may be urgently used as a last resort form of life support when all other treatment options for potentially reversible cardiopulmonary injury have failed. Objective: To examine the range and frequency of neurological injury in ECMO-treated adults. Design: Retrospective clinicopathological cohort study. Setting: Mayo Clinic, Rochester, Minnesota. Patients: A prospectively collected registry of all patients 15 years or older treated with ECMO for 12 or more hours from January 2002 to April 2010. Intervention: Patients were analyzed for potential risk factors for neurological events and death using logistic regression and Cox proportional hazards models. Main Outcome Measures: Neurological diagnosis and/or death. Results: A total of 87 adults were treated (35 female [40%]; median age, 54 years [interquartile range, 31]; mean duration of ECMO, 91 hours [interquartile range, 100]; overall survival ≲γτ∀7 days after ECMO, 52%). Neurological events occurred in 42 patients who received ECMO (50%; 95% confidence interval [CI], 39%-61%). Diagnoses included subarachnoid hemorrhage, ischemic watershed infarctions, hypoxic-ischemic encephalopathy, unexplained coma, and brain death. Death in patients who received ECMO who did not require antecedent cardiopulmonary resuscitation was associated with increased age (odds ratio,1.24 per decade; 95% CI, 1.03- 1.50; P=.02) and lower minimum arterial oxygen pressure (odds ratio, 0.79; 95% CI, 0.68-0.92; P=.03). Although stroke was rarely diagnosed clinically, 9 of 10 brains studied at autopsy demonstrated hypoxic-ischemic and hemorrhagic lesions of vascular origin. Conclusion: Severe neurological sequelae occur frequently in adult ECMO-treated patients with otherwise reversible cardiopulmonary injury (conservative estimate, 50%) and include a range of potentially fatal neurological diagnoses that may be due to the precipitating event and/or ECMO treatment. ©2011 American Medical Association. All rights reserved.
ER  - 
TY  - JOUR
T1  - Understanding the venous–arterial CO2 to arterial–venous O2 content difference ratio
A1  - Ospina-Tascón, Gustavo A.
A1  - Hernández, Glenn
A1  - Cecconi, Maurizio
Y1  - 2016/11//
PB  - Springer Berlin Heidelberg
JF  - Intensive Care Medicine
VL  - 42
IS  - 11
SP  - 1801
EP  - 1804
SN  - 1432-1238 (Electronic) 0342-4642 (Linking)
DO  - 10.1007/s00134-016-4233-7
UR  - http://www.ncbi.nlm.nih.gov/pubmed/26873834
UR  - http://link.springer.com/10.1007/s00134-016-4233-7
N2  - Blood sampling for venous-arterial CO2 to arterial-venous O2 content difference ratio starts to be widely used as a hemodynamic monitoring tool, despite that this calculation remains cumbersome. We propose using indirect calorimetry and respiratory quotient for this purpose, with the same physiological concept.
ER  - 
TY  - JOUR
T1  - Trends in Extracorporeal Membrane Oxygenation for the Treatment of Acute Respiratory Distress Syndrome in the United States
A1  - Rush, Barret
A1  - Wiskar, Katie
A1  - Berger, Landon
A1  - Griesdale, Donald
Y1  - 2017/10//
KW  - ECMO
KW  - epidemiology
KW  - hospital mortality
KW  - respiratory failure
JF  - Journal of Intensive Care Medicine
VL  - 32
IS  - 9
SP  - 535
EP  - 539
DO  - 10.1177/0885066616631956
UR  - http://journals.sagepub.com/doi/10.1177/0885066616631956
UR  - http://www.ncbi.nlm.nih.gov/pubmed/26893318
N2  - Objectives: Our aim was to describe patient characteristics and trends in the use of extracorporeal membrane oxygenation (ECMO) for the treatment of acute respiratory distress syndrome (ARDS) in the United States from 2006 to 2011. Methods: We used the Nationwide Inpatient Sample to isolate all patients aged 18 years who had a discharge International Classification of Diseases, Ninth Revision diagnosis of ARDS, with and without procedure codes for ECMO, between 2006 and 2011. Results: We examined a total of 47 911 414 hospital discharges, representing 235 911 271 hospitalizations using national weights. Of the 1 479 022 patients meeting the definition of ARDS (representing 7 281 206 discharges), 775 underwent ECMO. There was a 409% relative increase in the use of ECMO for ARDS in the United States between 2006 and 2011, from 0.0178% to 0.090% (P =.0041). Patients treated with ECMO had higher in-hospital mortality (58.6% vs 25.1%, P <.0001) and longer hospital stays (15.8 days vs 6.9 days, P <.0001). They were also younger (47.9 vs 66.4 years, P <.0001) and more likely to be male (62.2% vs 49.6%, P <.0001). The median time to initiate ECMO from the time of admission was 0.5 days (interquartile range [IQR] 4.9 days). Conclusion: There has been a dramatic increase in ECMO use for the treatment of ARDS in the United States.
ER  - 
TY  - JOUR
T1  - Monitoring tissue perfusion, oxygenation, and metabolism in critically ill patients
A1  - Ekbal, Nasirul J.
A1  - Dyson, Alex
A1  - Black, Claire
A1  - Singer, Mervyn
Y1  - 2013/06//
JF  - Chest
VL  - 143
IS  - 6
SP  - 1799
EP  - 1808
SN  - 0012-3692\r1931-3543
DO  - 10.1378/chest.12-1849
UR  - http://linkinghub.elsevier.com/retrieve/pii/S0012369213604158
UR  - http://www.ncbi.nlm.nih.gov/pubmed/23732592
N2  - Alterations in oxygen transport and use are integral to the development of multiple organ failure; therefore, the ultimate goal of resuscitation is to restore effective tissue oxygenation and cellular metabolism. Hemodynamic monitoring is the cornerstone of management to promptly identify and appropriately manage (impending) organ dysfunction. Prospective randomized trials have confirmed outcome benefit when preemptive or early treatment is directed toward maintaining or restoring adequate tissue perfusion. However, treatment end points remain controversial, in large part because of current difficulties in determining what constitutes "optimal." Information gained from global whole-body monitoring may not detect regional organ perfusion abnormalities until they are well advanced. Conversely, the ideal "canary" organ that is readily accessible for monitoring, yet offers an early and sensitive indicator of tissue "unwellness," remains to be firmly identified. This review describes techniques available for real-time monitoring of tissue perfusion and metabolism and highlights novel developments that may complement or even supersede current tools. © 2013 American College of Chest Physicians.
ER  - 
TY  - JOUR
T1  - Central venous O2saturation and venous-to-arterial CO2difference as complementary tools for goal-directed therapy during high-risk surgery
A1  - Futier, Emmanuel
A1  - Robin, Emmanuel
A1  - Jabaudon, Matthieu
A1  - Guerin, Renaud
A1  - Petit, Antoine
A1  - Bazin, Jean Etienne
A1  - Constantin, Jean Michel
A1  - Vallet, Benoit
Y1  - 2010/10//
PB  - BioMed Central
JF  - Critical Care
VL  - 14
IS  - 5
SP  - R193
EP  - R193
DO  - 10.1186/cc9310
UR  - http://www.ncbi.nlm.nih.gov/pubmed/21034476
UR  - http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC3219300
N2  - Introduction: Central venous oxygen saturation (ScvO2) is a useful therapeutic target in septic shock and high-risk surgery. We tested the hypothesis that central venous-to-arterial carbon dioxide difference (P(cv-a)CO2), a global index of tissue perfusion, could be used as a complementary tool to ScvO2for goal-directed fluid therapy (GDT) to identify persistent low flow after optimization of preload has been achieved by fluid loading during high-risk surgery.Methods: This is a secondary analysis of results obtained in a study involving 70 adult patients (ASA I to III), undergoing major abdominal surgery, and treated with an individualized goal-directed fluid replacement therapy. All patients were managed to maintain a respiratory variation in peak aortic flow velocity below 13%. Cardiac index (CI), oxygen delivery index (DO2i), ScvO2, P(cv-a)CO2and postoperative complications were recorded blindly for all patients.Results: A total of 34% of patients developed postoperative complications. At baseline, there was no difference in demographic or haemodynamic variables between patients who developed complications and those who did not. In patients with complications, during surgery, both mean ScvO2(78 ± 4 versus 81 ± 4%, P = 0.017) and minimal ScvO2(minScvO2) (67 ± 6 versus 72 ± 6%, P = 0.0017) were lower than in patients without complications, despite perfusion of similar volumes of fluids and comparable CI and DO2i values. The optimal ScvO2cut-off value was 70.6% and minScvO2< 70% was independently associated with the development of postoperative complications (OR = 4.2 (95% CI: 1.1 to 14.4), P = 0.025). P(cv-a)CO2was larger in patients with complications (7.8 ± 2 versus 5.6 ± 2 mmHg, P < 10-6). In patients with complications and ScvO2≥71%, P(cv-a)CO2was also significantly larger (7.7 ± 2 versus 5.5 ± 2 mmHg, P < 10-6) than in patients without complications. The area under the receiver operating characteristic (ROC) curve was 0.785 (95% CI: 0.74 to 0.83) for discrimination of patients with ScvO2≥71% who did and did not develop complications, with 5 mmHg as the most predictive threshold value.Conclusions: ScvO2reflects important changes in O2delivery in relation to O2needs during the perioperative period. A P(cv-a)CO2< 5 mmHg might serve as a complementary target to ScvO2during GDT to identify persistent inadequacy of the circulatory response in face of metabolic requirements when an ScvO2≥71% is achieved.Trial registration: Clinicaltrials.gov Identifier: NCT00852449. © 2010 Futier et al; licensee BioMed Central Ltd.
ER  - 
TY  - BILL
T1  - Extracorporeal Life Support Organization - ECMO and ECLS > Registry > Statistics > International Summary
Y1  - 2017///
UR  - http://www.elso.org/Registry/Statistics/InternationalSummary.aspx%5Cnhttp://files/272/InternationalSummary.html
ER  - 
TY  - JOUR
T1  - Veno-arterial carbon dioxide gradient in human septic shock
A1  - Bakker, J.
A1  - Vincent, J. L.
A1  - Gris, P.
A1  - Leon, M.
A1  - Coffernils, M.
A1  - Kahn, R. J.
Y1  - 1992/02//
KW  - CaO2
KW  - CvO2
KW  - DO2
KW  - O2ER
KW  - PaO2/FIO2
KW  - PvCO2
KW  - PvO2
KW  - SaO2
KW  - SvO2
KW  - arterial oxygen content difference
KW  - arterial oxygen saturation
KW  - arteriovenous oxygen content difference
KW  - dAVO2
KW  - dHCO3−
KW  - dPCO2
KW  - mixed venous PCO2
KW  - mixed venous oxygen content difference
KW  - mixed venous oxygen pressure
KW  - mixed venous oxygen saturation
KW  - oxygen delivery
KW  - oxygen extraction ratio
KW  - ratio of arterial oxygen pressure over inspired ox
KW  - veno-arterial bicarbonate difference
KW  - veno-arterial difference in PCO2
PB  - Elsevier
JF  - Chest
VL  - 101
IS  - 2
SP  - 509
EP  - 515
SN  - 0012-3692
DO  - 10.1378/chest.101.2.509
UR  - http://linkinghub.elsevier.com/retrieve/pii/S0012369216337850
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Bakker et al. - 1992 - Veno-arterial Carbon Dioxide Gradient in Human Septic Shock.pdf
N2  - Recent reports have shown that venous hypercarbia, resulting in a widening of the veno-arterial difference in PCO2 (dPCO2), is related to systemic hypoperfusion in various forms of low-flow state. Although septic shock usually is a hyperdynamic state, other factors can influence the CO2 production and elimination, and thus dPCO2 in septic shock. This study examined the dPCO2 and acid-base balance together with cardiac output measurements and oxygen-derived variables in 64 adult patients with documented septic shock. For a total of 191 observations, a significant exoponential relation between dPCO2 and CO was found. At time of first measurement, 15 patients had an increased dPCO2 (above 6 mm Hg) and a higher mixed venous PCO2 (PvCO2) (47.2±10.0 vs 35.9±7.3 mm Hg, p<0.001). These patients had a lower cardiac index (2.9±1.3 vs 3.8±2.0 L/min-m2, p <0.01), a higher oxygen extraction ratio, but a similar VO2 than patients with normal dPCO2. The higher dPCO2 could also be related to an impaired CO2 elimination as indicated by a higher PaCO2 and a lower PaO2/FIo2 in these patients. Nonsurvivors had a significantly higher dPCO2, than survivors (5.9±3.4 vs 4.4±2.3 mm Hg, p<0.05) in the presence of similar cardiac output. The higher dPCO2 in these patients was probably related to the higher blood lactate levels (7.7±5.3 mmol/L vs 4.5±2.8 mmol/L, p<0.01) and the more severe pulmonary impairment (SaO2 90±8 percent vs 95±4 percent, p<0.001). Arteriovenous oxygen content difference (dAVO2) and VO2 were similar in survivors and nonsurvivors. In conclusion, dPCO2 patients with septic shock is related principally to cardiac output but apparently also to the degree of pulmonary impairment. Although dPCO2 is larger in nonsurvivors, its prognostic value is modest.
ER  - 
TY  - JOUR
T1  - Extracorporal Life Support : The ELSO Red Book
A1  - Brogan, Thomas V.
A1  - Lequier, Laurance
A1  - Lorusso, Roberto
A1  - MacLaren, Graeme
A1  - Peek, Giles
Y1  - 2017///
PB  - Extracorporeal Life Support Organization
SP  - 831
EP  - 831
SN  - 978-0-9656756-5-9
N2  - 5th edition. I. Extracorporeal life support: General principles -- II. Extracorporeal life support: Neonatal respiratory disease -- III. Extracorporeal life support: Pediatric respiratory disease -- IV. Extracorporeal life support: Neonatal and pediatric cardiac disease -- V. Extracorporeal life support: Adult respiratory disease -- VI. Extracorporeal life support: Adult cardiac disease -- VII. Extracorporeal life support: Special indications -- VIII. ECLS: Procedures and adjunctive extracorporeal therapies -- IX. Extracorporeal life support: Organization.
ER  - 
TY  - JOUR
T1  - Monitoring Tissue Perfusion in Shock
A1  - Abut, Yesim Cokay
Y1  - 2019///
JF  - Anesthesia & Analgesia
VL  - 128
IS  - 6
SP  - e113
EP  - e113
DO  - 10.1213/ane.0000000000004122
N2  - This book describes various aspects of the basic physiological processes critical to tissue perfusion and cellular oxygenation, including the roles of the circulatory system, respiratory system, blood flow distribution and microcirculation. In the context of monitoring critically ill patients in the early hours of circulatory shock, it is essential to recognize changes in traditional parameters such as mean arterial pressure and cardiac output, and to assess the need for active intervention. However, even if global macrocirculatory variables are restored, abnormalities in tissue oxygenation may persist. Tissue hypoperfusion is connected to the development of organ failure and, if it goes unrecognized, may worsen the prognosis. As a result, there is a growing interest in methods for monitoring regional perfusion in peripheral tissues to predict or diagnose ongoing hypoperfusion. In this work, eminent experts from a range of disciplines convey a working knowledge of how regional monitoring in shock can complement the conventional global parameters of oxygen transport, and demonstrate that real-time bedside assessment of tissue oxygenation is readily achievable using noninvasive monitoring techniques. Accordingly, the book offers a valuable, easy-to-use guide for the entire ICU team and other clinicians. Part I. Introduction -- Chapter 1. Holistic Monitoring and Treatment of Septic Shock -- Part II. Principles of Oxygen Transport and Consumption -- Chapter 2. Oxygen Transport and Tissue Utilization -- Chapter 3. Guyton at the Bedside -- Chapter 4. Tissue Response to Hypoxia and its Clinical Relevance: Hypoxic Hypoxia, Circulatory Hypoxia, Anemic Hypoxia, Cytopathic Hypoxia -- Part III. Measuring Tissue perfusion: Systemic Assessment of Tissue Perfusion -- Chapter 5. Cardiac Function (Cardiac Output and its Determinants) -- Chapter 6. Oxygen Transport Assessment -- Chapter 7. Central and Mixed Venous O2 Saturation: A Physiological Appraisal -- Chapter 8. Central Venous-to-Arterial Carbon dioxide Partial Pressure Difference -- Chapter 9. Lactate -- Part IV. Measuring Tissue perfusion: Regional Assessment of Tissue Perfusion -- Chapter 10. Clinical Assessment -- Chapter 11. Optical Monitoring -- Chapter 12. Trans cutaneous O2 and CO2 Monitoring -- Chapter 13. Regional Capnography -- Chapter 14. Clinical Implications of Monitoring Tissue Perfusion in Cardiogenic Shock.
ER  - 
TY  - JOUR
T1  - Clinical applicability of the substitution of mixed venous oxygen saturation with central venous oxygen saturation
A1  - Turnaoǧlu, Simru
A1  - Tuǧrul, Mehmet
A1  - Çamci, Emre
A1  - Çakar, Nahit
A1  - Akinci, Özkan
A1  - Ergin, Perihan
Y1  - 2001/10//
KW  - Arterial carbon dioxide tension
KW  - Cardiac index
KW  - Central venous oxygen saturation
KW  - General anesthesia
KW  - Mixed venous oxygen saturation
KW  - Oxygen extraction ratio
KW  - Sepsis
PB  - W.B. Saunders
JF  - Journal of Cardiothoracic and Vascular Anesthesia
VL  - 15
IS  - 5
SP  - 574
EP  - 579
DO  - 10.1053/jcan.2001.26534
UR  - http://linkinghub.elsevier.com/retrieve/pii/S1053077001373676
UR  - https://pubmed.ncbi.nlm.nih.gov/11687997/
UR  - https://pubmed.ncbi.nlm.nih.gov/11687997/?from_single_result=Turnaoglu+S%2C+Tugrul+M%2C+Camci+E%2C+et+al.+Clinical+applicability+of+the+substitution+of
N2  - Objective: To examine the clinical applicability of substituting central venous oxygen saturation (ScvO2) for mixed venous oxygen saturation (SmvO2) in monitoring global tissue oxygenation. Design: Prospective clinical investigation. Setting: University hospital. Participants: Seventy-three adult patients. Interventions: Venous oxygen saturation was recorded, and oxygen saturation difference between SmvO2 and ScvO2 (ΔSmvcv) was calculated in 2 groups of patients (group I, sepsis patients [n = 41], and group II, general anesthesia for cardiovascular surgery patients [n = 32]) during initial placement of pulmonary artery catheters. Measurements and Main Results: Patients were classified as follows: Class A, patients having a ΔSmvcv >-5%; class B, patients having a ΔSmvcv between -5% and +5%; and class C, patients having a ΔSmvcv >+5 %. Statistically significant differences were observed in cardiac index, oxygen delivery index, and oxygen extraction ratio between class A and B in both groups. Class C of group II showed the worst correlation between SmvO2 and ScvO2 and had significantly lower arterial carbon dioxide tension values than class A and B. Conclusion: Pulmonary artery blood sampling should not be replaced with central venous blood. Hypocapnia and increased oxygen extraction ratio seem to be the major factors that worsen the relationship between ScvO2 and SmvO2. Copyright © 2001 by W.B. Saunders Company.
ER  - 
TY  - JOUR
T1  - Defining normal capillary refill: Variation with age, sex, and temperature
A1  - Schriger, David L.
A1  - Baraff, Larry
Y1  - 1988/09//
KW  - capillary refill
PB  - Elsevier
JF  - Annals of Emergency Medicine
VL  - 17
IS  - 9
SP  - 932
EP  - 935
SN  - 0196-0644
DO  - 10.1016/S0196-0644(88)80675-9
UR  - https://linkinghub.elsevier.com/retrieve/pii/S0196064488806759
N2  - Capillary refill has been advocated as an indicator of perfusion status (shock) in seriously ill patients. An upper limit of normal of two seconds has been recommended; there is no published evidence that supports this value. To investigate the validity of the two-second upper limit of normal and to examine the variation of capillary refill with age and temperature, we measured capillary refill in 100 healthy child, 104 adult, and 100 elderly volunteers. In addition, 20 adults were measured before and after a one-minute immersion in 14 C water. Median capillary refill times for the young female, young male, and adult male volunteers were 0.7, 0.8, and 1.0 seconds, respectively. These times were significantly shorter than those of the adult women, elderly women, and elderly men groups, whose median times were 1.2, 1.5, and 1.8 seconds, respectively. In the temperature experiment, preimmersion times were significantly shorter (median, 1.3 seconds) than those after immersion (median, 2.9 seconds) (P < .01). We conclude that capillary refill is age and temperature dependent. Application of the two-second upper limit of normal to our populations would result in a false-positive rate of 4.0% for the pediatric and adult male volunteers, 13.7% for the adult female volunteers, and 29.0% for the elderly volunteers. The upper limit of normal for adult women should be changed to 2.9 seconds, and the upper limit of normal for the elderly should be changed to 4.5 seconds if 95% of all normal patients are to be contained within the normal range. The temperature dependence of capillary refill raises questions regarding its reliability in the prehospital setting. Further studies are needed to determine the sensitivity, specificity, and predictive value of capillary refill as an indicator of circulatory impairment. © 1988 American College of Emergency Physicians.
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TY  - JOUR
T1  - Using near-infrared spectroscopy to monitor lower extremities in patients on venoarterial extracorporeal membrane oxygenation
A1  - Steffen, Robert J.
A1  - Sale, Shiva
A1  - Anandamurthy, Balaram
A1  - Cruz, Vincent B.
A1  - Grady, Patrick M.
A1  - Soltesz, Edward G.
A1  - Moazami, Nader
Y1  - 2014/11//
KW  - 25
PB  - Elsevier
JF  - Annals of Thoracic Surgery
VL  - 98
LA  - eng
IS  - 5
SP  - 1853
EP  - 1854
CY  - Netherlands
DO  - 10.1016/j.athoracsur.2014.04.057
UR  - http://www.ncbi.nlm.nih.gov/pubmed/25441810
N2  - Patients on peripheral extracorporeal membrane oxygenation (ECMO) are at risk for lower extremity ischemia. Effective monitoring is needed to identify complications quickly and allow timely correction. Near-infrared spectroscopy has been used extensively in cerebral monitoring during cardiac surgery. We present its use in monitoring lower extremity perfusion in patients on ECMO. Five patients on ECMO had near-infrared spectroscopy monitors placed on the calf of both lower extremities. Continuous real-time tissue oxygen saturation data (stO2) was displayed and recorded. Two patients had lower extremity complications in the leg with the arterial cannula. The patients with complications had lower stO2 in the cannulated leg at the time of ECMO insertion, larger differences in stO2 between the legs at the time of insertion, lower nadir stO2s, and larger peak differences in stO2 between the legs than patients without limb complications. The use of near-infrared spectroscopy for continuous monitoring of tissue oxygenation in the lower extremities in patients on ECMO may allow early identification of patients with lower extremity complications.
ER  - 
TY  - JOUR
T1  - Central nervous system complications during pediatric extracorporeal life support: Incidence and risk factors
A1  - Cengiz, Pelin
A1  - Seidel, Kristy
A1  - Rycus, Peter T.
A1  - Brogan, Thomas V.
A1  - Roberts, Joan S.
Y1  - 2005/12//
KW  - Brain death
KW  - Central nervous system
KW  - Complications
KW  - Extracorporeal life support
KW  - Infarction
KW  - Intracranial hemorrhage
KW  - Pediatric
PB  - Lippincott Williams and Wilkins
JF  - Critical Care Medicine
VL  - 33
IS  - 12
SP  - 2817
EP  - 2824
DO  - 10.1097/01.CCM.0000189940.70617.C3
UR  - http://journals.lww.com/00003246-200512000-00015
N2  - Objective: Identify the incidence and risk factors for development of acute, severe central nervous system (CNS) complications of pediatric extracorporeal life support (ECLS). Design: Retrospective review of Extracorporeal Life Support Organization (ELSO) registry database. Setting: Pediatric intensive care units of 115 tertiary centers internationally. Patients: Pediatric patients, 1 month to 18 yrs of age, who had ECLS between the years 1981-2002. Measurements and Main Results: Data concerning 4,942 patients who underwent one run of ECLS were analyzed. Six hundred thirty-six patients (12.9%) developed acute, severe CNS complications. Patients who required ECLS during extracorporeal cardiopulmonary resuscitation (n = 161; 3.3%) were more likely to develop CNS complications (n = 42; 26.1%) than patients who did not have extracorporeal cardiopulmonary resuscitation (p < .001; odds ratio [OR], 2.48; 95% confidence interval [CI], 1.73-3.57). Stepwise logistic regression analysis of therapies patients received before initiation of ECLS showed that the use of a left ventricular assist device (p = .001; OR, 3.45; 95% CI, 1.64-7.22), bicarbonate (p < .001; OR, 1.61; 95% CI, 1.26-2.05), and vasopressor/inotropic medications (p = .035; OR, 1.22; 95% CI, 1.01-1.48) were significant independent predictors of development of CNS complications. Among patients who had pulmonary failure as an indication for ECLS, the CNS complication rate was significantly higher for those treated with venoarterial ECLS than those who had venovenous ECLS (13.5% vs. 5.7%; p < .001; OR, 0.43; 95% CI, 0.34-0.67). Multiple logistic regression analysis of the complications other than CNS complications associated with the use of ECLS showed that pH <7.20, creatinine concentration >3.0 mg/dL, use of inotropes, presence of myocardial stun, and requirement of cardiopulmonary resuscitation during ECLS independently predicted development of CNS complications. Conclusion: Patients who have metabolic acidosis, a bicarbonate or inotrope/vasopressor requirement, cardiopulmonary resuscitation, or a left ventricular assist device before initiation of ECLS are at greater risk for development of CNS complications. After initiation of ECLS, patients who develop renal failure or metabolic acidosis or undergo venoarterial ECLS should be closely monitored for development of CNS complications. Copyright © 2005 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.
ER  - 
TY  - JOUR
T1  - Neurologic outcomes after extracorporeal membrane oxygenation: A systematic review
A1  - Boyle, Katharine
A1  - Felling, Ryan
A1  - Yiu, Alvin
A1  - Battarjee, Wejdan
A1  - Schwartz, Jamie Mc Elrath
A1  - Salorio, Cynthia
A1  - Bembea, Melania M.
Y1  - 2018/08//
KW  - Extracorporeal membrane oxygenation; intensive car
KW  - Neurocognitive outcomes
KW  - Neurodevelopmental outcomes
KW  - Pediatric intensive care unit
KW  - Pediatrics
PB  - Lippincott Williams and Wilkins
JF  - Pediatric Critical Care Medicine
VL  - 19
IS  - 8
SP  - 760
EP  - 766
DO  - 10.1097/PCC.0000000000001612
UR  - http://journals.lww.com/00130478-201808000-00010
N2  - Objectives: The goal of this systematic review of the literature was to summarize neurologic outcomes following neonatal and pediatric extracorporeal membrane oxygenation. Data Sources: We conducted electronic searches of PubMed, Scopus, Web of Science, CINAHL, Cochrane, and EMBASE. Study Selection: Inclusion criteria included publication dates 2000-2016, patient ages 0-18 years, and use of standardized measures to evaluate outcomes after extracorporeal membrane oxygenation. Data Extraction: We identified 3,497 unique citations; 60 full-Text articles were included in the final review. Data Synthesis: Studies evaluated patients with congenital diaphragmatic hernia (7), cardiac disease (8), cardiac arrest (13), and mixed populations (32). Follow-up was conducted at hospital discharge in 10 studies (17%) and at a median of 26 months (interquartile range, 8-61 mo) after extracorporeal membrane oxygenation in 50 studies (83%). We found 55 outcome measures that assessed overall health and function (4), global cognitive ability (7), development (4), motor function (5), adaptive function (2), behavior/mood (6), hearing (2), quality of life (2), school achievement (5), speech and language (6), learning and memory (4), and attention and executive function (8). Overall, 10% to as many as 50% of children scored more than 2 sds below the population mean on cognitive testing. Behavior problems were identified in 16-46% of children tested, and severe motor impairment was reported in 12% of children. Quality of life of former extracorporeal membrane oxygenation patients evaluated at school age or adolescence ranged from similar to healthy peers, to 31-53% having scores more than 1 sd below the population mean. Conclusions: This systematic review of the literature suggests that children who have undergone extracorporeal membrane oxygenation suffer from a wide range of disabilities. A meta-Analysis was not feasible due to heterogeneity in pathologies, outcome measures, and age at follow-up, underscoring the importance of developing and employing a core set of outcomes measures in future extracorporeal membrane oxygenation studies. (Pediatr Crit Care Med 2018; 19:760-766).
ER  - 
TY  - JOUR
T1  - Autopsy findings in patients on postcardiotomy extracorporeal membrane oxygenation (ECMO)
A1  - Rastan, Ardawan J.
A1  - Lachmann, N.
A1  - Walther, T.
A1  - Doll, N.
A1  - Gradistanac, T.
A1  - Gommert, J. F.
A1  - Lehmann, S.
A1  - Wittekind, C.
A1  - Mohr, F. W.
Y1  - 2006/12//
KW  - Autopsy
KW  - Cardiogenic shock
KW  - Thromboembolism
PB  - Wichtig Editore s.r.l.
JF  - International Journal of Artificial Organs
VL  - 29
IS  - 12
SP  - 1121
EP  - 1131
DO  - 10.1177/039139880602901205
UR  - http://journals.sagepub.com/doi/10.1177/039139880602901205
N2  - Objectives: To assess the clinical sensitivity of causes of death, concomitant diseases and postoperative complications including thromboembolic events in ECMO patients. Methods: Between January 2000 and December 2004 154/202 patients (76.2%) died after postcardiotomy ECIWO circulatory support. Autopsy was performed in 78 (50.6%) consecutive patients. Clinical and post-mortem data were prospectively recorded and compared concerning causes of death and postoperative complications including venous and arterial thromboembolisms and significant comorbidities. Results: Mean age was 62.1±11.3 years, ejection fraction was 43.4±17.3%. 39.7% were emergency operations including acute coronary syndrome in 25.6% and preoperative cardiogenic shock in 28.2%. Successful ECMO weaning rate was 43.6%. Mean postoperative survival was 11.3 days. Premortem unknown concomitant diseases were found in 63 patients (80.8%) with clinical relevance in 9 patients (11.5%). Clinically unrecognized postoperative complications were found in 59 patients (75.6%) including acute cerebral infarction (n=7), acute bowel ischemia (1), intestinal perforation (3), pneumonia (4), venous thrombus formation (25) and systemic thromboembolic events (24). Clinically based causes of death were cardiac in 62.8%, multi-organ failure in 10.3%, cerebral in 5.1%, respiratory in 10.3%, fatal pulmonary embolism in 2.6%, technical in 5.1%, and others in 3.8%. Unexpected causes of death were found by autopsy in 22 patients (28.2%) including myocardial infarction (n=5), acute heart failure (4), fatal pulmonary embolism (2), pneumonia (2), ARDS (1), lung bleeding (1), fatal cerebrovascular event (4) and multiorgan failure (3). Conclusions: In ECMO patients major discrepancies between clinical and post-mortem examination were found. The true incidence of thromboembolic events is highly underestimated by clinical evaluation. © Wichtig Editore, 2006.
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TY  - JOUR
T1  - Neurologic injury in neonates with congenital heart disease during extracorporeal membrane oxygenation: An analysis of extracorporeal life support organization registry data
A1  - Polito, Angelo
A1  - Barrett, Cindy S.
A1  - Rycus, Peter T.
A1  - Favia, Isabella
A1  - Cogo, Paola E.
A1  - Thiagarajan, Ravi R.
Y1  - 2015/01//
KW  - brain injuries
KW  - congenital heart disease
KW  - extracorporeal membrane oxygenation
KW  - newborn
PB  - Lippincott Williams and Wilkins
JF  - ASAIO Journal
VL  - 61
IS  - 1
SP  - 43
EP  - 48
DO  - 10.1097/MAT.0000000000000151
UR  - http://journals.lww.com/00002480-201501000-00008
N2  - The aim of this article is to describe the epidemiology and factors associated with acute neurologic injury in neonates with congenital heart disease (CHD) undergoing extracorporeal membrane oxygenation (ECMO). It is a retrospective cohort study. Multi-institutional data for purposes of this study were obtained from the extracorporeal life support organization registry Neonates with CHD supported with ECMO during 2005-2010. Of 1,898 neonates with CHD supported with ECMO, 273 (14%) had neurologic injury. Birth weight less than 3 kg (odds ratio [OR]: 1.5; 95% confidence intervals [CI]: 1.1-1.9), pre-ECMO blood pH ≤ 7.15 (OR: 1.5, 95% CI: 1.1-2.1) need for cardiopulmonary resuscitation before ECMO (OR: 1.7, 95% CI: 1.5-2.0) increased neurologic injury. In-hospital mortality was higher in patients with neurologic injury compared with those without (73% vs. 53%; p < 0.001). Neonates with CHD undergoing ECMO are highly vulnerable to acute neurologic injury regardless of cardiac lesion-specific physiology or the occurrence of cardiac surgery. The incidence of neurologic injuries in this population is higher in sicker patients. Severity of illness should therefore become the main target for improvement. Timely deployment of ECMO may therefore influence the development of ECMO complications.
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TY  - JOUR
T1  - Life-threatening intrathoracic complications during treatment with extracorporeal membrane oxygenation
A1  - Zwischenberger, Joseph B.
A1  - Cilley, Robert E.
A1  - Hirschl, Ronald B.
A1  - Heiss, Kurt F.
A1  - Conti, Vincent R.
A1  - Bartlett, Robert H.
Y1  - 1988/07//
KW  - Extracorporeal membrane oxygenation (ECMO)
KW  - pericardial tamponade
KW  - tension hemothorax
KW  - tension pneumothorax
JF  - Journal of Pediatric Surgery
VL  - 23
IS  - 7
SP  - 599
EP  - 604
DO  - 10.1016/S0022-3468(88)80626-2
UR  - https://linkinghub.elsevier.com/retrieve/pii/S0022346888806262
N2  - Extracorporeal membrane oxygenation (ECMO) has been successful (>80% survival) in 35 centers in >900 newborns with severe respiratory failure having an estimated mortality of >80% on conventional management. During the last 3 years we have treated 79 newborns with 74 survivors (94%). Their diagnoses included meconium aspiration, persistent fetal circulation, respiratory distress syndrome, congenital diaphragmatic hernia, and sepsis. Seven patients (9%) had life-threatening intrathoracic complications requiring emergent intervention while on ECMO: tension hemothorax (3), tension pneumothorax (2), and pericardial tamponade (2). Pericardial tamponade and tension hemothorax and pneumothorax show a similar pathophysiology of increasing intrapericardial pressure and decreasing venous return. Perfusion is initially maintained by the nonpulsatile flow of the ECMO circuit before further decrease in venous return results in decreasing ECMO flow and progressive hemodynamic deterioration. Each of the seven patients demonstrated a clinical triad that includes increasing PaO2 and decreasing peripheral perfusion (as evidenced by decreasing pulse pressure and decreasing SvO2) followed by decreasing ECMO flow with progressive deterioration. The diagnoses were confirmed by transillumination, chest x-ray, or cardiac echocardiogram. Initial emergent placement of a percutaneous drainage catheter was temporizing in all seven cases. However, four patients required emergent thoracotomy for definitive treatment while still on ECMO. All seven patients were weaned from ECMO and are short-term survivors (6 months to 3.5 years). As use of ECMO for newborn severe respiratory failure increases, responsible physicians must be familiar with life-threatening intrathoracic complications and appropriate treatment strategies. © 1988 Grune & Stratton, Inc.
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TY  - JOUR
T1  - Chest tube placement in children during extracorporeal membrane oxygenation (ECMO)
A1  - Jackson, Hope T.
A1  - Longshore, Shannon
A1  - Feldman, Jake
A1  - Zirschky, Katie
A1  - Gingalewski, Cynthia A.
A1  - Gollin, Gerald
Y1  - 2014/01//
KW  - Chest tube placement
KW  - ECMO
KW  - Hemothorax
KW  - Pleural Effusion
KW  - Pneumothorax
JF  - Journal of Pediatric Surgery
VL  - 49
IS  - 1
SP  - 51
EP  - 54
DO  - 10.1016/j.jpedsurg.2013.09.028
UR  - https://linkinghub.elsevier.com/retrieve/pii/S0022346813007471
N2  - Background Pleural collections of air and fluid are frequent in infants and children treated with extracorporeal membrane oxygenation (ECMO). In this anticoagulated population, chest tube placement is potentially hazardous, and catastrophic hemorrhage has been reported. We sought to define the risks associated with chest tube placement in a large population of children managed with ECMO. Methods The records of 189 consecutive children managed with ECMO at two children's hospitals were reviewed. Demographics, indications for ECMO, and ECMO courses were reviewed. In particular, the occurrence of pleural collections and the frequency and technique of chest tube placement were evaluated. The incidence of complications and mortality were determined. Results The median age of the subjects was 2 days. The overall mortality was 26.5%. A pneumothorax was found in 19 (10.1%), a pleural effusion in 26 (13.8%), and a hemothorax in 2 (1.0%). A chest tube was placed in 27 (19 by a needle-guide wire technique and 8 by cut-down). Major bleeding complications occurred in 6 subjects (22%). Conclusions There was a significant incidence of major bleeding complications and death in subjects in whom chest tubes were placed. The placement of a chest tube during ECMO should be done only if it is likely to improve pump flow or promote weaning of support. © 2014 Elsevier Inc. All rights reserved.
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TY  - JOUR
T1  - Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: A meta-analysis of 1,866 adult patients
A1  - Cheng, Richard
A1  - Hachamovitch, Rory
A1  - Kittleson, Michelle
A1  - Patel, Jignesh
A1  - Arabia, Francisco
A1  - Moriguchi, Jaime
A1  - Esmailian, Fardad
A1  - Azarbal, Babak
Y1  - 2014/02//
KW  - 27
KW  - CTSNet classification
JF  - Annals of Thoracic Surgery
VL  - 97
IS  - 2
SP  - 610
EP  - 616
DO  - 10.1016/j.athoracsur.2013.09.008
UR  - https://linkinghub.elsevier.com/retrieve/pii/S0003497513020055
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Cheng et al. - 2014 - Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest A meta-.pdf
N2  - Background Venoarterial extracorporeal membrane oxygenation (ECMO) has been used successfully for treatment of cardiogenic shock or cardiac arrest. The exact complication rate is not well understood, in part because of small study sizes. In the absence of large clinical trials, performance of pooled analysis represents the best method for ascertaining complication rates for ECMO. Methods A systematic PubMed search was conducted on ECMO for treatment of cardiogenic shock or cardiac arrest in adult patients only, updated to November 2012. Studies with more than 10 patients published in the year 2000 or later that reported complication rates for ECMO were included. Specific complications analyzed included lower extremity ischemia, fasciotomy or compartment syndrome, amputation, stroke, neurologic complications, acute kidney injury, renal replacement therapy, major or significant bleeding, rethoracotomy for bleeding or tamponade, and significant infection. For studies that included overlapping patients, the largest study was included and the others excluded. Cochran's Q and I-squared were calculated. A more conservative random-effects model was chosen for all analyses. Results Twenty studies were included in the analyses encompassing 1,866 patients. Seventeen studies reported survival to hospital discharge, with a cumulative survival rate of 534 of 1,529, and a range of 20.8% to 65.4%. Analyses encompassed 192 to 1,452 patients depending on the specific complication analyzed. The pooled estimate rates of complications with 95% confidence intervals were as follows: lower extremity ischemia, 16.9% (12.5% to 22.6%); fasciotomy or compartment syndrome, 10.3% (7.3% to 14.5%); lower extremity amputation, 4.7% (2.3% to 9.3%); stroke, 5.9% (4.2% to 8.3%); neurologic complications, 13.3% (9.9% to 17.7%); acute kidney injury, 55.6% (35.5% to 74.0%); renal replacement therapy, 46.0% (36.7% to 55.5%); major or significant bleeding, 40.8% (26.8% to 56.6%); rethoracotomy for bleeding or tamponade in postcardiotomy patients, 41.9% (24.3% to 61.8%); and significant infection, 30.4% (19.5% to 44.0%). Conclusions Although ECMO can improve survival of patients with advanced heart disease, there is significant associated morbidity with performance of this intervention. These findings should be incorporated in the risk-benefit analysis when initiation of ECMO for cardiogenic shock is being considered. © 2014 by The Society of Thoracic Surgeons Published by Elsevier Inc.
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TY  - JOUR
T1  - Venoarterial extracorporeal membrane oxygenation for treatment of cardiogenic shock: Clinical experiences in 45 adult patients
A1  - Bakhtiary, Farhad
A1  - Keller, Harald
A1  - Dogan, Selami
A1  - Dzemali, Omer
A1  - Oezaslan, Feyzan
A1  - Meininger, Dirk
A1  - Ackermann, Hanns
A1  - Zwissler, Bernhard
A1  - Kleine, Peter
A1  - Moritz, Anton
Y1  - 2008/02//
PB  - Mosby
JF  - Journal of Thoracic and Cardiovascular Surgery
VL  - 135
IS  - 2
SP  - 382
EP  - 388
DO  - 10.1016/j.jtcvs.2007.08.007
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Bakhtiary et al. - 2008 - Venoarterial extracorporeal membrane oxygenation for treatment of cardiogenic shock Clinical experiences in 45.pdf
N2  - Objective: Venoarterial extracorporeal membrane oxygenation is an established treatment option in patients with cardiogenic shock. This report reviews our 3-year experience with this support system with respect to early and midterm outcome, as well as predictors of survival. Methods: From January 2003 until November 2006, 45 (0.8%) of 5750 patients undergoing cardiac surgery procedures required the following: temporary extracorporeal membrane oxygenation support coronary artery bypass grafting, n = 20; implantation of a left ventricular assist device, n = 5; heart transplantation, n = 1; heart and lung transplantation, n = 1; coronary artery bypass grafting plus repair of postinfarction ventricular septal defect, n = 3; coronary artery bypass grafting plus mitral valve repair, n = 5; aortic valve replacement, n = 2; coronary artery bypass grafting plus aortic valve replacement, n = 3; and other procedures, n = 5. Extracorporeal membrane oxygenation implantation was performed through the femoral vessels or axillary artery or through the right atrium and ascending aorta. Additional intra-aortic balloon pumps were used in 30 patients. Results: Average patient age was 60.1 ± 13.6 years. There were 35 male patients. Average duration of extracorporeal membrane oxygenation was 6.4 ± 4.5 days. Twenty-five patients could be successfully weaned from extracorporeal membrane oxygenation. The 30-day mortality was 53% (24/45 patients). The in-hospital mortality was 71% (32/45 patients). Thirteen (29%) patients could be successfully discharged. After a follow-up period of up to 3 years, 10 (22%) patients were still alive. Conclusions: Extracorporeal membrane oxygenation offers sufficient cardiopulmonary support in adults with similar hospital and midterm survival rates to those of other mechanical support systems. Early indication, alternative peripheral cannulation techniques, and reduced anticoagulation to avoid perioperative bleeding could improve our results with increasing experience. © 2008 The American Association for Thoracic Surgery.
ER  - 
TY  - JOUR
T1  - Early and Intermediate Results of Rescue Extracorporeal Membrane Oxygenation in Adult Cardiogenic Shock
A1  - Wang, Jiangang
A1  - Han, Jie
A1  - Jia, Yixin
A1  - Zeng, Wen
A1  - Shi, Jiahai
A1  - Hou, Xiaotong
A1  - Meng, Xu
Y1  - 2009/12//
JF  - Annals of Thoracic Surgery
VL  - 88
IS  - 6
SP  - 1897
EP  - 1903
DO  - 10.1016/j.athoracsur.2009.08.009
UR  - https://linkinghub.elsevier.com/retrieve/pii/S0003497509016063
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Wang et al. - 2009 - Early and Intermediate Results of Rescue Extracorporeal Membrane Oxygenation in Adult Cardiogenic Shock.pdf
N2  - Background: We retrospectively evaluated the early and intermediate results of use of temporary extracorporeal membrane oxygenation (ECMO) support and examined its effect on quality of life (QOL). Methods: Over four years 62 of 12,644 patients (0.49%) undergoing cardiac surgery (valve procedures, n = 39; coronary artery bypass grafting, n = 13; coronary artery bypass grafting plus valve procedures, n = 4; heart transplantation, n = 4; and total aortic arch replacement, n = 2) required temporary postoperative ECMO support. During a follow-up study (mean 2.3 ± 1.5 years, 100% complete), 32 were still alive and answered the Short-Form 36 Health Survey QOL questionnaire. Results: The mean duration of ECMO support was 61 ± 37 hours. Forty patients (64.5%) were successfully weaned from ECMO. Thirty-four patients (54.8%) were discharged from the hospital after 44.3 ± 17.6 days. The in-hospital mortality rate was 45.2% and the main cause of death was multiple organ failure. A risk factor for in-hospital death was a peak lactate level greater than 12 mol/L before ECMO initiation. There were few significant differences in the mean QOL scores between the ECMO survivors and other patients who had undergone cardiac surgery without ECMO support; only the measures of vitality and mental health were significantly lower in the ECMO survivors (p < 0.05). Both the ECMO survivors and the patients who did not receive ECMO support had significantly lower QOL scores (except for vitality and mental health) than the general Chinese population (p < 0.05). Conclusions: Extracorporeal membrane oxygenation is an acceptable technique for the treatment of postoperative cardiogenic shock in adults, although early intervention and reduced complications could improve results. However, the use of ECMO has little influence on QOL. © 2009 The Society of Thoracic Surgeons.
ER  - 
TY  - JOUR
T1  - Outcomes after peripheral extracorporeal membrane oxygenation therapy for postcardiotomy cardiogenic shock: A single-center experience
A1  - Slottosch, Ingo
A1  - Liakopoulos, Oliver
A1  - Kuhn, Elmar
A1  - Deppe, Antje Christin
A1  - Scherner, Maximilian
A1  - Madershahian, Navid
A1  - Choi, Yeong Hoon
A1  - Wahlers, Thorsten
Y1  - 2013/05//
KW  - Cardiac surgery
KW  - ECMO
KW  - Extracorporeal membrane oxygenation
KW  - Postcardiotomy cardiogenic shock
JF  - Journal of Surgical Research
VL  - 181
IS  - 2
SP  - e47
EP  - e55
DO  - 10.1016/j.jss.2012.07.030
UR  - https://linkinghub.elsevier.com/retrieve/pii/S0022480412006701
N2  - Background: We assessed the short-term outcomes and predictors of 30-d mortality in patients requiring temporary, peripheral extracorporeal membrane oxygenation (ECMO) for postcardiotomy cardiac failure. Methods: The data were retrospectively obtained using our institutional patient database. All patients who had received peripheral ECMO support after surgery for acquired heart disease from 2006 to 2010 were included in the present study. The demographic and perioperative variables of the 30-d survivors and nonsurvivors were compared using the chi-square and t-test, and multivariate logistic regression analysis was performed to identify the predictors of 30-d all-cause mortality. Results: A total of 77 patients with a mean age of 60 ± 13 years were included in the present analysis. Successful weaning from peripheral ECMO was achieved in 62% after 79 ± 57 h of ECMO support. The overall 30-d mortality rate was 70%, and mortality was reduced to 52% in the patients in whom ECMO support could be weaned successfully. Age (per year) at ECMO implantation was the only independent preoperative predictor of 30-d mortality (odds ratio 1.09, 95% confidence interval 1.03-1.15; P = 0.003). In addition, greater lactate levels after 24 h of ECMO therapy, a longer duration of ECMO support, and the presence of any ECMO-related or gastrointestinal complications were independent predictive factors for 30-d mortality (P < 0.05). Conclusions: ECMO therapy provides a valuable therapeutic strategy for postcardiotomy myocardial failure but is still limited by high complication rates with fewer than 30% of patients discharged from the hospital. Patient age appears to be an essential preoperative predictor for mortality, and the blood lactate level is a relevant marker for the assessment of efficient ECMO support. © 2013 Elsevier Inc. All rights reserved.
ER  - 
TY  - GEN
T1  - Clinical Management of Venoarterial Extracorporeal Membrane Oxygenation
A1  - Hoyler, Marguerite M.
A1  - Flynn, Brigid
A1  - Iannacone, Erin Mills
A1  - Jones, Mandisa Maia
A1  - Ivascu, Natalia S.
Y1  - 2020/01//
KW  - cardiac critical care
KW  - cardiogenic shock
KW  - extracorporeal cardiopulmonary resuscitation
KW  - mechanical circulatory support
KW  - venoarterial extracorporeal membrane oxygenation
PB  - W.B. Saunders
JF  - Journal of Cardiothoracic and Vascular Anesthesia
DO  - 10.1053/j.jvca.2019.12.047
UR  - https://linkinghub.elsevier.com/retrieve/pii/S1053077020300173
N2  - Venoarterial extracorporeal membrane oxygenation (ECMO) is a well-established technique to rescue patients experiencing cardiogenic shock. As a form of temporary mechanical circulatory support, venoarterial ECMO can be life-saving, but it is resource intensive and associated with substantial morbidity and mortality. Optimal clinical outcomes require specific expertise in the principles and nuances of ECMO physiology and management. Key considerations discussed in this review include hemodynamic assessment and goals; pharmacologic anticoagulation; ECMO weaning strategies; and the prevention, evaluation, and treatment of common complications.
ER  - 
TY  - JOUR
T1  - Venoarterial extracorporeal membrane oxygenation: A systematic review of selection criteria, outcome measures and definitions of complications
A1  - Burrell, Aidan J.C.
A1  - Bennett, Victoria
A1  - Serra, Alexis L.
A1  - Pellegrino, Vincent A.
A1  - Romero, Lorena
A1  - Fan, Eddy
A1  - Brodie, Daniel
A1  - Cooper, D. James
A1  - Kaye, David M.
A1  - Fraser, John F.
A1  - Hodgson, Carol L.
Y1  - 2019/10//
KW  - Definitions
KW  - Extracorporeal membrane oxygenation
KW  - Heart failure
KW  - Outcomes
KW  - Venoarterial
PB  - W.B. Saunders
JF  - Journal of Critical Care
VL  - 53
SP  - 32
EP  - 37
DO  - 10.1016/j.jcrc.2019.05.011
UR  - https://linkinghub.elsevier.com/retrieve/pii/S0883944118316058
N2  - Purpose: The purpose of this study was to systematically investigate the reporting of selection criteria and outcome measures, and to examine definitions of complications used in venoarterial extracorporeal membrane oxygenation studies (V-A ECMO). Materials and methods: Medline, EMBASE and the Cochrane central register were searched for V-A ECMO studies from January 2005 to July 2017. Studies with ≤99 patients or without patient centered outcomes were excluded. Two reviewers independently assessed search results and undertook data extraction. Results: Forty-six studies met the inclusion criteria, and all were retrospective, observational studies. Inconsistent reporting of selection criteria, ECMO management and outcome measures was common. In-hospital mortality was the most common primary outcome (41% of studies), followed by 30-day mortality (11%). Bleeding was the most frequent complication reported, most commonly defined as “bleeding requiring transfusion” (median ≥ 2 Units/day). Significant variation in reporting and definitions was also evident for vascular, neurological renal and infectious complications. Conclusion: This systematic review provides clinicians with the most commonly reported selection criteria, outcome measures and complications used in ECMO practice. However non-standardized definitions and inconsistent reporting limits their ability to inform practice. New consensus driven definitions of complications and patient centred outcomes are urgently needed.
ER  - 
TY  - JOUR
T1  - Outcome in patients who require venoarterial extracorporeal membrane oxygenation support after cardiac surgery
A1  - Elsharkawy, Hesham A.
A1  - Li, Liang
A1  - Esa, Wael Ali Sakr
A1  - Sessler, Daniel I.
A1  - Bashour, C. Allen
Y1  - 2010/12//
KW  - Anesthesia
KW  - Cardiac surgery
KW  - ECMO
KW  - Mortality
KW  - Outcome
KW  - Venoarterial extracorporeal membrane oxygenation
JF  - Journal of Cardiothoracic and Vascular Anesthesia
VL  - 24
IS  - 6
SP  - 946
EP  - 951
DO  - 10.1053/j.jvca.2010.03.020
UR  - https://linkinghub.elsevier.com/retrieve/pii/S1053077010001175
N2  - Objective: The authors analyzed hospital mortality in adult cardiac surgery patients who required postoperative venoarterial extracorporeal membrane oxygenation (ECMO) support for circulatory failure and identified perioperative patient variables associated with hospital mortality in these patients. Design: A retrospective study. Setting: A single institution, tertiary academic center. Participants: Adult patients requiring venoarterial ECMO support after cardiac surgery from January 1995 to December 2005 were identified from the Anesthesiology Institute Patient Registry. Twenty-two preselected patient variables were entered into a logistic regression model of hospital death. Interventions: None. Results: Two hundred thirty-three of 40,116 (0.58%) adult cardiac surgery patients required postoperative venoarterial ECMO, and among these, 149 (64%) died in the hospital. In an unadjusted analysis, older age, higher preoperative albumin, diabetes history, coronary artery bypass graft surgery, and longer total cardiopulmonary bypass (CPB) time were associated with increased hospital mortality, and a history of cardiogenic shock was associated with decreased mortality. In an adjusted logistic regression analysis, a history of cardiogenic shock and younger age were associated with decreased hospital mortality. The overall use of postoperative venoarterial ECMO in this patient population decreased since its peak in 1996. Conclusion: Venoarterial ECMO support after cardiac surgery was required in a small fraction of patients and was associated with very high hospital mortality; but among those requiring ECMO, mortality in these patients was lower in younger, nondiabetic patients with cardiogenic shock who had shorter CPB times. The mortality associated patient variables identified are not easily modifiable and do not appear sufficiently robust to define which patients should be selected for this potentially life-saving therapy.
ER  - 
TY  - JOUR
T1  - Investigation of microcirculation in patients with venoarterial extracorporeal membrane oxygenation life support
A1  - Yeh, Yu Chang
A1  - Lee, Chen Tse
A1  - Wang, Chih Hsien
A1  - Tu, Yu Kang
A1  - Lai, Chien Heng
A1  - Wang, Yin Chin
A1  - Chao, Anne
A1  - Huang, Chi Hsiang
A1  - Cheng, Ya Jung
A1  - Chen, Yih Sharng
Y1  - 2018/08//
KW  - Cardiogenic shock
KW  - Extracorporeal membrane oxygenation
KW  - Microcirculation
KW  - Survival
PB  - BioMed Central Ltd.
JF  - Critical Care
VL  - 22
IS  - 1
DO  - 10.1186/s13054-018-2081-2
UR  - https://pubmed.ncbi.nlm.nih.gov/30121090/
N2  - Background: Microcirculatory dysfunction develops in both septic and cardiogenic shock patients, and it is associated with poor prognosis in patients with septic shock. Information on the association between microcirculatory dysfunction and prognosis in cardiogenic shock patients with venoarterial extracorporeal membrane oxygenation (VA-ECMO) support is limited. Methods: Sublingual microcirculation images were recorded using an incident dark-field video microscope at the following time points: within 12h (T1), 24h (T2), 48h (T3), 72h (T4), and 96h (T5) after VA-ECMO placement. If a patient could be weaned off VA-ECMO, sublingual microcirculation images were recorded before and after VA-ECMO removal. Microcirculatory parameters were compared between 28-day nonsurvivors and survivors with VA-ECMO support. In addition, the microcirculation and clinical parameters were assessed as prognostic tests of 28-day mortality, and patients were divided into three subgroups according to microcirculation parameters for survival analysis. Results: Forty-eight patients were enrolled in this study. At T1, the observed heart rate, mean arterial pressure, inotropic score and lactate level of 28-day nonsurvivors and survivors did not differ significantly, but the perfused small vessel density (PSVD) and proportion of perfused vessels (PPV) were lower in the 28-day nonsurvivors than in the survivors. The PSVD and PPV were slightly superior to lactate levels in predicting 28-day mortality (area under curve of 0.68, 0.70, and 0.62, respectively). The subgroup with the lowest PSVD (<15mm/mm2) and PPV (<64%) values exhibited less favorable survival compared with the other two subgroups. Conclusions: Early microcirculatory parameters could be used to predict the survival of cardiogenic shock patients with VA-ECMO support.
ER  - 
TY  - JOUR
T1  - Functional evaluation of sublingual microcirculation indicates successful weaning from VA-ECMO in cardiogenic shock
A1  - Akin, Sakir
A1  - dos Reis Miranda, Dinis
A1  - Caliskan, Kadir
A1  - Soliman, Osama I.
A1  - Guven, Goksel
A1  - Struijs, Ard
A1  - van Thiel, Robert J.
A1  - Jewbali, Lucia S.
A1  - Lima, Alexandre
A1  - Gommers, Diederik
A1  - Zijlstra, Felix
A1  - Ince, Can
Y1  - 2017/10//
KW  - Cardiac recovery
KW  - Cardiogenic shock
KW  - CytoCam
KW  - Incident dark field imaging
KW  - Microcirculation
KW  - Sublingual
KW  - VA-ECMO
KW  - Weaning
PB  - BioMed Central Ltd.
JF  - Critical Care
VL  - 21
IS  - 1
SP  - 265
EP  - 265
DO  - 10.1186/s13054-017-1855-2
UR  - http://ccforum.biomedcentral.com/articles/10.1186/s13054-017-1855-2
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Akin et al. - 2017 - Functional evaluation of sublingual microcirculation indicates successful weaning from VA-ECMO in cardiogenic shock.pdf
N2  - Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly adopted for the treatment of cardiogenic shock (CS). However, a marker of successful weaning remains largely unknown. Our hypothesis was that successful weaning is associated with sustained microcirculatory function during ECMO flow reduction. Therefore, we sought to test the usefulness of microcirculatory imaging in the same sublingual spot, using incident dark field (IDF) imaging in assessing successful weaning from VA-ECMO and compare IDF imaging with echocardiographic parameters. Methods: Weaning was performed by decreasing the VA-ECMO flow to 50% (F50) from the baseline. The endpoint of the study was successful VA-ECMO explantation within 48 hours after weaning. The response of sublingual microcirculation to a weaning attempt (WA) was evaluated. Microcirculation was measured in one sublingual area (single spot (ss)) using CytoCam IDF imaging during WA. Total vessel density (TVDss) and perfused vessel density (PVDss) of the sublingual area were evaluated before and during 50% flow reduction (TVDssF50, PVDssF50) after a WA and compared to conventional echocardiographic parameters as indicators of the success or failure of the WA. Results: Patients (n = 13) aged 49 ± 18 years, who received VA-ECMO for the treatment of refractory CS due to pulmonary embolism (n = 5), post cardiotomy (n = 3), acute coronary syndrome (n = 2), myocarditis (n = 2) and drug intoxication (n = 1), were included. TVDssF50 (21.9 vs 12.9 mm/mm2, p = 0.001), PVDssF50 (19.7 vs 12.4 mm/mm2, p = 0.01) and aortic velocity-time integral (VTI) at 50% flow reduction (VTIF50) were higher in patients successfully weaned vs not successfully weaned. The area under the curve (AUC) was 0.99 vs 0.93 vs 0.85 for TVDssF50 (small vessels) >12.2 mm/mm2, left ventricular ejection fraction (LVEF) >15% and aortic VTI >11 cm. Likewise, the AUC was 0.91 vs 0.93 vs 0.85 for the PVDssF50 (all vessels) >14.8 mm/mm2, LVEF >15% and aortic VTI >11 cm. Conclusion: This study identified sublingual microcirculation as a novel potential marker for identifying successful weaning from VA-ECMO. Sustained values of TVDssF50 and PVDssF50 were found to be specific and sensitive indicators of successful weaning from VA-ECMO as compared to echocardiographic parameters.
ER  - 
TY  - JOUR
T1  - Association of hospital-level volume of extracorporeal membrane oxygenation cases and mortality: Analysis of the extracorporeal life support organization registry
A1  - Barbaro, Ryan P
A1  - Odetola, Folafoluwa O
A1  - Kidwell, Kelley M
A1  - Paden, Matthew L
A1  - Bartlett, Robert H
A1  - Davis, Matthew M
A1  - Annich, Gail M
Y1  - 2015///
KW  - Adult
KW  - Extracorporeal membrane oxygenation
KW  - High-volume hospitals
KW  - Low-volume hospitals
KW  - Pediatric
JF  - American Journal of Respiratory and Critical Care Medicine
VL  - 191
IS  - 8
SP  - 894
EP  - 901
DO  - 10.1164/rccm.201409-1634OC
UR  - www.atsjournals.org
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Barbaro et al. - 2015 - Association of Hospital-Level Volume of Extracorporeal Membrane Oxygenation Cases and Mortality Analysis of the.pdf
N2  - Rationale: Recent pediatric studies suggest a survival benefit exists for higher-volume extracorporeal membrane oxygenation (ECMO) centers. Objectives: To determine if higher annual ECMO patient volume is associated with lower case-mix-adjusted hospital mortality rate. Methods: We retrospectively analyzed an international registry of ECMOsupport from 1989 to 2013. Patients were separated into three age groups: neonatal (0-28 d), pediatric (29 d to <18 yr), and adult (≥18 yr). The measure of hospital ECMO volume was age group-specific and adjusted for patient-level case-mix and hospitallevel variance using multivariable hierarchical logistic regression modeling. The primary outcome was death before hospital discharge. A subgroup analysis was conducted for 2008-2013. Measurements and Main Results: From 1989 to 2013, a total of 290 centers provided ECMO support to 56,222 patients (30,909 neonates, 14,725 children, and 10,588 adults). Annual ECMO mortality rates varied widely across ECMO centers: the interquartile range was 18-50% for neonates, 25-66% for pediatrics, and 33-92% for adults. For 1989-2013, higher age group-specific ECMO volume was associated with lower odds of ECMO mortality for neonates and adults but not for pediatric cases. In 2008-2013, the volume-outcome association remained statistically significant only among adults. Patients receiving ECMO at hospitals with more than 30 adult annual ECMO cases had significantly lower odds of mortality (adjusted odds ratio, 0.61; 95% confidence interval, 0.46-0.80) compared with adults receiving ECMO at hospitals with less than six annual cases. Conclusions: In this international, case-mix-adjusted analysis, higher annual hospital ECMO volume was associated with lower mortality in 1989-2013 for neonates and adults; the association among adults persisted in 2008-2013.
ER  - 
TY  - JOUR
T1  - Elevated Venous to Arterial Carbon Dioxide Gap and Anion Gap Are Associated with Poor Outcome in Cardiogenic Shock Requiring Extracorporeal Membrane Oxygenation Support
A1  - McDonald, Charles I.
A1  - Brodie, Daniel
A1  - Schmidt, Matthieu
A1  - Hay, Karen
A1  - Shekar, Kiran
Y1  - 2021///
KW  - P(v-a)CO2gap
KW  - anion gap
KW  - cardiogenic shock
KW  - extracorporeal support
KW  - microcirculation
JF  - ASAIO Journal
VL  - Online Fir
SP  - 263
EP  - 269
DO  - 10.1097/MAT.0000000000001215
UR  - https://journals.lww.com/asaiojournal/Fulltext/9000/Elevated_Venous_to_Arterial_Carbon_Dioxide_Gap_and.98498.aspx
N2  - Optimal management of cardiogenic shock requiring extracorporeal membrane oxygenation (ECMO) is still an evolving area in which assessment and optimization of the microcirculation may be critically important. We hypothesized that the venous arterial carbon dioxide gap (P(v-a)CO2 gap); the ratio of this gap to arterio-venous oxygen content (P(v-a)CO2/C(a-v)O2 ratio) and the anion gap would be early indicators of microcirculatory status and useful parameters for outcome prediction during ECMO support. We retrospectively reviewed 31 cardiogenic shock patients requiring veno-arterial ECMO, calculating P(v-a)CO2 gap and P(v-a)CO2/C(a-v)O2 ratios in the first 36 hours and the final 24 hours of ECMO support. Sixteen patients (52%) survived and 15 (48%) died. After 24 hours of ECMO support, the P(v-a)CO2 gap (4.9 ± 1.5 vs. 6.8 ± 1.9 mm Hg; p = 0.004) and anion gap (5.2 ± 1.8 vs. 8.7 ± 2.7 mmol/L; p < 0.001) were significantly higher in non-survivors. In the final 24 hours of ECMO support, the P(v-a)CO2 gap (3.5 ± 1.6 vs. 10.5 ± 3.2 mm Hg; p < 0.001), P(v-a)CO2/C(a-v)O2 ratio (1.1 ± 0.5 vs. 2.7 ± 1.0; p < 0.001), anion gap (5.1 ± 3.0 vs. 9.3 ± 5.9 mmol/L; p = 0.02), and lactate (median 1.0 [interquartile range {IQR}: 0.7-1.5] vs. 2.8 [IQR: 1.7-7.7] mmol/L; p = <0.001) were all significantly lower in survivors. Increasing P(v-a)CO2 gap and increasing anion gap were significantly associated with increased risk of mortality. Optimum cut-points for prediction of mortality were 6 mm Hg for P(v-a)CO2 gap in combination with an anion gap above 6 mmol/L in the first 24 hours of ECMO in patients with cardiogenic shock requiring ECMO.
ER  - 
TY  - JOUR
T1  - Pediatric and neonatal extracorporeal membrane oxygenation: Does center volume impact mortality?
A1  - Freeman, Carrie L.
A1  - Bennett, Tellen D.
A1  - Casper, T. Charles
A1  - Larsen, Gitte Y.
A1  - Hubbard, Ania
A1  - Wilkes, Jacob
A1  - Bratton, Susan L.
Y1  - 2014/03//
KW  - cardiopulmonary resuscitation
KW  - critical care
KW  - extracorporeal membrane oxygenation
KW  - low-volume hospitals
KW  - pediatrics
KW  - risk adjustment
JF  - Critical Care Medicine
VL  - 42
IS  - 3
SP  - 512
EP  - 519
DO  - 10.1097/01.ccm.0000435674.83682.96
UR  - http://journals.lww.com/00003246-201403000-00003
N2  - OBJECTIVE:: Extracorporeal membrane oxygenation, an accepted rescue therapy for refractory cardiopulmonary failure, requires a complex multidisciplinary approach and advanced technology. Little is known about the relationship between a center's case volume and patient mortality. The purpose of this study was to analyze the relationship between hospital extracorporeal membrane oxygenation annual volume and in-hospital mortality and assess if a minimum hospital volume could be recommended. DESIGN:: Retrospective cohort study. SETTING:: A retrospective cohort admitted to children's hospitals in the Pediatric Health Information System database from 2004 to 2011 supported with extracorporeal membrane oxygenation was identified. Indications were assigned based on patient age (neonatal vs pediatric), diagnosis, and procedure codes. Average hospital annual volume was defined as 0-19, 20-49, or greater than or equal to 50 cases per year. Maximum likelihood estimates were used to assess minimum annual case volume. PATIENTS:: A total of 7,322 pediatric patients aged 0-18 were supported with extracorporeal membrane oxygenation and had an indication assigned. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Average hospital extracorporeal membrane oxygenation volume ranged from 1 to 58 cases per year. Overall mortality was 43% but differed significantly by indication. After adjustment for case-mix, complexity of cardiac surgery, and year of treatment, patients treated at medium-volume centers (odds ratio, 0.86; 95% CI, 0.75-0.98) and high-volume centers (odds ratio, 0.75; 95% CI, 0.63-0.89) had significantly lower odds of death compared with those treated at low-volume centers. The minimum annual case load most significantly associated with lower mortality was 22 (95% CI, 22-28). CONCLUSIONS:: Pediatric centers with low extracorporeal membrane oxygenation average annual case volume had significantly higher mortality and a minimum volume of 22 cases per year was associated with improved mortality. We suggest that this threshold should be evaluated by additional study. Copyright © 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.
ER  - 
TY  - JOUR
T1  - Position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure in adult patients
A1  - Combes, Alain
A1  - Brodie, Daniel
A1  - Bartlett, Robert
A1  - Brochard, Laurent
A1  - Brower, Roy
A1  - Conrad, Steve
A1  - De Backer, Daniel
A1  - Fan, Eddy
A1  - Ferguson, Niall
A1  - Fortenberry, James
A1  - Fraser, John
A1  - Gattinoni, Luciano
A1  - Lynch, William
A1  - MacLaren, Graeme
A1  - Mercat, Alain
A1  - Mueller, Thomas
A1  - Ogino, Mark
A1  - Peek, Giles
A1  - Pellegrino, Vince
A1  - Pesenti, Antonio
A1  - Ranieri, Marco
A1  - Slutsky, Arthur
A1  - Vuylsteke, Alain
Y1  - 2014/09//
KW  - Acute respiratory distress syndrome
KW  - Critical care networks
KW  - Extracorporeal membrane oxygenation
KW  - Hospital organization
KW  - Position article
PB  - American Thoracic Society
JF  - American Journal of Respiratory and Critical Care Medicine
VL  - 190
IS  - 5
SP  - 488
EP  - 496
DO  - 10.1164/rccm.201404-0630CP
UR  - http://www.atsjournals.org/doi/abs/10.1164/rccm.201404-0630CP
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Combes et al. - 2014 - Position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure.pdf
N2  - The use of extracorporeal membrane oxygenation (ECMO)for severe acute respiratory failure (ARF) in adults is growing rapidly given recent advances in technology, even though there is controversy regarding the evidence justifying its use. Because ECMOis a complex, high-risk, and costly modality, at present it should be conducted in centers with sufficient experience, volume, and expertise to ensure it is used safely. This position paper represents the consensus opinion of an international group of physicians and associated health-care workers who have expertise in therapeutic modalities used in the treatment of patients with severe ARF, with a focus on ECMO. The aim of this paper is to provide physicians,ECMOcenter directors and coordinators, hospital directors, health-care organizations, and regional, national, and international policy makers a description of the optimal approach to organizing ECMO programs for ARF in adult patients. Importantly, this will help ensure that ECMO is delivered safely and proficiently, such that future observational and randomized clinical trials assessing this technique may be performed by experienced centers under homogeneous and optimal conditions. Given the need for further evidence, we encourage restraint in the widespread use of ECMO until we have a better appreciation for both the potential clinical applications and the optimal techniques for performing ECMO.
ER  - 
TY  - JOUR
T1  - Noninvasive assessment of hemodynamic variables using near-infrared spectroscopy in patients experiencing cardiogenic shock and individuals undergoing venoarterial extracorporeal membrane oxygenation
A1  - Ostadal, Petr
A1  - Kruger, Andreas
A1  - Vondrakova, Dagmar
A1  - Janotka, Marek
A1  - Psotova, Hana
A1  - Neuzil, Petr
Y1  - 2014/08//
KW  - Aged
KW  - Blood Pressure
KW  - Body Surface Area
KW  - Cardiogenic shock
KW  - Cerebrovascular Circulation
KW  - Extracorporeal Membrane Oxygenation
KW  - Extracorporeal membrane oxygenation
KW  - Female
KW  - Hemodynamics
KW  - Male
KW  - Middle Aged
KW  - Near-infrared spectroscopy
KW  - Nonparametric
KW  - Oximetry
KW  - Retrospective Studies
KW  - Statistics
KW  - Vascular Resistance
JF  - Journal of Critical Care
VL  - 29
IS  - 4
SP  - 690.e11
EP  - 5
DO  - 10.1016/j.jcrc.2014.02.003
UR  - http://www.ncbi.nlm.nih.gov/pubmed/24636922
N2  - Purpose: The relationship between near-infrared spectroscopy cerebral oximetry (CrSO2), peripheral oximetry (PrSO2) and hemodynamic variables is not fully understood. Methods: The relationship between CrSO2/PrSO2and cardiac index (CI), systemic vascular resistance index (SVRI) and mean arterial pressure (MAP) in patients experiencing cardiogenic shock and those undergoing venoarterial extracorporeal membrane oxygenation (ECMO) was retrospectively analyzed; in patients on ECMO, total circulatory index (TCI) was calculated from the sum of CI and extracorporeal blood flow index. Results: In patients experiencing cardiogenic shock (n = 10), significant correlations between PrSO2values and CI (Spearman r = 0.81; P < .0001), SVRI (r = -0.45; P < .0001), and MAP (r = 0.58; P < .0001) were found. Significant correlations between CrSO2and CI (r = 0.55; P < .0001) and SVRI (r = -0.47; P < .0001), but not MAP, were observed. Linear regression analysis revealed that CI could be calculated using the following equation: CI = PrSO2/24.0.In patients on VA ECMO (n = 12), significant correlations were found between PrSO2and TCI (r = 0.68; P < .0001), SVRI (r = -0.47; P < .0001), and MAP (r = 0.27; P = .025). Significant correlations were also found between CrSO2and TCI (r = 0.68; P < .0001) and SVRI (r = -0.51; P < .0001), but not MAP. Conclusions: Results of the present study suggest that CrSO2and PrSO2in particular can be used for noninvasive estimation and monitoring of global circulatory status in patients experiencing cardiogenic shock and individuals undergoing ECMO. © 2014 Elsevier Inc.
ER  - 
TY  - JOUR
T1  - Discrepancy between superior vena cava oxygen saturation and mixed venous oxygen saturation can predict postoperative complications in cardiac surgery patients
A1  - Suehiro, Koichi
A1  - Tanaka, Katsuaki
A1  - Matsuura, Tadashi
A1  - Funao, Tomoharu
A1  - Yamada, Tokuhiro
A1  - Mori, Takashi
A1  - Nishikawa, Kiyonobu
Y1  - 2014/06//
KW  - cardiac surgery
KW  - complication
KW  - mixed venous oxygen saturation
KW  - superior vena cava oxygen saturation
PB  - W.B. Saunders
JF  - Journal of Cardiothoracic and Vascular Anesthesia
VL  - 28
IS  - 3
SP  - 528
EP  - 533
DO  - 10.1053/j.jvca.2013.03.002
UR  - https://pubmed.ncbi.nlm.nih.gov/23972741/
UR  - https://pubmed.ncbi.nlm.nih.gov/23972741/?from_single_result=106.+Suehiro+K%2C+Tanaka+K%2C+Matsura+T%2C+et+al.+Discrepancy+between+superior+vena+cava+saturation+and+mixed+venous+oxygen+saturation+can+predict+posto
N2  - Objective To determine if increases in discrepancy between ScvO2 and SvO2 (ScvO2 - SvO2 = ΔSO 2) during surgery in cardiac surgery patients can predict postoperative complications. Design Prospective, observational study. Setting University hospital. Participants One hundred two patients undergoing cardiac surgery were enrolled. Interventions None. Measurements and Main Results Central venous oxygen saturation (ScvO2) and mixed venous oxygen saturation (SvO2) values during surgery automatically were collected. The average value of ΔSO2 for every minute was calculated. The area under the receiver operating characteristic curve for prolonged postoperative ICU stay (≥3 days) was 0.745 for ΔSO2, which was significantly different from those of ScvO2 and SvO2 (p<0.05) (ScvO2; 0.584, SvO2; 0.598). The optimal threshold value of ΔSO2 to predict prolonged ICU stay (≥3 days) was 12% (sensitivity: 72.0%, specificity: 76.9%). Postoperative ICU duration, ventilation time, and hospital stay were significantly longer in Group D patients (intraoperative maximum ΔSO2 ≥12%) than those in Group N patients (intraoperative maximum ΔSO2<12%). As for postoperative complications, the number of patients with postoperative use of intra-aortic balloon pumping, delirium, respiratory failure requiring tracheotomy, and severe complications was significantly higher in Group D patients. Multivariate logistic regression models were used to evaluate the independent effects of perioperative variables on the risk of developing prolonged ventilation (>24 hours) and prolonged ICU stay (≥3 days). A discrepancy in intraoperative ΔSO2 was an independent risk factor for prolonged postoperative ventilation and ICU stay. Conclusion The discrepancy between ScvO2 and SvO2 during cardiac surgery is an independent risk factor of postoperative complications such as prolonged ICU stay and ventilation time. © 2014 Elsevier Inc.
ER  - 
TY  - JOUR
T1  - ELSO Adult Respiratory Failure Supplement to the ELSO General Guidelines Extracorporeal Life Support Organization (ELSO) Guidelines for Adult Respiratory Failure
Y1  - 2013///
UR  - https://www.elso.org/Portals/0/IGD/Archive/FileManager/989d4d4d14cusersshyerdocumentselsoguidelinesforadultrespiratoryfailure1.3.pdf
UR  - https://www.elso.org/Portals/0/IGD/Archive/FileManager/e76ef78eabcusersshyerdocumentselsoguidelinesforadultcardiacfailure1
ER  - 
TY  - CHAP
T1  - Extracorporeal Membrane Oxygenation (ECMO) for Long-Term Support: Recent Advances
A1  - Gregory Conway, R.
A1  - Tran, Douglas
A1  - P. Griffith, Bartley
A1  - J. Wu, Zhongjun
Y1  - 2019/01//
KW  - blood oxygenator
KW  - blood pump
KW  - cardiac failure
KW  - cardiopulmonary failure
KW  - critical care medicine
KW  - extracorporeal membrane oxygenation (ECMO)
KW  - long-term ECMO
KW  - respiratory failure
PB  - IntechOpen
JF  - Advances in Extra-corporeal Perfusion Therapies
DO  - 10.5772/intechopen.76506
UR  - http://dx.doi.org/10.5772/intechopen.76506
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Gregory Conway et al. - 2019 - Extracorporeal Membrane Oxygenation (ECMO) for Long-Term Support Recent Advances.pdf
N2  - Considerable progress has been made in component technology, circuitry, and clinical practice related to extracorporeal membrane oxygenation (ECMO). These advances allow prolonged support with fewer complications when compared to the past eras. Long-term support cases were frequently reported with indications including respiratory failure, cardiac failure, bridge to transplantation, extracorporeal cardiopulmonary resuscitation (ECPR), and even ambulatory extracorporeal membrane oxygenation (ECMO) support. The common complications associated with ECMO, including thrombosis, hemorrhage, nosocomial infection, neurological injury, vessel injury, multiple organ failure and mechanical failure, and the disease process of patients remain limiting factors. In spite of the complications, ECMO remains the only possible option in treatments for patients requiring long-term respiratory or cardiopulmonary support. In this chapter, the recent advances in long-term ECMO support are reviewed. Clinical etiology of patients placed on long-term ECMO support, the various circuit configurations, clinical and technical issues, management aspects, and clinical outcomes are discussed.
ER  - 
TY  - JOUR
T1  - Long-term survival and costs following extracorporeal membrane oxygenation in critically ill children - A population-based cohort study
A1  - Fernando, Shannon M.
A1  - Qureshi, Danial
A1  - Tanuseputro, Peter
A1  - Dhanani, Sonny
A1  - Guerguerian, Anne Marie
A1  - Shemie, Sam D.
A1  - Talarico, Robert
A1  - Fan, Eddy
A1  - Munshi, Laveena
A1  - Rochwerg, Bram
A1  - Scales, Damon C.
A1  - Brodie, Daniel
A1  - Thavorn, Kednapa
A1  - Kyeremanteng, Kwadwo
Y1  - 2020/05//
KW  - Acute respiratory distress syndrome
KW  - Cardiac arrest
KW  - Cardiogenic shock
KW  - ECMO
KW  - Extracorporeal membrane oxygenation
KW  - Health services
KW  - Pediatrics
PB  - Elsevier Ireland Ltd
JF  - Critical Care
VL  - 24
IS  - 1
SP  - 620
EP  - 627
DO  - 10.1186/s13054-020-02844-3
UR  - https://linkinghub.elsevier.com/retrieve/pii/S0167527315005239
N2  - Background: Extracorporeal membrane oxygenation (ECMO) is used to provide temporary cardiorespiratory support to critically ill children. While short-term outcomes and costs have been evaluated in this population, less is known regarding long-term survival and costs. Methods: Population-based cohort study from Ontario, Canada (October 1, 2009 to March 31, 2017), of pediatric patients (< 18 years of age) receiving ECMO, identified through the use of an ECMO procedural code. Outcomes were identified through linkage to provincial health databases. Primary outcome was survival, measured to hospital discharge, as well as at 1 year, 2 years, and 5 years following ECMO initiation. We evaluated total patient costs in the first year following ECMO. Results: We analyzed 342 pediatric patients. Mean age at ECMO initiation was 2.9 years (standard deviation [SD] = 5.0). Median time from hospital admission to ECMO initiation was 5 days (interquartile range [IQR] = 1-13 days). Overall survival to hospital discharge was 56.4%. Survival at 1 year, 2 years, and 5 years was 51.5%, 50.0%, and 42.1%, respectively. Among survivors, 99.5% were discharged home. Median total costs among all patients in the year following hospital admission were $147,957 (IQR $70,571-$300,295). Of these costs, the large proportion were attributable to the inpatient cost from the index admission (median $119,197, IQR $57,839-$250,675). Conclusions: Children requiring ECMO continue to have a significant in-hospital mortality, but reassuringly, there is little decrease in long-term survival at 1 year. Median costs among all patients were substantial, but largely reflect inpatient hospital costs, rather than post-discharge outpatient costs. This information provides value to providers and health systems, allowing for prognostication of short- and long-term outcomes, as well as long-term healthcare-related expenses for pediatric ECMO survivors.
ER  - 
TY  - JOUR
T1  - Long-term survival and costs following extracorporeal membrane oxygenation in critically ill children - A population-based cohort study
A1  - Fernando, Shannon M.
A1  - Qureshi, Danial
A1  - Tanuseputro, Peter
A1  - Dhanani, Sonny
A1  - Guerguerian, Anne Marie
A1  - Shemie, Sam D.
A1  - Talarico, Robert
A1  - Fan, Eddy
A1  - Munshi, Laveena
A1  - Rochwerg, Bram
A1  - Scales, Damon C.
A1  - Brodie, Daniel
A1  - Thavorn, Kednapa
A1  - Kyeremanteng, Kwadwo
Y1  - 2020/04//
KW  - Acute respiratory distress syndrome
KW  - Cardiac arrest
KW  - Cardiogenic shock
KW  - ECMO
KW  - Extracorporeal membrane oxygenation
KW  - Health services
KW  - Pediatrics
PB  - BioMed Central Ltd.
JF  - Critical Care
VL  - 24
IS  - 1
SP  - 131
EP  - 131
DO  - 10.1186/s13054-020-02844-3
UR  - https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-02844-3
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Fernando et al. - 2020 - Long-term survival and costs following extracorporeal membrane oxygenation in critically ill children - A popul.pdf
N2  - Background: Extracorporeal membrane oxygenation (ECMO) is used to provide temporary cardiorespiratory support to critically ill children. While short-term outcomes and costs have been evaluated in this population, less is known regarding long-term survival and costs. Methods: Population-based cohort study from Ontario, Canada (October 1, 2009 to March 31, 2017), of pediatric patients (< 18 years of age) receiving ECMO, identified through the use of an ECMO procedural code. Outcomes were identified through linkage to provincial health databases. Primary outcome was survival, measured to hospital discharge, as well as at 1 year, 2 years, and 5 years following ECMO initiation. We evaluated total patient costs in the first year following ECMO. Results: We analyzed 342 pediatric patients. Mean age at ECMO initiation was 2.9 years (standard deviation [SD] = 5.0). Median time from hospital admission to ECMO initiation was 5 days (interquartile range [IQR] = 1-13 days). Overall survival to hospital discharge was 56.4%. Survival at 1 year, 2 years, and 5 years was 51.5%, 50.0%, and 42.1%, respectively. Among survivors, 99.5% were discharged home. Median total costs among all patients in the year following hospital admission were $147,957 (IQR $70,571-$300,295). Of these costs, the large proportion were attributable to the inpatient cost from the index admission (median $119,197, IQR $57,839-$250,675). Conclusions: Children requiring ECMO continue to have a significant in-hospital mortality, but reassuringly, there is little decrease in long-term survival at 1 year. Median costs among all patients were substantial, but largely reflect inpatient hospital costs, rather than post-discharge outpatient costs. This information provides value to providers and health systems, allowing for prognostication of short- and long-term outcomes, as well as long-term healthcare-related expenses for pediatric ECMO survivors.
ER  - 
TY  - GEN
T1  - Postoperative Atrial Fibrillation. Incidence, Mechanisms, and Clinical Correlates
A1  - Yadava, Mrinal
A1  - Hughey, Andrew B.
A1  - Crawford, Thomas Christopher
Y1  - 2016/04//
KW  - Atrial fibrillation
KW  - Beta-blockers
KW  - Coronary artery bypass grafting
KW  - Postoperative atrial fibrillation
PB  - Elsevier Inc.
JF  - Heart Failure Clinics
VL  - 12
IS  - 2
SP  - 299
EP  - 308
DO  - 10.1016/j.hfc.2015.08.023
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Yadava, Hughey, Crawford - 2016 - Postoperative Atrial Fibrillation. Incidence, Mechanisms, and Clinical Correlates.pdf
N2  - Atrial fibrillation is the most commonly encountered arrhythmia after cardiac surgery. Although usually self-limiting, it represents an important predictor of increased patient morbidity, mortality, and health care costs. Numerous studies have attempted to determine the underlying mechanisms of postoperative atrial fibrillation (POAF) with varied success. A multifactorial pathophysiology is hypothesized, with inflammation and postoperative β-adrenergic activation recognized as important contributing factors. The management of POAF is complicated by a paucity of data relating to the outcomes of different therapeutic interventions in this population. This article reviews the literature on epidemiology, mechanisms, and risk factors of POAF, with a subsequent focus on the therapeutic interventions and guidelines regarding management.
ER  - 
TY  - JOUR
T1  - Systemic magnesium to reduce postoperative arrhythmias after coronary artery bypass graft surgery: A meta-analysis of randomized controlled trials
A1  - De Oliveira, Gildasio S.
A1  - Knautz, Jennifer S.
A1  - Sherwani, Saadia
A1  - McCarthy, Robert J.
Y1  - 2012/08//
KW  - complications
KW  - coronary artery surgery
KW  - magnesium
KW  - postoperative arrhythmia
JF  - Journal of Cardiothoracic and Vascular Anesthesia
VL  - 26
IS  - 4
SP  - 643
EP  - 650
DO  - 10.1053/j.jvca.2012.03.012
UR  - https://linkinghub.elsevier.com/retrieve/pii/S1053077012001383
N2  - Objective: To evaluate the effect of systemic magnesium on the prevention of postoperative cardiac arrhythmias after coronary artery bypass graft surgery. Design: A meta-analysis. Setting: Randomized controlled trials evaluating the effect of systemic magnesium on the incidence of postoperative arrhythmias. Participants: Patients undergoing coronary artery bypass graft surgery. Interventions: Systemic perioperative administration of magnesium sulfate. Measurements and Main Results: Twenty studies evaluating 3,696 subjects were included. The combined effect suggested that systemic magnesium reduced the incidence of supraventricular arrhythmias compared with saline (odds ratio [OR] = 0.69; 95% confidence interval [CI], 0.53-0.90; number needed to treat [NNT] = 14). The effect was present for lower-quality studies (Jadad score ≤3; OR = 0.47; 95% CI, 0.28-0.81; NNT = 8), but it was not detected for higher-quality studies (Jadad >3; OR = 0.85; 95% CI, 0.66-1.11). There was no association between the total dose of magnesium administration and the incidence of supraventricular arrhythmias (p = 0.19). There was no effect of magnesium on the incidence of postoperative stroke, myocardial infarction, and death. In addition, magnesium did not reduce the hospital or intensive care unit lengths of stay (all p > 0.05). Conclusions: The effect of magnesium sulfate in reducing postoperative supraventricular arrhythmias was significant when examined by lower-quality studies but not when examined by higher-quality studies. This fact probably is responsible for controversial findings reported in the literature. Also, magnesium sulfate did not reduce the incidence of complications associated with the development of postoperative cardiac arrhythmias. More effective strategies should be used to prevent complications caused by arrhythmias in this patient population. © 2012 Elsevier Inc.
ER  - 
TY  - GEN
T1  - Meta-analysis of randomized controlled trials of systemic magnesium to reduce postoperative arrhythmias after coronary artery bypass graft surgery: A study left out?
A1  - Gu, Wan Jie
A1  - Liu, Jing Chen
Y1  - 2013/08//
KW  - Arrhythmias
KW  - Cardiac / prevention & control*
KW  - Comment
KW  - Coronary Artery Bypass / adverse effects*
KW  - Humans
KW  - Jing-Chen Liu
KW  - Letter
KW  - MEDLINE
KW  - Magnesium / therapeutic use*
KW  - NCBI
KW  - NIH
KW  - NLM
KW  - National Center for Biotechnology Information
KW  - National Institutes of Health
KW  - National Library of Medicine
KW  - Postoperative Complications / prevention & control*
KW  - PubMed Abstract
KW  - Wan-Jie Gu
KW  - doi:10.1053/j.jvca.2013.01.025
KW  - pmid:23623889
PB  - J Cardiothorac Vasc Anesth
JF  - Journal of Cardiothoracic and Vascular Anesthesia
VL  - 27
IS  - 4
DO  - 10.1053/j.jvca.2013.01.025
UR  - https://pubmed.ncbi.nlm.nih.gov/23623889/
ER  - 
TY  - JOUR
T1  - Long-term outcomes of secondary atrial fibrillation in the community the framingham heart study
A1  - Lubitz, Steven A.
A1  - Yin, Xiaoyan
A1  - Rienstra, Michiel
A1  - Schnabel, Renate B.
A1  - Walkey, Allan J.
A1  - Magnani, Jared W.
A1  - Rahman, Faisal
A1  - McManus, David D.
A1  - Tadros, Thomas M.
A1  - Levy, Daniel
A1  - Vasan, Ramachandran S.
A1  - Larson, Martin G.
A1  - Ellinor, Patrick T.
A1  - Benjamin, Emelia J.
Y1  - 2015///
KW  - Atrial fibrillation
KW  - Atrial flutter
KW  - Epidemiology
KW  - Heart failure
KW  - Risk factors
KW  - Stroke
PB  - Lippincott Williams and Wilkins
JF  - Circulation
VL  - 131
IS  - 19
SP  - 1648
EP  - 1655
DO  - 10.1161/CIRCULATIONAHA.114.014058
UR  - /pmc/articles/PMC4430386/?report=abstract
UR  - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4430386/
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Lubitz et al. - 2015 - Long-term outcomes of secondary atrial fibrillation in the community the framingham heart study.pdf
N2  - Background-Guidelines have proposed that atrial fibrillation (AF) can occur as an isolated event, particularly when precipitated by a secondary, or reversible, condition. However, knowledge of long-term AF outcomes after diagnosis during a secondary precipitant is limited. Methods and Results-In 1409 Framingham Heart Study participants with new-onset AF, we examined associations between first-detected AF episodes occurring with and without a secondary precipitant and both long-term AF recurrence and morbidity. We selected secondary precipitants based on guidelines (surgery, infection, acute myocardial infarction, thyrotoxicosis, acute alcohol consumption, acute pericardial disease, pulmonary embolism, or other acute pulmonary disease). Among 439 patients (31%) with AF diagnosed during a secondary precipitant, cardiothoracic surgery (n=131 [30%]), infection (n=102 [23%]), noncardiothoracic surgery (n=87 [20%]), and acute myocardial infarction (n=78 [18%]) were most common. AF recurred in 544 of 846 eligible individuals without permanent AF (5-, 10-, and 15-year recurrences of 42%, 56%, and 62% with versus 59%, 69%, and 71% without secondary precipitants; multivariable-adjusted hazard ratio, 0.65 [95% confidence interval, 0.54-0.78]). Stroke risk (n=209/1262 at risk; hazard ratio, 1.13 [95% confidence interval, 0.82-1.57]) and mortality (n=1098/1409 at risk; hazard ratio, 1.00 [95% confidence interval, 0.87-1.15]) were similar between those with and without secondary precipitants, although heart failure risk was reduced (n=294/1107 at risk; hazard ratio, 0.74 [95% confidence interval, 0.56-0.97]). Conclusions-AF recurs in most individuals, including those diagnosed with secondary precipitants. Long-term AF-related stroke and mortality risks were similar between individuals with and without secondary AF precipitants. Future studies may determine whether increased arrhythmia surveillance or adherence to general AF management principles in patients with reversible AF precipitants will reduce morbidity.
ER  - 
TY  - JOUR
T1  - Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association
A1  - Sandau, Kristin E.
A1  - Funk, Marjorie
A1  - Auerbach, Andrew
A1  - Barsness, Gregory W.
A1  - Blum, Kay
A1  - Cvach, Maria
A1  - Lampert, Rachel
A1  - May, Jeanine L.
A1  - McDaniel, George M.
A1  - Perez, Marco V.
A1  - Sendelbach, Sue
A1  - Sommargren, Claire E.
A1  - Wang, Paul J.
Y1  - 2017/11//
KW  - AHA Scientific Statements
KW  - ECG
KW  - arrhythmias, cardiac
KW  - clinical alarms
KW  - documentation
KW  - education
KW  - electrocardiographic monitoring
KW  - electrocardiography
KW  - guidelines
KW  - ischemia
KW  - long QT syndrome
KW  - myocardial infarction
KW  - pediatrics
KW  - telemetry
PB  - 
Lippincott Williams & Wilkins
Hagerstown, MD

JF  - Circulation
VL  - 136
IS  - 19
SP  - e273
EP  - e344
DO  - 10.1161/CIR.0000000000000527
UR  - http://ahajournals.org
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Sandau et al. - 2017 - Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings A Scientific Statement From.pdf
N2  - BACKGROUND AND PURPOSE: This scientific statement provides an interprofessional, comprehensive review of evidence and recommendations for indications, duration, and implementation of continuous electro cardiographic monitoring of hospitalized patients. Since the original practice standards were published in 2004, new issues have emerged that need to be addressed: overuse of arrhythmia monitoring among a variety of patient populations, appropriate use of ischemia and QT-interval monitoring among select populations, alarm management, and documentation in electronic health records.
METHODS: Authors were commissioned by the American Heart Association and included experts from general cardiology, electrophysiology (adult and pediatric), and interventional cardiology, as well as a hospitalist and experts in alarm management. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Authors were assigned topics relevant to their areas of expertise, reviewed the literature with an emphasis on publications since the prior practice standards, and drafted recommendations on indications and duration for electrocardiographic monitoring in accordance with the American Heart Association Level of Evidence grading algorithm that was in place at the time of commissioning.
RESULTS: The comprehensive document is grouped into 5 sections: (1) Overview of Arrhythmia, Ischemia, and QTc Monitoring; (2) Recommendations for Indication and Duration of Electrocardiographic Monitoring presented by patient population; (3) Organizational Aspects: Alarm Management, Education of Staff, and Documentation; (4) Implementation of Practice Standards; and (5) Call for Research.
CONCLUSIONS: Many of the recommendations are based on limited data, so authors conclude with specific questions for further research.
ER  - 
TY  - CHAP
T1  - Atrial fibrillation after cardiac surgery
A1  - Chung, Mina K.
Y1  - 2004/01//
KW  - Aged
KW  - Atrial Fibrillation / etiology*
KW  - Cardiac Surgical Procedures / adverse effects*
KW  - Coronary Artery Bypass / adverse effects
KW  - Female
KW  - G H Almassi
KW  - Heart Valve Prosthesis Implantation / adverse effects
KW  - Hospitals
KW  - Humans
KW  - Incidence
KW  - Intensive Care Units
KW  - K E Hammermeister
KW  - Length of Stay
KW  - Logistic Models
KW  - MEDLINE
KW  - Male
KW  - Middle Aged
KW  - Multicenter Study
KW  - NCBI
KW  - NIH
KW  - NLM
KW  - National Center for Biotechnology Information
KW  - National Institutes of Health
KW  - National Library of Medicine
KW  - Non-P.H.S.
KW  - Odds Ratio
KW  - PMC1191069
KW  - PubMed Abstract
KW  - Research Support
KW  - Risk Factors
KW  - T Schowalter
KW  - U.S. Gov't
KW  - Veterans
KW  - doi:10.1097/00000658-199710000-00011
KW  - pmid:9351718
PB  - CRC Press
JF  - Atrial Fibrillation
VL  - 226
IS  - 4
SP  - 279
EP  - 337
SN  - 9780203996935
DO  - 10.1097/00000658-199710000-00011
UR  - https://pubmed.ncbi.nlm.nih.gov/9351718/
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Chung - 2004 - Atrial fibrillation after cardiac surgery.pdf
N2  - Despite efforts to identify risk factors and establish effective prophylactic agents, postoperative atrial arrhythmias remain a prominent clinical problem. Atrial fibrillation (AF) is the most frequently encountered arrhythmia after cardiac surgery. This chapter addresses the epidemiology, pathogenesis, complications, prevention, and treatment of atrial arrhythmias following cardiac surgery.
ER  - 
TY  - JOUR
T1  - Genetic control of postoperative systemic inflammatory reaction and pulmonary and renal complications after coronary artery surgery
A1  - Gaudino, Mario
A1  - Di Castelnuovo, Augusto
A1  - Zamparelli, Roberto
A1  - Andreotti, Felicita
A1  - Burzotta, Francesco
A1  - Iacoviello, Licia
A1  - Glieca, Franco
A1  - Alessandrini, Francesco
A1  - Nasso, Giuseppe
A1  - Donati, Maria Benedetta
A1  - Maseri, Attilio
A1  - Schiavello, Rocco
A1  - Possati, Gianfederico
Y1  - 2003/10//
PB  - Mosby Inc.
JF  - Journal of Thoracic and Cardiovascular Surgery
VL  - 126
IS  - 4
SP  - 1107
EP  - 1112
DO  - 10.1016/S0022-5223(03)00396-9
L1  - file:///Users/JuanSebastian/Library/Application Support/Mendeley Desktop/Downloaded/Gaudino et al. - 2003 - Genetic control of postoperative systemic inflammatory reaction and pulmonary and renal complications after coro.pdf
N2  - Background: Although some data suggest that the individual genetic predisposition for developing major or minor degrees of postoperative systemic inflammatory reaction may influence postoperative morbidity, this hypothesis has not been clinically tested to date. Methods and Results: The -174 G/C polymorphism of the promoter of the interleukin 6 gene was determined preoperatively in 111 consecutive patients submitted to primary isolated coronary artery bypass. The results of the genetic analysis were then correlated with the postoperative interleukin 6 levels and the development of postoperative renal and pulmonary complications. G homozygotes had significantly higher interleukin 6 levels postoperatively (P < .0001 for the difference between areas under the curve). These patients also had worse postoperative pulmonary and renal function. The mean perioperative difference in serum creatinine, potassium, and nitrogen was 0.82 ± 0.34, 0.99 ± 0.44, and 10.1 ± 7.8 mg/dL versus 0.18 ± 0.14, 0.15 ± 0.48, and 2.6 ± 4.1 mg/dL for GG versus non-GG carriers (P < .0001), respectively. The mean respiratory index at 6 and 12 hours was 2.9 ± 0.8 and 2.8 ± 0.3 versus 2.1 ± 0.5 and 1.3 ± 0.1, respectively (P < .0001). The mean duration of mechanical ventilation was 22.5 ± 2.1 versus 12.7 ± 6.7 hours (P < .01). A correlation was found between postoperative interleukin 6 levels and renal and pulmonary complications. Conclusion: The interleukin 6 - 174 G/C polymorphism modulates postoperative interleukin 6 levels and is associated with the degree of postoperative renal and pulmonary dysfunction and in-hospital stay after coronary surgery.
ER  - 
TY  - JOUR
T1  - Interleukin-2 as a predictor of early postoperative atrial fibrillation after cardiopulmonary bypass graft (CABG)
A1  - Hak, Łukasz
A1  - Myśliwska, Jolanta
A1  - Wi, Joanna
A1  - Szyndler, Krzysztof
A1  - Siebert, Janusz
A1  - Rogowski, Jan
Y1  - 2009/06//
KW  - Aged
KW  - Atrial Fibrillation / blood
KW  - Atrial Fibrillation / immunology*
KW  - Cardiopulmonary Bypass
KW  - Female
KW  - Humans
KW  - Inflammation
KW  - Interferon-gamma / metabolism
KW  - Interleukin-10 / metabolism
KW  - Interleukin-2 / blood
KW  - Interleukin-2 / immunology*
KW  - Jan Rogowski
KW  - Jolanta Myśliwska
KW  - MEDLINE
KW  - Male
KW  - Middle Aged
KW  - NCBI
KW  - NIH
KW  - NLM
KW  - National Center for Biotechnology Information
KW  - National Institutes of Health
KW  - National Library of Medicine
KW  - Postoperative Complications / blood
KW  - Postoperative Complications / immunology*
KW  - Prognosis
KW  - PubMed Abstract
KW  - Risk Factors
KW  - Time Factors
KW  - doi:10.1089/jir.2008.0082.2906
KW  - pmid:19450160
KW  - Łukasz Hak
PB  - J Interferon Cytokine Res
JF  - Journal of Interferon and Cytokine Research
VL  - 29
IS  - 6
SP  - 327
EP  - 332
DO  - 10.1089/jir.2008.0082.2906
UR  - https://pubmed.ncbi.nlm.nih.gov/19450160/
N2  - Recently, inflammation has been considered as a risk factor of postoperative atrial fibrillation (PAF). The main purpose of this study was to estimate the connections between occurrence of PAF and cytokine release. Thirty-three patients who qualified for cardiopulmonary bypass graft (CABG) were included in the study. Blood was taken from all of them before CABG, then 3 h, 24 h, and 72 h afterwards. Cytokine (IL-6, IL-2, IL-4, IL-10, IFN-, TNF-) concentration was measured at every time point. Eleven patients developed atrial fibrillation after the CABG. Five of them developed PAF until 1 day post-CABG and six of them after 1 day post-CABG. Patients who developed PAF before 1 day post-CABG were characterized by a higher level of IL-2 in sera before 24 h and 72 h post-CABG compared with patients without PAF. Moreover, the PAF before 1 day post-CABG group was also characterized by the higher level of IFN- and IL-10 at 24 h after intervention. Analysis of patients who developed PAF after 1 day post-CABG revealed a higher level of IL-10 and IFN- at 24 h post-CABG compared with patients without PAF. In this study, we have shown for the first time a straightforward connection between IL-2 sera levels and the development of PAF shortly after CABG. © 2009 Mary Ann Liebert, Inc.
ER  - 
TY  - JOUR
T1  - Rate-control versus conversion strategy in postoperative atrial fibrillation: A prospective, randomized pilot study
A1  - Lee, John K.
A1  - Klein, George J.
A1  - Krahn, Andrew D.
A1  - Yee, Raymond
A1  - Zarnke, Kelly
A1  - Simpson, Christopher
A1  - Skanes, Allan
A1  - Spindler, Bonnie
Y1  - 2000/12//
PB  - Mosby
JF  - American Heart Journal
VL  - 140
IS  - 6
SP  - 871
EP  - 877
DO  - 10.1067/mhj.2000.111104
N2  - Background: Atrial fibrillation remains a frequent complication after heart surgery. The optimal strategy to treat the condition has not been established. Several retrospective studies have suggested that a primary rate-control strategy may be equivalent to a strategy that restores sinus rhythm. Methods: Fifty patients with atrial fibrillation after heart surgery were randomly assigned to a strategy of antiarrhythmic therapy with or without electrical cardioversion or ventricular rate control. Both arms received anticoagulation with heparin overlapped with warfarin. The primary end point was time to conversion to sinus rhythm analyzed by the Kaplan-Meier method. Atrial fibrillation relapse after the initial conversion was monitored in the hospital over a 2-month period. Results: There was no significant difference between an antiarrhythmic conversion strategy (n = 27) and a rate-control strategy (n = 23) in time to conversion to sinus rhythm (11.2 ± 3.2 vs 11.8 ± 3.9 hours; P= .8). With the use of Cox multivariate analysis to control for the effects of age, sex, β-blocker usage, and type of surgery, the antiarrhythmic strategy showed a trend toward reducing the time from treatment to restoration of sinus rhythm (P = .08). The length of hospital stay was reduced in the antiarrhythmic arm compared with the rate-control strategy (9.0 ± 0.7 vs 13.2 ± 2.0 days; P = .05). In-hospital relapse rates in the antiarrhythmic arm were 30% compared with 57% in the rate-control strategy (P = .24). There were no significant difference in relapse rates at 1 week (24% vs 28%), 4 weeks (6% vs 12%), and 6 to 8 weeks (4% vs 9%). At the end of the study, 91% of the patients in the rate-control arm were in sinus rhythm compared with 96% in the antiarrhythmic arm (P = .6). Conclusions: This pilot study shows little difference between a rate-control strategy and a strategy to restore sinus rhythm. Regardless of strategy, most patients will be in sinus rhythm after 2 months. A larger randomized, controlled study is needed to assess the impact of restoration of sinus rhythm on length of stay.
ER  - 
TY  - JOUR
T1  - Elevated Venous to Arterial Carbon Dioxide Gap and Anion Gap Are Associated with Poor Outcome in Cardiogenic Shock Requiring Extracorporeal Membrane Oxygenation Support
A1  - McDonald, Charles I.
A1  - Brodie, Daniel
A1  - Schmidt, Matthieu
A1  - Hay, Karen
A1  - Shekar, Kiran
Y1  - 2021///
KW  - P(v-a)CO2gap
KW  - anion gap
KW  - cardiogenic shock
KW  - extracorporeal support
KW  - microcirculation
JF  - ASAIO Journal
SP  - 263
EP  - 269
SN  - 0000000000
DO  - 10.1097/MAT.0000000000001215
L1  - file:///Users/JuanSebastian/Library/Mobile Documents/com~apple~CloudDocs/ECMO/00002480-900000000-98498.pdf
N2  - Optimal management of cardiogenic shock requiring extracorporeal membrane oxygenation (ECMO) is still an evolving area in which assessment and optimization of the microcirculation may be critically important. We hypothesized that the venous arterial carbon dioxide gap (P(v-a)CO2 gap); the ratio of this gap to arterio-venous oxygen content (P(v-a)CO2/C(a-v)O2 ratio) and the anion gap would be early indicators of microcirculatory status and useful parameters for outcome prediction during ECMO support. We retrospectively reviewed 31 cardiogenic shock patients requiring veno-arterial ECMO, calculating P(v-a)CO2 gap and P(v-a)CO2/C(a-v)O2 ratios in the first 36 hours and the final 24 hours of ECMO support. Sixteen patients (52%) survived and 15 (48%) died. After 24 hours of ECMO support, the P(v-a)CO2 gap (4.9 ± 1.5 vs. 6.8 ± 1.9 mm Hg; p = 0.004) and anion gap (5.2 ± 1.8 vs. 8.7 ± 2.7 mmol/L; p < 0.001) were significantly higher in non-survivors. In the final 24 hours of ECMO support, the P(v-a)CO2 gap (3.5 ± 1.6 vs. 10.5 ± 3.2 mm Hg; p < 0.001), P(v-a)CO2/C(a-v)O2 ratio (1.1 ± 0.5 vs. 2.7 ± 1.0; p < 0.001), anion gap (5.1 ± 3.0 vs. 9.3 ± 5.9 mmol/L; p = 0.02), and lactate (median 1.0 [interquartile range {IQR}: 0.7-1.5] vs. 2.8 [IQR: 1.7-7.7] mmol/L; p = <0.001) were all significantly lower in survivors. Increasing P(v-a)CO2 gap and increasing anion gap were significantly associated with increased risk of mortality. Optimum cut-points for prediction of mortality were 6 mm Hg for P(v-a)CO2 gap in combination with an anion gap above 6 mmol/L in the first 24 hours of ECMO in patients with cardiogenic shock requiring ECMO.
ER  - 
TY  - JOUR
T1  - ProtekDuo as a bridge to lung transplant and heart-lung transplant
A1  - Sinha, Neeraj
A1  - Goodarzi, Ahmad
A1  - Akku, Radhika
A1  - Balayla, Galit
Y1  - 2021///
KW  - ECMO
KW  - ProtekDuo
KW  - heart-lung transplant
KW  - lung transplant
JF  - Clinical Transplantation
VL  - 35
IS  - 5
SP  - 30
EP  - 33
DO  - 10.1111/ctr.14273
L1  - file:///Users/JuanSebastian/Desktop/VP-ECMO/ProtekDuo as a bridge to lung transplant and heart-lung transplant.pdf
N2  - Recent advances in technology have led to significantly greater use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation with better outcomes. The novel ProtekDuo veno-venous ECMO (CardiacAssist, Inc.) has gained significance as it facilitates effective decompression of the right heart in patients with acute decompensation, while also providing consistent and effective gas exchange by eliminating recirculation. Here, we report two cases of effectively using ProtekDuo veno-venous ECMO: one case as a bridge to lung transplantation and another case as a bridge to heart-lung transplantation.
ER  - 
TY  - JOUR
T1  - Right Ventricular Assist Device With Extracorporeal Membrane Oxygenation for Bridging Right Ventricular Heart Failure to Lung Transplantation: A Single-Center Case Series and Literature Review
A1  - Lee, Jae Guk
A1  - Pak, Chuiyong
A1  - Oh, Dong Kyu
A1  - Kim, Ho Cheol
A1  - Kang, Pil Je
A1  - Lee, Geun Dong
A1  - Choi, Se Hoon
A1  - Jung, Sung Ho
A1  - Hong, Sang Bum
Y1  - 2021///
KW  - extracorporeal membrane oxygenation
KW  - lung transplantation
KW  - right ventricular assist device
KW  - right ventricular heart failure
JF  - Journal of Cardiothoracic and Vascular Anesthesia
VL  - 000
DO  - 10.1053/j.jvca.2021.07.010
L1  - file:///Users/JuanSebastian/Desktop/VP-ECMO/Oxy-RVAD Puente A Tx Pulmonar En falla Derecha (JCTVA 2021).pdf
N2  - Objective: Right ventricular heart failure (RVHF) is a critical complication in patients with respiratory failure, particularly among those who transitioned to lung transplantation using venovenous (VV) extracorporeal membrane oxygenation (ECMO). In these patients, both cardiac and respiratory functions are supported using venoarterial or venoarterial-venous ECMO. However, these modalities increase the risk of device-related complications, such as thromboembolism, bleeding, and limb ischemia, and they may disturb early rehabilitation. Due to these limitations, a right ventricular assist device with an oxygenator (Oxy-RVAD) using ECMO may be considered for patients with RVHF with VV ECMO. Design: A retrospective case series and literature review. Setting: A single tertiary care university hospital. Participants: The study comprised lung transplantation candidates on ECMO bridging who developed right-sided heart failure. Interventions: An RVAD with ECMO. Measurements and Main Results: Of eight patients who underwent the study protocol, seven were bridged successfully to lung transplantation (BTT), and all patients with BTT were discharged, with a 30-day survival rate of 100% (7/7 patients). The 180-day survival rate was 85% (6/7 patients). Conclusions: The study suggested that Oxy-RVAD using ECMO may be a viable option for bridging patients with RVHF to lung transplantation. Trial Registration: Retrospectively registered.
ER  - 
TY  - JOUR
T1  - Oxy-right Ventricular Assist Device for Bridging of Right Heart Failure to Lung Transplantation
A1  - Lee, Sung Kwang
A1  - Kim, Do Hyung
A1  - Cho, Woo Hyun
A1  - Yeo, Hye Ju
Y1  - 2021///
JF  - Transplantation
VL  - 105
IS  - 7
SP  - 1610
EP  - 1614
SN  - 0000000000
DO  - 10.1097/TP.0000000000003459
L1  - file:///Users/JuanSebastian/Desktop/VP-ECMO/Oxy-RVAD Puente A Tu Pulmonar En Falla Derecha (Transplantation 2021).pdf
N2  - BACKGROUND: Right heart failure develops in lung transplantation candidates on extracorporeal membrane oxygenation (ECMO) support and increases mortality. The safety and feasibility of the oxy-right ventricular assist device (oxyRVAD) as a bridge to lung transplantation in severe right heart failure caused by terminal lung disease have not been evaluated. METHODS: We retrospectively reviewed 14 patients who used oxyRVAD for bridging of right heart failure to lung transplantation. RESULTS: The major cause of lung transplantation was acute exacerbation of interstitial lung disease (78.6%), and the median venovenous ECMO duration was 7 d. Before oxyRVAD, median mean pulmonary artery pressure was 60.5 mm Hg (interquartile range [IQR], 54-68), and the median peak tricuspid regurgitation velocity was 3.9 m/s (IQR, 3.7-4.1). After oxyRVAD conversion, median mean pulmonary artery pressure was 60.5 mm Hg (IQR, 57.3-65), and the median peak tricuspid regurgitation velocity was 2.9 (IQR, 2.6-3.2). All patients were hemodynamically stable (median arterial blood pressure, 83 mm Hg; median heart rate, 79 bpm). Three patients developed pulmonary congestion (21.4%), and all patients stabilized within 24 h. Active rehabilitation during ECMO was possible in all patients, and the median duration of awake state during ECMO was 14 d. A total of 10 patients were bridged successfully to lung transplantation, and hospital survival rates were 90%. CONCLUSIONS: OxyRVAD stabilized hemodynamic parameters without fatal complications, permitted the discontinuation of sedation, and allowed active rehabilitation in patients with severe right heart failure. OxyRVAD may be a feasible option for bridging of right heart failure to lung transplantation.
ER  - 
TY  - JOUR
T1  - Mechanical circulatory support devices for acute right ventricular failure
A1  - Kapur, Navin K.
A1  - Esposito, Michele L.
A1  - Bader, Yousef
A1  - Morine, Kevin J.
A1  - Kiernan, Michael S.
A1  - Pham, Duc Thinh
A1  - Burkhoff, Daniel
Y1  - 2017///
KW  - assisted circulation
KW  - hemodynamics
KW  - ventricular dysfunction, right
JF  - Circulation
VL  - 136
IS  - 3
SP  - 314
EP  - 326
DO  - 10.1161/CIRCULATIONAHA.116.025290
L1  - file:///Users/JuanSebastian/Desktop/VP-ECMO/Mechanical Circulatory Support Devices for acute RVF (Circulation 2017).pdf
N2  - Right ventricular (RV) failure remains a major cause of global morbidity and mortality for patients with advanced heart failure, pulmonary hypertension, or acute myocardial infarction and after major cardiac surgery. Over the past 2 decades, percutaneously delivered acute mechanical circulatory support pumps specifically designed to support RV failure have been introduced into clinical practice. RV acute mechanical circulatory support now represents an important step in the management of RV failure and provides an opportunity to rapidly stabilize patients with cardiogenic shock involving the RV. As experience with RV devices grows, their role as mechanical therapies for RV failure will depend less on the technical ability to place the device and more on improved algorithms for identifying RV failure, patient monitoring, and weaning protocols for both isolated RV failure and biventricular failure. In this review, we discuss the pathophysiology of acute RV failure and both the mechanism of action and clinical data exploring the utility of existing RV acute mechanical circulatory support devices.
ER  - 
TY  - JOUR
T1  - ELSO Guidelines for Adult and Pediatric Extracorporeal Membrane Oxygenation Circuits
A1  - Gajkowski, Evan F.
A1  - Herrera, Guillermo
A1  - Hatton, Laura
A1  - Velia Antonini, Marta
A1  - Vercaemst, Leen
A1  - Cooley, Elaine
Y1  - 2022///
JF  - ASAIO Journal
VL  - 68
IS  - 2
SP  - 133
EP  - 152
SN  - 0000000000
DO  - 10.1097/mat.0000000000001630
L1  - file:///Users/JuanSebastian/Desktop/VP-ECMO/Guías Canulación ELSO (ASAIO 2022).pdf
ER  - 
TY  - JOUR
T1  - Dynamic extracorporeal life support: A novel management modality in temporary cardio-circulatory assistance
A1  - Lo Coco, Valeria
A1  - Swol, Justyna
A1  - De Piero, Maria Elena
A1  - Massimi, Giulio
A1  - Chiarini, Giovanni
A1  - Broman, Lars Mikael
A1  - Lorusso, Roberto
Y1  - 2021///
KW  - cardiogenic shock
KW  - dynamic extracorporeal life support
KW  - extracorporeal life support
KW  - hybrid extracorporeal life support
KW  - pulmonary artery cannulation
JF  - Artificial Organs
VL  - 45
IS  - 4
SP  - 427
EP  - 434
DO  - 10.1111/aor.13869
L1  - file:///Users/JuanSebastian/Desktop/VP-ECMO/ECLS Dinámico (Artificial Organs 2020).pdf
N2  - Extracorporeal life support (ECLS) is a temporary mechanical assistance method employed in acute respiratory, cardiocirculatory, and cardio-respiratory failure, refractory to conventional treatments. Patient's hemodynamic, respiratory and metabolic condition, or situations related to ECLS support or performance, may change during ECLS treatment. Provision of an additional drainage or perfusion cannula, or even of an additional associated device, for example, transaortic suction device or intra-aortic balloon pump (IABP), may be required to improve the ECLS/patient interaction and effects. Besides such a modified ECLS mode, however, a potential asset is represented by the “dynamic ECLS,” which is the change of the flow direction (drainage or perfusion) in the already implanted cannula during the ECLS run. This particular management may be achieved in venous femoral or jugular cannulation, but it finds an even more appealing potential with the pulmonary artery (PA) cannulation. The PA allows the institution of a multitasking ECLS circuit, ranging from enhanced left ventricle (LV) unloading (drainage from the PA) to a right ventricular support or “central” veno-venous ECLS (perfusing the PA), tailored according to the patient hemodynamic, gas exchange, metabolic state, underlying cardiac involvement, and ECLS performance. Dynamic ECLS may, therefore, represent an additional option in ECLS management, particularly including the PA cannulation. Based on this new dynamic management of ECLS mode, we propose the Extracorporeal Life Support Organization nomenclature update.
ER  - 
TY  - JOUR
T1  - Use of ProtekDuo as Veno-arterial and Veno-venous Extracorporeal Membrane Oxygenation During Bilateral Lung Transplantation
A1  - Budd, Ashley N.
A1  - Kozarek, Katherine
A1  - Kurihara, Chitaru
A1  - Bharat, Ankit
A1  - Reynolds, Aaron
A1  - Kretzer, Adam
Y1  - 2019///
KW  - ProtekDuo
KW  - extracorporeal membrane oxygenation
KW  - lung transplantation
KW  - right ventricular dysfunction
PB  - Elsevier Inc.
JF  - Journal of Cardiothoracic and Vascular Anesthesia
VL  - 33
IS  - 8
SP  - 2250
EP  - 2254
DO  - 10.1053/j.jvca.2018.12.025
L1  - file:///Users/JuanSebastian/Desktop/VP-ECMO/Use of ProtekDuo as Veno-arterial and Veno-venous Extracorporeal Membrane Oxygenation During Bilateral Lung Transplantation (JCVTA 2018).pdf
ER  - 
TY  - JOUR
T1  - Cerebral Near-Infrared Spectroscopy in Adult Patients Undergoing Veno-Arterial Extracorporeal Membrane Oxygenation
A1  - Pozzebon, Selene
A1  - Blandino Ortiz, Aaron
A1  - Franchi, Federico
A1  - Cristallini, Stefano
A1  - Belliato, Mirko
A1  - Lheureux, Olivier
A1  - Brasseur, Alexandre
A1  - Vincent, Jean Louis
A1  - Scolletta, Sabino
A1  - Creteur, Jacques
A1  - Taccone, Fabio Silvio
Y1  - 2018///
KW  - Brain
KW  - Cerebral oxygenation
KW  - ECMO
KW  - Monitoring
KW  - NIRS
PB  - Springer US
JF  - Neurocritical Care
VL  - 29
IS  - 1
SP  - 94
EP  - 104
DO  - 10.1007/s12028-018-0512-1
UR  - https://doi.org/10.1007/s12028-018-0512-1
L1  - file:///Users/JuanSebastian/Downloads/Cerebral Near-Infrared Spectroscopy in Adult Patients Undergoing Veno-Arterial Extracorporeal Membrane Oxygenation.pdf
N2  - Background: Acute cerebral complications (ACC) of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) are associated with poor long-term neurologic outcome. We described the role of rSO2 monitoring in detecting ACC and desaturations and their relationship with poor outcome when employing VA-ECMO. Methods: Retrospective analysis of patients monitored by cerebral frontal near-infrared spectroscopy (NIRS) (CAS Medical Systems Inc., Branford, CT, USA) during VA-ECMO (November 2008–December 2015). ACC was defined as the presence of stroke and/or brain death, while cerebral desaturation as cortical oxygen tissue saturation (rSO2) < 60%. Results: Fifty-six of 159 VA-ECMO patients (age 55 [36–60] years) were included; 18 (32%) developed ACC and 36 died (64%). Cerebral desaturation occurred in 43 (74%) patients, who had a higher mortality than those without cerebral desaturation (74 vs. 31%). A high sequential organ failure assessment (SOFA) score on the first day of ECMO (OR 1.40 [95% CIs 1.06–1.84]) and the minimum ECMO blood flow during the first 4 days of therapy (OR 3.05 [1.01–9.17]) were independently associated with the occurrence of cerebral desaturation. Cerebral desaturation occurred more frequently in patients with ACC than others (94 vs. 68%); patients with ACC also had a lower minimal rSO2 over time (49 vs. 54%) and more frequently had high right-left rSO2 differences (33 vs. 8%), which were both independent predictors of ACC. The occurrence of cerebral desaturation (OR 7.93 [1.62–38.74]) and high lactate concentrations during the first 4 days of ECMO support (OR 1.22 [1.03–1.46]) was independently associated with hospital mortality. Conclusions: Monitoring of rSO2 could be considered as an interesting tool to monitor the brain of patients on VA-ECMO.
ER  - 
TY  - JOUR
T1  - Mechanical circulatory support for right ventricular failure
A1  - Kapur, Navin K.
A1  - Paruchuri, Vikram
A1  - Jagannathan, Anand
A1  - Steinberg, Daniel
A1  - Chakrabarti, Anjan K.
A1  - Pinto, Duane
A1  - Aghili, Nima
A1  - Najjar, Samer
A1  - Finley, John
A1  - Orr, Nicole M.
A1  - Tempelhof, Michael
A1  - Mudd, James O.
A1  - Kiernan, Michael S.
A1  - Pham, Duc Thinh
A1  - DeNofrio, David
Y1  - 2013///
KW  - Invasive hemodynamics
KW  - Mechanical circulatory support
KW  - Right heart failure
PB  - Elsevier Inc
JF  - JACC: Heart Failure
VL  - 1
IS  - 2
SP  - 127
EP  - 134
DO  - 10.1016/j.jchf.2013.01.007
UR  - http://dx.doi.org/10.1016/j.jchf.2013.01.007
L1  - file:///Users/JuanSebastian/Desktop/VP-ECMO/THRIVE Study (TH-RVAD).pdf
N2  - Objectives: The aim of this study was to explore the clinical utility of a commercially available centrifugal flow pump as a centrifugal flow-right ventricular support device (CF-RVSD) in patients with right ventricular failure (RVF). Background: RVF is associated with high in-hospital mortality. Limited data regarding efficacy of the CF-RVSD for RVF exist. Methods: We retrospectively reviewed data from 46 patients receiving a CF-RVSD for RVF from a registry comprising data from 8 tertiary-care hospitals in the United States. CF-RVSD use was recorded in the setting of acute myocardial infarction; myocarditis; chronic left heart failure; after valve surgery, orthotopic heart transplantation, left ventricular assist device surgery, coronary bypass grafting. Devices were implanted via the percutaneous (n = 22) or surgical (n = 24) route. Results: No intraprocedural mortality was observed. Mean time from admission to CF-RVSD implantation was 5.7 ± 8.5 days, with a mean of 6,769 ± 789 rotations/min, providing 4.2 ± 1.3 l/min of flow. Mean duration of support was 5.4 ± 5.1 days. Mean arterial pressure (65 ± 12 mm Hg vs. 73 ± 14 mm Hg; p < 0.05), right atrial pressure (21 ± 8 mm Hg vs. 16 ± 7 mm Hg; p = 0.05), pulmonary artery systolic pressure (43 ± 15 mm Hg vs. 33 ± 15 mm Hg; p = 0.01), and cardiac index (1.7 ± 0.7 vs. 2.2 ± 0.6; p = 0.01) were improved within 48 h of CF-RVSD implantation. Total in-hospital mortality was 57% and was lowest in the setting of left ventricular assist device implantation, chronic left heart failure, and acute myocardial infarction. Increased age, biventricular failure, and Thrombolysis In Myocardial Infarction-defined major bleeding were associated with increased in-hospital mortality. Conclusions: Use of the CF-RVSD for RVF is clinically feasible and associated with improved hemodynamic status. Observations from the registry of patients who have received this device may support the development of prospective studies that will examine the role of percutaneous circulatory support for RVF. © 2013 American College of Cardiology Foundation.
ER  - 
TY  - JOUR
T1  - The ELSO Maastricht Treaty for ECLS Nomenclature: Abbreviations for cannulation configuration in extracorporeal life support - A position paper of the Extracorporeal Life Support Organization
A1  - Broman, Lars Mikael
A1  - Taccone, Fabio Silvio
A1  - Lorusso, Roberto
A1  - Malfertheiner, Maximilian Valentin
A1  - Pappalardo, Federico
A1  - DI Nardo, Matteo
A1  - Belliato, Mirko
A1  - Bembea, Melania M.
A1  - Barbaro, Ryan P.
A1  - DIaz, Rodrigo
A1  - Grazioli, Lorenzo
A1  - Pellegrino, Vincent
A1  - Mendonca, Malaika H.
A1  - Brodie, Daniel
A1  - Fan, Eddy
A1  - Bartlett, Robert H.
A1  - McMullan, Michael M.
A1  - Conrad, Steven A.
Y1  - 2019///
KW  - Abbreviation
KW  - Cannula
KW  - Configuration
KW  - ELSO
KW  - Extracorporeal life support
KW  - Membrane oxygenation
KW  - Nomenclature
PB  - Critical Care
JF  - Critical Care
VL  - 23
IS  - 1
SP  - 1
EP  - 9
DO  - 10.1186/s13054-019-2334-8
L1  - file:///Users/JuanSebastian/Desktop/VP-ECMO/Nomenclatura ECLS ( Critical Care 2019).pdf
N2  - Background: The Extracorporeal Life Support Organization (ELSO) Maastricht Treaty for Nomenclature in Extracorporeal Life Support (ECLS) established consensus nomenclature and abbreviations for ECLS to ensure accurate, concise communication. Methods: We build on this consensus nomenclature by layering a framework of precise and efficient abbreviations for cannula configuration that describe flow direction, number of cannulae used, any additional ECLS-related catheters, and cannulation sites. This work is a consensus of international representatives of the ELSO, including those from the North American, Latin American, European, South and West Asian, and Asian-Pacific chapters of ELSO. Results: The classification increases in descriptive capability by introducing a third (cannula tip position) and fourth (cannula dimension) level to those provided in the previous consensus on ECLS cannulation configuration nomenclature. This expansion offers the simplest level needed to convey cannulation information yet allows for more details when required. Conclusions: A complete nomenclature for ECLS cannulation configurations accommodating future revisions was developed to facilitate ability to compare practices and results, to promote efficient communication, and to improve quality of registry data.
ER  - 
TY  - JOUR
T1  - The Right Ventricle During Veno-Venous Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome
A1  - Zochios, Vasileios
A1  - Yusuff, Hakeem
A1  - Conway, Hannah
A1  - Lau, Gary
A1  - Schmidt, Matthieu
Y1  - 2022///
JF  - ASAIO Journal
VL  - Publish Ah
SP  - 1
EP  - 5
SN  - 0000000000
DO  - 10.1097/mat.0000000000001655
L1  - file:///Users/JuanSebastian/Desktop/VP-ECMO/The Right Ventricle During Veno-Venous Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome: Can We Protect the Injured Ventricle%3F (ASAIO 2022).pdf
N2  - for ProtectinG the riGht Ventricle network (ProrVnet) Right ventricular (RV) and pulmonary vascular injury is common in acute respiratory distress syndrome (ARDS) and is a major determinant of adverse outcomes. 1,2 The reported prevalence of RV injury (defined as RV dysfunction with hemo-dynamic compromise or RV failure or acute cor pulmonale) in ARDS is 21%. 1 In a recent pooled meta-analysis of nine ARDS studies, the presence of RV injury was associated with significantly higher overall and short-term mortality. 1 Recent data suggests that RV injury in the context of severe lung injury caused by the coronavirus disease 2019 (COVID-19), occurs in approximately 20% of patients and it is associated with a threefold increase in all-cause mortality. 3 Veno-venous extra-corporeal membrane oxygenation (VV ECMO) is increasingly being used as part of the algorithm to treat ARDS patients in whom conventional measures fail to preserve adequate gas exchange and mitigate ventilator-induced lung injury. 4 By reversing hypoxemia, hypercapnia, and acidemia, VV ECMO theoretically reduces RV afterload leading to an improvement in pulmonary hemodynamics. 5 However, RV injury can persist despite initiation of VV ECMO or even develop late in the course of VV ECMO support. 6 The purpose of this editorial is to briefly discuss the pathophysiology and mechanisms of RV injury during VV ECMO support for ARDS, and potential strategies to mitigate injury and support the RV. Right Ventricular Injury in Acute Respiratory Distress Syndrome Dissociation and uncoupling between RV and pulmonary artery (PA) biomechanics is key in understanding the mechanisms of different RV injury phenotypes leading to RV failure and death. The end-systolic and pulmonary arterial elastance (E es and E a , representing RV contractility and afterload, respectively) are the main determinants of RV-PA coupling. 7,8 Pulmonary vasoconstriction caused by hypoxemia, hyper-capnia, and acidemia in patients with ARDS, as well as high driving pressure and high intensity of invasive ventilation (i.e. mechanical power) lead to the development of acute pulmonary arterial hypertension (PAH). 7-9 As a consequence, the RV dilates (heterometric adaptation), together with a reduction in E es :E a ratio (<1) resulting in RV-PA uncoupling. This renders the RV unable to meet the flow demands without excessive use of Frank-Starling mechanism and systemic congestion ensues. 7,8 There is currently lack of a consensual RV injury definition. In a recent systematic review of ARDS studies, the most frequently used definition was the composite of size ratio and elevated RV pressure or septal dyskinesia. 10 In this article, we use RV injury as an umbrella term that encompasses one or more different RV and pulmonary vasculature pathologies (echocardiography phenotypes) which affect RV-PA coupling such as: acute PAH, RV dilatation, RV dysfunction, acute cor pulmonale, and RV failure. Does Veno-Venous Extracorporeal Membrane Oxygenation Unload the Injured Right Ventricle? Veno-venous ECMO reverses hypoxemia, hypercapnia, and acidemia when mechanical ventilatory support alone becomes insufficient in managing severe acute respiratory failure. This results in a reduction in pulmonary vasoconstriction caused by the aforementioned factors and a decrease in PAH and RV after-load. 8,9 In a prospective observational study of ARDS patients requiring VV ECMO in whom a pulmonary artery catheter was inserted before ECMO cannulation, initiation of VV ECMO was associated with an immediate substantial decline in PA pressure and an increase in cardiac index. 11
ER  - 
TY  - JOUR
T1  - Benefits of a novel percutaneous ventricular assist device for right heart failure: The prospective RECOVER RIGHT study of the Impella RP device
A1  - Anderson, Mark B.
A1  - Goldstein, James
A1  - Milano, Carmelo
A1  - Morris, Lynn D.
A1  - Kormos, Robert L.
A1  - Bhama, Jay
A1  - Kapur, Navin K.
A1  - Bansal, Aditya
A1  - Garcia, Jose
A1  - Baker, Joshua N.
A1  - Silvestry, Scott
A1  - Holman, William L.
A1  - Douglas, Pamela S.
A1  - O'Neill, William
Y1  - 2015///
KW  - cardiogenic shock
KW  - heart failure
KW  - hemodynamics
KW  - right ventricular assist device
KW  - right ventricular failure
PB  - Elsevier
JF  - Journal of Heart and Lung Transplantation
VL  - 34
IS  - 12
SP  - 1549
EP  - 1560
DO  - 10.1016/j.healun.2015.08.018
UR  - http://dx.doi.org/10.1016/j.healun.2015.08.018
L1  - file:///Users/JuanSebastian/Desktop/VP-ECMO/RECOVER RIGHT trial (Impella RP).pdf
N2  - Background Right ventricular failure (RVF) increases morbidity and mortality. The RECOVER RIGHT study evaluated the safety and efficacy of a novel percutaneous right ventricular assist device, the Impella RP (Abiomed, Danvers, MA), in a prospective, multicenter trial. Methods Thirty patients with RVF refractory to medical treatment received the Impella RP device at 15 United States institutions. The study population included 2 cohorts: 18 patients with RVF after left ventricular assist device (LVAD) implantation (Cohort A) and 12 patients with RVF after cardiotomy or myocardial infarction (Cohort B). The primary end point was survival to 30 days or hospital discharge (whichever was longer). Major secondary end points included indices of safety and efficacy. Results The patients (77% male) were a mean age of 59 ± 15 years, 53% had diabetes, 88.5% had a history of congestive heart failure, and 37.5% had renal dysfunction. Patients were on an average of 3.2 inotropes/pressors. Device delivery was achieved in all but 1 patient. Hemodynamics improved immediately after initiation of Impella RP support, with an increase in cardiac index from 1.8 ± 0.2 to 3.3 ± 0.23 liters/min/m2 (p < 0.001) and a decrease in central venous pressure from 19.2 ± 4 to 12.6 ± 1 mm Hg (p < 0.001). Patients were supported for an average of 3.0 ± 1.5 days (range, 0.5-7.8 days). The overall survival at 30 days was 73.3%. All patients discharged were alive at 180 days. Conclusions In patients with life-threatening RVF, the novel percutaneous Impella RP device was safe, easy to deploy, and reliably resulted in immediate hemodynamic benefit. These data support its probable benefit in this gravely ill patient population.
ER  - 
TY  - GEN
T1  - WHO Coronavirus (COVID-19) Dashboard. WHO Coronavirus (COVID-19) Dashboard With Vaccination Data
A1  - World Health Organization
Y1  - 2021///
JF  - Who
SP  - 1
EP  - 5
UR  - https://covid19.who.int/
N2  - Estadísticas COVID-19 de la OMS
ER  -