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  • 1
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    Observational study of thrombosis and bleeding in COVID-19 VV ECMO patients
    SAGE Publications ; 2022
    In:  The International Journal of Artificial Organs Vol. 45, No. 2 ( 2022-02), p. 239-242
    Details
    In: The International Journal of Artificial Organs, SAGE Publications, Vol. 45, No. 2 ( 2022-02), p. 239-242
    Abstract: COVID-19 has been associated with increased risk of thrombosis, heparin resistance and coagulopathy in critically ill patients admitted to intensive care. We report the incidence of thrombotic and bleeding events in a single center cohort of 30 consecutive patients with COVID-19 supported by veno-venous extracorporeal oxygenation (ECMO) and who had a whole body Computed Tomography Scanner (CT) on admission. Methodology: All patients were initially admitted to other hospitals and later assessed and retrieved by our ECMO team. ECMO was initiated in the referral center and all patients admitted through our CT scan before settling in our intensive care unit. Clinical management was guided by our institutional ECMO guidelines, established since 2011 and applied to at least 40 patients every year. Results: We diagnosed a thrombotic event in 13 patients on the initial CT scan. Two of these 13 patients subsequently developed further thrombotic complications. Five of those 13 patients had a subsequent clinically significant major bleeding. In addition, two patients presented with isolated intracranial bleeds. Of the 11 patients who did not have baseline thrombotic events, one had a subsequent oropharyngeal hemorrhage. When analyzed by ROC analysis, the area under the curve for % time in intended anticoagulation range did not predict thrombosis or bleeding during the ECMO run (0.36 (95% CI 0.10–0.62); and 0.51 (95% CI 0.25–0.78); respectively). Conclusion: We observed a high prevalence of VTE and a significant number of hemorrhages in these severely ill patients with COVID-19 requiring veno-venous ECMO support.
    Type of Medium: Online Resource
    ISSN: 0391-3988 , 1724-6040
    URL: Article
    DOI: 10.1177/0391398821989065
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
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  • 2
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    Direct Complications of the Avalon Bicaval Dual-Lumen Cannula in Respiratory Extracorporeal Membrane Oxygenation (ECMO): Single-Center Experience
    SAGE Publications ; 2014
    In:  The International Journal of Artificial Organs Vol. 37, No. 10 ( 2014-10), p. 741-747
    Details
    In: The International Journal of Artificial Organs, SAGE Publications, Vol. 37, No. 10 ( 2014-10), p. 741-747
    Abstract: Cannulation for veno-venous extracorporeal membrane oxygenation (VVECMO) may involve a single site when using a dual-lumen cannula. Benefits include a decrease in blood recirculation, easier patient mobilization, and lower risk of dislodgment. We aimed to review all complications related to the cannula. Methods The study included all adult patients admitted to a single intensive care unit (ICU), between November 2009 and September 2013, requiring VVECMO in whom an Avalon Cannula was inserted. The list of patients, complications, and patient data were retrieved from the local ECMO database and the intensive care Clinical Information System (CIS). Results Seventy two patients were cannulated with an Avalon cannula between November 1, 2009 and September 31, 2013. Forty-four patients had no cannula-related complications. A total of 35 complications were recorded in 28 patients, 6 of whom required further intervention. Conclusions Successful cannulation was possible in all patients with the majority of complications graded as minor.
    Type of Medium: Online Resource
    ISSN: 0391-3988 , 1724-6040
    URL: Article
    DOI: 10.5301/ijao.5000357
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2014
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  • 3
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    Agreement between ACT and aPTT during extracorporeal membrane oxygenation shows intra- and inter-individual variation
    SAGE Publications ; 2016
    In:  Perfusion Vol. 31, No. 6 ( 2016-09), p. 503-507
    Details
    In: Perfusion, SAGE Publications, Vol. 31, No. 6 ( 2016-09), p. 503-507
    Abstract: We explored the relationship between activated clotting time (ACT) and activated partial thromboplastin time (aPTT) when used to monitor anticoagulation in patients undergoing extracorporeal membrane oxygenation (ECMO) support. Methods: Data obtained in patients undergoing ECMO support between October 2012 and August 2013 in a single centre were reviewed. Clinical data were extracted from our Clinical Information System and ECMO database. ACT and aPTT values were paired when taken from the same patient, with the ACT preceding the aPTT and the heparin infusion rate was kept constant between samples. The aPTT and ACT were normalized by dividing by the mean of their respective reference ranges and are referred to as APR and N-ACT, respectively. Bivariate analysis and Bland-Altman plots were used to assess correlation and agreement. Mixed effects regression was used to model the effects of variables, including platelet count, creatinine and urea levels, plasma free haemoglobin, white cell count and ECMO flow rate on concordance between APR and N-ACT measurements. Results: The Pearson product-moment correlation coefficient in 15 patients was calculated as r=0.55. The Bland-Altman plot shows a mean difference between the APR and the N-ACT of −0.08. The 95% limits of agreement were −0.67 to 0.51. Results from mixed effects regression analysis on data from the 15 patients identified platelet count (and thrombocytopenia) and urea as significant independent predictors of concordance between APR and N-ACT. Conclusion: We report a moderate degree of positive correlation between APR and N-ACT. We conclude that there is poor agreement between the ACT and aPTT for the heparin concentrations in patients supported with ECMO. Our results indicate that platelet count and urea are significant independent variables affecting concordance between ACT and aPTT measurements.
    Type of Medium: Online Resource
    ISSN: 0267-6591 , 1477-111X
    URL: Article
    DOI: 10.1177/0267659116637420
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
    detail.hit.zdb_id: 2029611-3
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  • 4
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    Lung ultrasound and the role of lung aeration score in patients with acute respiratory distress syndrome on extracorporeal membrane oxygenation
    SAGE Publications ; 2021
    In:  The International Journal of Artificial Organs Vol. 44, No. 11 ( 2021-11), p. 854-860
    Details
    In: The International Journal of Artificial Organs, SAGE Publications, Vol. 44, No. 11 ( 2021-11), p. 854-860
    Abstract: This was a pilot study to determine the utility of daily lung ultrasound (LUS) in patients requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO) for acute respiratory distress syndrome (ARDS). Design: This was a prospective, observational study. Setting: The study took place in the intensive care unit at Royal Papworth Hospital in Cambridge, UK. Participants: We recruited adult patients receiving VV-ECMO for ARDS. Interventions: All patients received a lung computed tomography (CT) scan and LUS on admission. Bedside chest radiography (CXR) and LUS were done on a daily basis until patients were decannulated. Measurements and main results: Daily LUS aeration scores were calculated according to the appearance of four defined patterns. An independent radiologist calculated corresponding scores for CT and CXR, retrospectively. These were checked for correlation with LUS aeration scores. There were statistically significant correlations between LUS versus CT ( r = 0.868, p = 0.002) and LUS versus CXR ( r = 0.498, p = 0.018) with good agreement and no evidence of proportional bias. LUS was able to detect 13.5% of pleural effusions and 54.2% of pneumothorax that were not picked up on CXR. In most of the patients who were weaned off VV-ECMO, a progressive reduction of LUS aeration scores corresponding to lung re-aeration was observed. Conclusions: LUS correlated with findings on CT and CXR for quantifying lung aeration and the clinical presentation of patients. LUS also picked up more pleural effusions and pneumothorax than CXR. Together with traditional imaging techniques, the routine use of LUS should be considered for this patient group.
    Type of Medium: Online Resource
    ISSN: 0391-3988 , 1724-6040
    URL: Article
    DOI: 10.1177/03913988211051395
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
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  • 5
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    Continuous hemadsorption with cytokine adsorber for severe COVID-19: A case series of 15 patients
    SAGE Publications ; 2021
    In:  The International Journal of Artificial Organs Vol. 44, No. 10 ( 2021-10), p. 664-674
    Details
    In: The International Journal of Artificial Organs, SAGE Publications, Vol. 44, No. 10 ( 2021-10), p. 664-674
    Abstract: Hyperinflammation and cytokine release has been associated with severe Covid-19. Hemadsorption cartridges may have a potential role in treatment of cytokine storm associated with the development of severe Covid-19. Methods: We retrospectively examined the case records of patients with severe Covid-19 receiving adjunctive hemadsorption (HA) in our ICU. We analyzed inflammatory biomarkers pre- and post- HA. Results: Fifteen patients received HA during the study period. All were intubated, ventilated and required renal replacement therapy. 11/15 were supported on ECMO. Mean ferritin 2652 (±3286) ng/ml, mean CRP 154 (±92) mg/ml, median D-dimer 3071 (±2689) ng/ml, mean troponin 236 (±461) ng/L. We found significant difference in pre-and post- treatment ferritin 3622 ng/ml versus 1682 ng/ml ( p = 0.022), CRP 222 mg/ml versus 103 mg/ml ( p = 0.008, 95% CI 22.4–126.5), lactate 2 mmol/L versus 1.3 mmol/L ( p = 0.017), and procalcitonin 15.3 ng/ml versus 4.2 ng/ml ( p = 0.023). No significant difference in pre- and post- treatment IL-6 14 pg/ml versus 43 pg/ml ( p = 0.32), IL-10 3.4 pg/ml versus 2.6 pg/ml ( p = 0.31), IL1 β 0.37 pg/ml versus 0.77 pg/ml ( p = 0.75), TNF α 12.77 pg/ml versus 12.49 pg/ml ( p = 0.75), VIS 10.04 versus 6.01 ( p = 0.31, 95% CI 5.98–17.16) was seen. Conclusions: The use of HA as adjunctive treatment in a critically unwell group of COVID-19 patients lead to a reduction in ferritin, CRP, procalcitonin and lactate with no significant change in other parameters. The use of HA in the treatment of severe COVID-19 requires further larger randomized studies.
    Type of Medium: Online Resource
    ISSN: 0391-3988 , 1724-6040
    URL: Article
    DOI: 10.1177/03913988211023782
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
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  • 6
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    Barriers to the secondary use of data in critical care
    SAGE Publications ; 2018
    In:  Journal of the Intensive Care Society Vol. 19, No. 2 ( 2018-05), p. 127-131
    Details
    In: Journal of the Intensive Care Society, SAGE Publications, Vol. 19, No. 2 ( 2018-05), p. 127-131
    Abstract: We explore the challenges of the secondary use of data in clinical information systems which critical care units in the National Health Service (England) are facing. Methods We conducted an online survey of critical care units in England regarding their practices in collecting and using clinical information systems and data. Results Critical care units use clinical information systems typically independently of hospital information systems and focus mainly on using data for auditing, management reporting and research. Respondents reported that extracting data from their clinical information system was difficult and that they would use stored data more if it were easier to access. Data extraction takes time and who extracts data, the training they receive and the tools they use affect the extraction and use of data. Conclusion A number of key challenges affect the secondary use of data in critical care: a lack of integration of information systems within critical care and across departments; barriers to accessing data; mismatched data tools and user requests. Data are predominantly used for reporting and research with less emphasis on using data to inform clinical practice.
    Type of Medium: Online Resource
    ISSN: 1751-1437
    URL: Article
    DOI: 10.1177/1751143717741082
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2018
    detail.hit.zdb_id: 2701626-2
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  • 7
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    Predictors of health-related quality of life in patients undergoing extracorporeal membrane oxygenation for acute severe respiratory failure
    SAGE Publications ; 2023
    In:  Journal of the Intensive Care Society Vol. 24, No. 3 ( 2023-08), p. 283-291
    Details
    In: Journal of the Intensive Care Society, SAGE Publications, Vol. 24, No. 3 ( 2023-08), p. 283-291
    Abstract: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a form of life support used in severe respiratory failure. While the short-term complications of VV-ECMO are well described, impacts on health-related quality of life (HRQOL) are less well characterised. This study aims to assess the HRQOL of patients who underwent VV-ECMO for acute severe respiratory failure and explore predictors of poor HRQOL. Methods We performed a retrospective, observational study of a large cohort of adults who underwent VV-ECMO for acute severe respiratory failure in a single tertiary centre (June 2013–March 2019). Patients surviving critical care discharge were invited to a six-month clinic, where they completed an EQ-5D-5L questionnaire assessing HRQOL. Multivariate analysis was performed to assess prognostic factors for HRQOL. Results Among the 245 consecutive patients included in this study (median age 45 years), 187 (76.3%) survived until ECMO decannulation and 172 (70.2%) until hospital discharge. Of those, 98 (57.3%) attended a follow-up clinic at a mean (±SD) of 204 (±45) days post-discharge. Patients reported problems with pain/discomfort (56%), usual daily activities (53%), anxiety/depression (49%), mobility (46%), and personal care (21%). Multivariate analysis identified limb ischaemia (−0.266, 95% C.I. [−0.116; −0.415], p = 0.0005), renal replacement therapy (−0.149, [−0.046; −0.252] , p = 0.0044), and having received more than four platelet units (−0.157, [−0.031; −0.283], p = 0.0146) as predictors of poor HRQOL. Conclusion We report that survivors of VV-ECMO have reduced HRQOL in multiple domains at 6 months, with pain reported most frequently. Patients who had limb ischaemia, renal replacement therapy or were transfused more than four units of platelets are particularly at risk of poor HRQOL and may benefit from added support measures.
    Type of Medium: Online Resource
    ISSN: 1751-1437
    URL: Article
    DOI: 10.1177/17511437221111639
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
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  • 8
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    Use of extracorporeal life support to support patients with acute respiratory distress syndrome due to H1N1/2009 influenza and other respiratory infections
    SAGE Publications ; 2011
    In:  Perfusion Vol. 26, No. 1 ( 2011-01), p. 7-20
    Details
    In: Perfusion, SAGE Publications, Vol. 26, No. 1 ( 2011-01), p. 7-20
    Abstract: A large proportion of critically ill H1N1/2009 patients with respiratory failure subsequently developed ARDS and, to date, about 400 patients receiving extracorporeal life support (ECLS) have been accounted for globally, with a reported survival rate from 63% to 79%. The survival rates of patients with ARDS due to non-H1N1/2009 infections are similar. There is no definite evidence to suggest that patient outcomes are changed by ECLS, but its use is associated with serious short-term complications. ECLS relies on an extracorporeal circuit, with extracorporeal membrane oxygenation (ECMO) and pumpless interventional lung assist (ILA) being the two major types employed in ARDS. Both have the potential to correct respiratory failure and related haemodynamic instability. There are only a very limited number of clinical trials to test either and, although ECLS has been used in treating H1N1/2009 patients with ARDS with some success, it should only be offered in the context of clinical trials and in experienced centres.
    Type of Medium: Online Resource
    ISSN: 0267-6591 , 1477-111X
    URL: Article
    DOI: 10.1177/0267659110383342
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2011
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  • 9
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    Extracorporeal membrane oxygenation for the treatment of adult sickle cell acute chest syndrome
    SAGE Publications ; 2016
    In:  Perfusion Vol. 31, No. 3 ( 2016-04), p. 262-265
    Details
    In: Perfusion, SAGE Publications, Vol. 31, No. 3 ( 2016-04), p. 262-265
    Abstract: Sickle cell disease (SCD) is a hereditary haemoglobinopathy that results in polymerization of haemoglobin molecules and subsequent vaso-occlusion. A common cause of death in adults is acute chest syndrome (AChS) with resulting hypoxemic respiratory failure. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been used successfully in acutely reversible respiratory failure when conventional mechanical ventilation has been unable to adequately oxygenate and ventilate in a lung-protective fashion. We present an adult SCD patient with severe respiratory failure due to AChS, successfully treated with VV-ECMO. We also discuss some of the technical challenges and considerations when using ECMO in the SCD patient.
    Type of Medium: Online Resource
    ISSN: 0267-6591 , 1477-111X
    URL: Article
    DOI: 10.1177/0267659115593172
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
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  • 10
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    Extracorporeal Membrane Oxygenation: Coming to an ICU near you
    SAGE Publications ; 2012
    In:  Journal of the Intensive Care Society Vol. 13, No. 1 ( 2012-01), p. 31-38
    Details
    In: Journal of the Intensive Care Society, SAGE Publications, Vol. 13, No. 1 ( 2012-01), p. 31-38
    Abstract: Extra-corporeal membrane oxygenation has come of age after publication of the CESAR trial and the experience of its use during the 2009 H1N1 influenza pandemic, showing its increasing benefit for the treatment of hypoxaemic respiratory failure and combined cardiovascular and respiratory failure, including post-cardiac arrest. The article reviews the evidence for this technology and its indications, modes, methods, complications and recent advances. The authors suggest that ECMO will be used increasingly, even in non-cardiac specialist centres.
    Type of Medium: Online Resource
    ISSN: 1751-1437
    URL: Article
    DOI: 10.1177/175114371201300110
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2012
    detail.hit.zdb_id: 2701626-2
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