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  • 1
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    Online Resource
    In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study
    Elsevier BV ; 2023
    In:  The Lancet Respiratory Medicine Vol. 11, No. 2 ( 2023-02), p. 151-162
    Details
    In: The Lancet Respiratory Medicine, Elsevier BV, Vol. 11, No. 2 ( 2023-02), p. 151-162
    Type of Medium: Online Resource
    ISSN: 2213-2600
    URL: Article
    DOI: 10.1016/S2213-2600(22)00403-9
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 2686754-0
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  • 2
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    Cervical Emphysema in Boerhaave Syndrome
    Deutscher Arzte-Verlag GmbH ; 2019
    In:  Deutsches Ärzteblatt international ( 2019-03-22)
    Details
    In: Deutsches Ärzteblatt international, Deutscher Arzte-Verlag GmbH, ( 2019-03-22)
    Type of Medium: Online Resource
    ISSN: 1866-0452
    URL: Article
    DOI: 10.3238/arztebl.2019.0211
    Language: German
    Publisher: Deutscher Arzte-Verlag GmbH
    Publication Date: 2019
    detail.hit.zdb_id: 2406159-1
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  • 3
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    Additive treatment considerations in COVID‐19—The clinician’s perspective on extracorporeal adjunctive purification techniques
    Wiley ; 2020
    In:  Artificial Organs Vol. 44, No. 9 ( 2020-09), p. 918-925
    Details
    In: Artificial Organs, Wiley, Vol. 44, No. 9 ( 2020-09), p. 918-925
    Abstract: The aim of this document was to inform the scientific community of sparse preliminary results regarding advanced supportive therapies and technology‐driven systems in addition to highlighting the benefits and possibilities of performing concise research during challenging times. Advanced organ support for lung and heart offers the possibility to buy the time needed for recovery. However, remaining a bridging strategy, extracorporeal life support cannot act as the ultimate treatment for the underlying COVID‐19 disease. Appropriate patient selection criteria addressed by experts and scientific organizations, such as Extracorporeal Life Support Organization and World Health Organization, may provide significant help in the difficult decision‐making and to reduce mortality in patients with profound respiratory and/or cardiac failure due to COVID‐19. Severe, systemic cytokine‐mediated inflammation associated with the SARS‐CoV‐2 has also been described. Effects of crosstalk between coagulation and inflammatory pathways appear to significantly affect disease progression and lead to poor outcomes. Multiple therapeutic strategies, including antibody therapies (such as Tocilizumab, Sarilumab, Siltuximab), therapeutic plasma exchange (TPE), and blood purification techniques for direct removal of cytokines, including filtration, dialysis (diffusion), and adsorption are available. Further, we believe, that research should be facilitated and promoted, particularly under the guidance of recognized scientific societies or expert‐based multicenter investigation, with rapid communication of critical and relevant information to enhance better appraisal of patient profiles, complications, and treatment modalities.
    Type of Medium: Online Resource
    ISSN: 0160-564X , 1525-1594
    URL: Issue
    URL: Article
    DOI: 10.1111/aor.v44.9
    DOI: 10.1111/aor.13748
    Language: English
    Publisher: Wiley
    Publication Date: 2020
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    detail.hit.zdb_id: 2003825-2
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  • 4
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    Extracorporeal life support in COVID‐19‐related acute respiratory distress syndrome: A EuroELSO international survey
    Wiley ; 2021
    In:  Artificial Organs Vol. 45, No. 5 ( 2021-05), p. 495-505
    Details
    In: Artificial Organs, Wiley, Vol. 45, No. 5 ( 2021-05), p. 495-505
    Abstract: Extracorporeal life support (ECLS) is a means to support patients with acute respiratory failure. Initially, recommendations to treat severe cases of pandemic coronavirus disease 2019 (COVID‐19) with ECLS have been restrained. In the meantime, ECLS has been shown to produce similar outcomes in patients with severe COVID‐19 compared to existing data on ARDS mortality. We performed an international email survey to assess how ECLS providers worldwide have previously used ECLS during the treatment of critically ill patients with COVID‐19. A questionnaire with 45 questions (covering, e.g., indication, technical aspects, benefit, and reasons for treatment discontinuation), mostly multiple choice, was distributed by email to ECLS centers. The survey was approved by the European branch of the Extracorporeal Life Support Organization (ELSO); 276 ECMO professionals from 98 centers in 30 different countries on four continents reported that they employed ECMO for very severe COVID‐19 cases, mostly in veno‐venous configuration (87%). The most common reason to establish ECLS was isolated hypoxemic respiratory failure (50%), followed by a combination of hypoxemia and hypercapnia (39%). Only a small fraction of patients required veno‐arterial cannulation due to heart failure (3%). Time on ECLS varied between less than 2 and more than 4 weeks. The main reason to discontinue ECLS treatment prior to patient’s recovery was lack of clinical improvement (53%), followed by major bleeding, mostly intracranially (13%). Only 4% of respondents reported that triage situations, lack of staff or lack of oxygenators, were responsible for discontinuation of ECLS support. Most ECLS physicians (51%, IQR 30%) agreed that patients with COVID‐19‐induced ARDS (CARDS) benefitted from ECLS. Overall mortality of COVID‐19 patients on ECLS was estimated to be about 55%. ECLS has been utilized successfully during the COVID‐19 pandemic to stabilize CARDS patients in hypoxemic or hypercapnic lung failure. Age and multimorbidity limited the use of ECLS. Triage situations were rarely a concern. ECLS providers stated that patients with severe COVID‐19 benefitted from ECLS.
    Type of Medium: Online Resource
    ISSN: 0160-564X , 1525-1594
    URL: Issue
    URL: Article
    DOI: 10.1111/aor.v45.5
    DOI: 10.1111/aor.13940
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 5
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    HEROES V‐V—HEmorRhagic cOmplications in Veno‐Venous Extracorporeal life Support—Development and internal validation of multivariable prediction model in adult patients
    Wiley ; 2022
    In:  Artificial Organs Vol. 46, No. 5 ( 2022-05), p. 932-952
    Details
    In: Artificial Organs, Wiley, Vol. 46, No. 5 ( 2022-05), p. 932-952
    Abstract: During extracorporeal life support (ECLS), bleeding is one of the most frequent complications, associated with high morbidity and increased mortality, despite continuous improvements in devices and patient care. Risk factors for bleeding complications in veno‐venous (V‐V) ECLS applied for respiratory support have been poorly investigated. We aim to develop and internally validate a prediction model to calculate the risk for bleeding complications in adult patients receiving V‐V ECLS support. Methods Data from adult patients reported to the extracorporeal life support organization (ELSO) registry between the years 2010 and 2020 were analyzed. The primary outcome was bleeding complications recorded during V‐V ECLS. Multivariable logistic regression with backward stepwise elimination was used to develop the predictive model. The performance of the model was tested by discriminative ability and calibration with receiver operating characteristic curves and visual inspection of the calibration plot. Results In total, 18 658 adult patients were included, of which 3 933 (21.1%) developed bleeding complications. The prediction model showed a prediction of bleeding complications with an AUC of 0.63. Pre‐ECLS arrest, surgical cannulation, lactate, pO 2 , HCO 3 , ventilation rate, mean airway pressure, pre‐ECLS cardiopulmonary bypass or renal replacement therapy, pre‐ECLS surgical interventions, and different types of diagnosis were included in the prediction model. Conclusions The model is based on the largest cohort of V‐V ECLS patients and reveals the most favorable predictive value addressing bleeding events given the predictors that are feasible and when compared to the current literature. This model will help identify patients at risk of bleeding complications, and decision making in terms of anticoagulation and hemostatic management.
    Type of Medium: Online Resource
    ISSN: 0160-564X , 1525-1594
    URL: Issue
    URL: Article
    DOI: 10.1111/aor.v46.5
    DOI: 10.1111/aor.14148
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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  • 6
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    Temporary mechanical circulatory support for COVID‐19 patients: A systematic review of literature
    Wiley ; 2022
    In:  Artificial Organs Vol. 46, No. 7 ( 2022-07), p. 1249-1267
    Details
    In: Artificial Organs, Wiley, Vol. 46, No. 7 ( 2022-07), p. 1249-1267
    Abstract: Myocardial damage occurs in up to 25% of coronavirus disease 2019 (COVID‐19) cases. While veno‐venous extracorporeal life support (V‐V ECLS) is used as respiratory support, mechanical circulatory support (MCS) may be required for severe cardiac dysfunction. This systematic review summarizes the available literature regarding MCS use rates, disease drivers for MCS initiation, and MCS outcomes in COVID‐19 patients. Methods PubMed/EMBASE were searched until October 14, 2021. Articles including adults receiving ECLS for COVID‐19 were included. The primary outcome was the rate of MCS use. Secondary outcomes included mortality at follow‐up, ECLS conversion rate, intubation‐to‐cannulation time, time on ECLS, cardiac diseases, use of inotropes, and vasopressors. Results Twenty‐eight observational studies (comprising both ECLS‐only populations and ECLS patients as part of larger populations) included 4218 COVID‐19 patients (females: 28.8%; median age: 54.3 years, 95%CI: 50.7–57.8) of whom 2774 (65.8%) required ECLS with the majority (92.7%) on V‐V ECLS, 4.7% on veno‐arterial ECLS and/or Impella, and 2.6% on other ECLS. Acute heart failure, cardiogenic shock, and cardiac arrest were reported in 7.8%, 9.7%, and 6.6% of patients, respectively. Vasopressors were used in 37.2%. Overall, 3.1% of patients required an ECLS change from V‐V ECLS to MCS for heart failure, myocarditis, or myocardial infarction. The median ECLS duration was 15.9 days (95%CI: 13.9–16.3), with an overall survival of 54.6% and 28.1% in V‐V ECLS and MCS patients. One study reported 61.1% survival with oxy‐right ventricular assist device. Conclusion MCS use for cardiocirculatory compromise has been reported in 7.3% of COVID‐19 patients requiring ECLS, which is a lower percentage compared to the incidence of any severe cardiocirculatory complication. Based on the poor survival rates, further investigations are warranted to establish the most appropriated indications and timing for MCS in COVID‐19.
    Type of Medium: Online Resource
    ISSN: 0160-564X , 1525-1594
    URL: Issue
    URL: Article
    DOI: 10.1111/aor.v46.7
    DOI: 10.1111/aor.14261
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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  • 7
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    Refractory out‐of‐hospital cardiac arrest and extracorporeal cardiopulmonary resuscitation: A meta‐analysis of randomized trials
    Wiley ; 2023
    In:  Artificial Organs Vol. 47, No. 5 ( 2023-05), p. 806-816
    Details
    In: Artificial Organs, Wiley, Vol. 47, No. 5 ( 2023-05), p. 806-816
    Abstract: In adults with refractory out‐of‐hospital cardiac arrest, when conventional cardiopulmonary resuscitation (CPR) alone does not achieve return of spontaneous circulation, extracorporeal CPR is attempted to restore perfusion and improve outcomes. Considering the contrasting findings of recent studies, we conducted a meta‐analysis of randomized controlled trials to ascertain the effect of extracorporeal CPR on survival and neurological outcome. Methods Pubmed via MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched up to February 3, 2023, for randomized controlled trials comparing extracorporeal CPR versus conventional CPR in adults with refractory out‐of‐hospital cardiac arrest. Survival with a favorable neurological outcome at the longest follow‐up available was the primary outcome. Results Among four randomized controlled trials included, extracorporeal CPR compared with conventional CPR increased survival with favorable neurological outcome at the longest follow‐up available for all rhythms (59/220 [27%] vs. 39/213 [18%] ; OR = 1.72; 95% CI, 1.09–2.70; p  = 0.02; I 2  = 26%; number needed to treat of 9), for initial shockable rhythms only (55/164 [34%] vs. 38/165 [23%] ; OR = 1.90; 95% CI, 1.16–3.13; p  = 0.01; I 2  = 23%; number needed to treat of 7), and at hospital discharge or 30 days (55/220 [25%] vs. 34/212 [16%] ; OR = 1.82; 95% CI, 1.13–2.92; p  = 0.01; I 2  = 0.0%). Overall survival at the longest follow‐up available was similar (61/220 [25%] vs. 34/212 [16%] ; OR = 1.82; 95% CI, 1.13–2.92; p  = 0.59; I 2  = 58%). Conclusions Extracorporeal CPR compared with conventional CPR increased survival with favorable neurological outcome in adults with refractory out‐of‐hospital cardiac arrest, especially when the initial rhythm was shockable. Review Registration PROSPERO CRD42023396482.
    Type of Medium: Online Resource
    ISSN: 0160-564X , 1525-1594
    URL: Issue
    URL: Article
    DOI: 10.1111/aor.v47.5
    DOI: 10.1111/aor.14516
    Language: English
    Publisher: Wiley
    Publication Date: 2023
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  • 8
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    Extracorporeal cardiopulmonary resuscitation for out‐of‐hospital cardiac arrest: A systematic review and meta‐analysis of randomized and propensity score‐matched studies
    Wiley ; 2022
    In:  Artificial Organs Vol. 46, No. 5 ( 2022-05), p. 755-762
    Details
    In: Artificial Organs, Wiley, Vol. 46, No. 5 ( 2022-05), p. 755-762
    Abstract: In selected patients with refractory out‐of‐hospital cardiac arrest, extracorporeal cardiopulmonary resuscitation represents a promising approach when conventional cardiopulmonary resuscitation fails to achieve return of spontaneous circulation. This systematic review and meta‐analysis aimed to compare extracorporeal cardiopulmonary resuscitation to conventional cardiopulmonary resuscitation. Methods We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials up to November 28, 2021, for randomized trials and observational studies reporting propensity score‐matched data and comparing adults with out‐of‐hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation with those treated with conventional cardiopulmonary resuscitation. The primary outcome was survival with favorable neurological outcome at the longest follow‐up available. Secondary outcomes were survival at the longest follow‐up available and survival at hospital discharge/30 days. Results We included six studies, two randomized and four propensity score‐matched studies. Patients treated with extracorporeal cardiopulmonary resuscitation had higher rates of survival with favorable neurological outcome (81/584 [14%] vs. 46/593 [7.8%] ; OR = 2.11; 95% CI, 1.41–3.15; p   〈  0.001, number needed to treat 16) and of survival (131/584 [22%] vs. 102/593 [17%] ; OR = 1.40; 95% CI, 1.05–1.87; p  = 0.02) at the longest follow‐up available compared with conventional cardiopulmonary resuscitation. Survival at hospital discharge/30 days was similar between the two groups (142/584 [24%] vs. 122/593 [21%] ; OR = 1.26; 95% CI, 0.95–1.66; p  = 0.10). Conclusions Evidence from randomized trials and propensity score‐matched studies suggests increased survival and favorable neurological outcome in patients with refractory out‐of‐hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation. Large, multicentre randomized studies are still ongoing to confirm these findings.
    Type of Medium: Online Resource
    ISSN: 0160-564X , 1525-1594
    URL: Issue
    URL: Article
    DOI: 10.1111/aor.v46.5
    DOI: 10.1111/aor.14205
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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  • 9
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    Extremely obese patients treated with venovenous ECMO—an intensivist’s challenge
    Elsevier BV ; 2015
    In:  The American Journal of Emergency Medicine Vol. 33, No. 11 ( 2015-11), p. 1720.e3-1720.e4
    Details
    In: The American Journal of Emergency Medicine, Elsevier BV, Vol. 33, No. 11 ( 2015-11), p. 1720.e3-1720.e4
    Type of Medium: Online Resource
    ISSN: 0735-6757
    URL: Article
    DOI: 10.1016/j.ajem.2015.03.065
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2015
    detail.hit.zdb_id: 605890-5
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  • 10
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    Hematocrit and impact of transfusion in patients receiving extracorporeal life support
    SAGE Publications ; 2018
    In:  Perfusion Vol. 33, No. 7 ( 2018-10), p. 546-552
    Details
    In: Perfusion, SAGE Publications, Vol. 33, No. 7 ( 2018-10), p. 546-552
    Abstract: Introduction: Increasing the hematocrit is considered to increase oxygen delivery to the patient, especially when hypoxic conditions exist and the patient may become more stable. The aim of this study was to evaluate the relationship between hematocrit and hospital mortality via subgroup analyses of trauma and non-trauma patients. Methods: The hospital length of stay (LOS) and LOS in the intensive care unit (ICU) and hospital after extracorporeal life support (ECLS) treatment of 81 patients were analyzed and compared. In-hospital survival until extracorporeal membrane oxygen (ECMO) weaning and hospital discharge were defined as the clinical outcome. Results: Significantly increased mortality, with a relative risk of 1.73 with a 95% confidence interval of 1.134 to 2.639, was identified in the group with an hematocrit greater than 31%. However, no significant differences in relative risk (95% confidence interval) of death for each group were found among groups with an hematocrit less than or equal to 25%, 26-28% and 29-31%. Additionally, no significant relationship between survival and median hematocrit level was observed at a significance level of 0.413 and an Exp (B) of 1.089 at a 95% confidence interval of 0.878 to 1.373 in binary logistic regression analysis; a model was established with a -2 log likelihood of 40.687 for the entire group of patients. Moreover, a significant increase in mortality was observed as the average number of transfusions per day in the hospital increased (significance level 0.024, Exp (B) 4.378, 95% confidence interval for Exp (B) 1.212 to 15.810). Conclusion: Because a variety of factors influence therapy, the indication for transfusion should be re-evaluated and adapted repeatedly on a case-by-case basis. Further studies are needed to demonstrate whether an acceptable outcome from ECLS device therapy can also be achieved with a low hematocrit and a restrictive indication for transfusion.
    Type of Medium: Online Resource
    ISSN: 0267-6591 , 1477-111X
    URL: Article
    DOI: 10.1177/0267659118772457
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2018
    detail.hit.zdb_id: 2029611-3
    detail.hit.zdb_id: 645038-6
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