Optimizing Gas Exchange in ECMO: Key Insights for Clinical Management.

This review examines the role of extracorporeal membrane oxygenation (ECMO) in the management of severe acute respiratory distress syndrome (ARDS), emphasizing its contribution to lung-protective ventilation by optimizing oxygenation and ensuring optimal decarboxylation. Key determinants of oxygen delivery during ECMO include circuit blood flow, cannula size and positioning, and hemoglobin concentration. Strategies for troubleshooting oxygenation issues, including recirculation, increased oxygen consumption, and oxygenator dysfunction, are reviewed.

Liberal or restrictive transfusion for veno-arterial extracorporeal membrane oxygenation patients: a target trial emulation using the OBLEX study data.

Background: The optimal transfusion threshold for patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) remains uncertain.

Methods: We used data from OBLEX (ClinicalTrials.gov: NCT03714048), an international, prospective, observational study conducted across 12 centres in Australia, Europe, and North America between 2019 and 2022.

Incidence, kinetics, and clinical impact of thrombocytopenia in venovenous ECMO: insights from the multicenter observational PROTECMO study.

Background: Thrombocytopenia is a recognized risk factor for bleeding during extracorporeal membrane oxygenation (ECMO). This study determines the incidence, risk factors, and clinical relevance of thrombocytopenia and platelet transfusions during venovenous (VV) ECMO.

Methods: The multicenter, prospective observational PROTECMO study included 652 adult patients who received VV ECMO for respiratory failure.

Extracorporeal life support for adult patients with ARDS.

Extracorporeal Life Support (ECLS), including venovenous (VV) extracorporeal membrane oxygenation (ECMO) and extracorporeal carbon dioxide removal (ECCO2R) is a temporary support option for patients with severe respiratory failure. Current data and recent guidelines support the use of VV ECMO for select patients with very severe respiratory failure as this technique might improve survival in appropriately selected patients. Patient selection criteria, timing of ECMO initiation and optimal management of mechanical ventilation and anticoagulation, and other adjunctive treatment options are a matter of ongoing research.

Optimum electrical impedance tomography-based PEEP and recruitment-to-inflation ratio in patients with severe ARDS on venovenous ECMO.

Rationale: The significance of the Recruitment to Inflation (R/I) ratio in identifying PEEP recruiters in patients undergoing ultra-protective lung ventilation during venovenous ECMO is not well established.

Objectives: To compare the concordance of the R/I ratio and Electrical Impedance Tomography (EIT) in determining optimum PEEP settings in severe ARDS patients on ECMO and ventilated with very low tidal volumes.

Methods: Initially, a low-flow insufflation was performed to detect and measure the airway opening pressure (AOP).

Improving the Reporting of Trials Evaluating Organ Support Therapies Using Multistate Modeling.

Managing critically ill patients in the ICU often involves organ support therapies (OSTs), such as mechanical ventilation, extracorporeal membrane oxygenation, renal replacement therapy, and various pharmacologic strategies. Clinical trials in this context pursue diverse goals, including improving survival, reducing OST use, facilitating weaning, or comparing timing of OST initiation, which leads to substantial heterogeneity in OST-related endpoints. One commonly used outcome, the number of OST-free days, has been criticized for its composite nature, which can obscure important clinical differences between patients with similar OST-free day values.

Does Levosimendan hasten veno-arterial ECMO weaning? A propensity score matching analysis.

Background: Preliminary evidence from small, single-center studies suggests levosimendan may improve the likelihood of successful venoarterial extracorporeal membrane oxygenation (VA-ECMO) weaning in patients with cardiogenic shock. However, the literature is limited and presents conflicting results. We aimed to assess the benefits of levosimendan on VA-ECMO for time to successful ECMO weaning, using a pragmatic and rigorous definition of successful VA-ECMO weaning in patients with potential for cardiac function recovery.

Anti-RNApol3-Associated myocarditis: an emerging disease linking autoimmunity and infection.

Background: Fulminant myocarditis (FM) is a severe condition primarily triggered by viruses. Anti-RNA polymerase III autoantibodies (RNApol3) which are typically found in patients with severe systemic sclerosis, have been reported in patients with influenza-related FM. Our objective is to provide additional insight into RNApol3-associated FM.

Echography monitoring in patients with temporary mechanical circulatory support.

Purpose Of Review: To examine the role of echocardiography in managing patients with refractory cardiogenic shock supported by temporary mechanical circulatory support (t-MCS) and provide practical recommendations to improve clinical practice.

Recent Findings: t-MCS devices are increasingly used to stabilize patients with refractory cardiogenic shock. Echocardiography, due to its accessibility and ability to assess both structural and functional aspects of heart failure, is ideally suited for daily bedside evaluation of cardiac function and t-MCS-myocardial interactions.

Infrared illumination for difficult peripheral venous catheterisation in critically ill adult patients: the prospective, randomised, multicentre ICARE trial.

Introduction: The insertion of a peripheral venous line is of paramount importance in the stabilisation of critically ill patients. It is a preferred method of venous access over more invasive techniques due to its immediacy and fewer complications. Difficulties of catheterisation can result in delays to treatment, increased complication risks and pain, and a waste of valuable time and healthcare resources.

Right Ventricular Injury Definition and Management in Veno-Venous Extracorporeal Membrane Oxygenation.

Right ventricular injury (RVI) in respiratory failure receiving veno-venous extracorporeal membrane oxygenation (VV ECMO) is associated with significant mortality. A scoping review is necessary to map the current literature and guide future research regarding the definition and management of RVI in patients receiving VV ECMO. We searched for relevant publications on RVI in patients receiving VV ECMO in Medline, EMBASE, and Web of Science.

Fever following extracorporeal membrane oxygenation decannulation: Infection, thrombosis or just physiology?

Purpose: Fever is frequent after extracorporeal membrane oxygenation (ECMO) decannulation. We aimed to evaluate the incidence of post-decannulation fever and describe its causes.

Methods: Adult ECMO patients who were successfully weaned from ECMO were retrospectively included.