Publications by authors named "Lars M Broman"
Purpose: Globally, trauma is a leading cause of death in young adults. The use of extracorporeal membrane oxygenation (ECMO) in the trauma population remains controversial due to the limited published research. This study aimed to analyze 30-day survival of all the trauma ECMO patients at our center, with respect to injury severity score (ISS) and new injury severity score (NISS).
View Article and Find Full Text PDFArticle Synopsis
- The text discusses the occurrence of dual circulation during venoarterial extracorporeal membrane oxygenation (VA-ECMO), where blood from the body and an artificial heart/lung system mix, resulting in differing oxygen and carbon dioxide levels in two separate circulations.
- This phenomenon arises when native blood flow from the heart meets retrograde blood flow from the artificial system, creating distinct physiological environments on either side of the mixing point.
- The authors aim to clarify the terminology surrounding this issue to improve communication and clinical management for patients undergoing VA-ECMO treatment.
Despite ECMO being a well-accepted and established life-saving support for newborns, prematurity (<34 weeks of gestation) and low birth weight <2.0 kg are still considered relative contraindications due to the fear of intracranial bleeding complications. In the last decades, outcome in extracorporeal life support for pre-term babies has improved, and morbidity dominated by intracranial bleedings has decreased.
View Article and Find Full Text PDFLimb ischaemia is a clinically relevant complication of venoarterial extracorporeal membrane oxygenation (VA ECMO) with femoral artery cannulation. No selective distal perfusion or other advanced techniques were used in the past to maintain adequate distal limb perfusion. A more recent trend is the shift from the reactive or emergency management to the pro-active or prophylactic placement of a distal perfusion cannula to avoid or reduce limb ischaemia-related complications.
View Article and Find Full Text PDFBackground: Increasingly, computational fluid dynamics (CFD) is helping explore the impact of variables like: cannula design/size/position/flow rate and patient physiology on venovenous (VV) extracorporeal membrane oxygenation (ECMO). Here we use a CFD model to determine what role cardiac output (CO) plays and to analyse return cannula dynamics.
Methods: Using a patient-averaged model of the right atrium and venae cava, we virtually inserted a 19Fr return cannula and a 25Fr drainage cannula.
Background: Extracorporeal membrane oxygenation (ECMO) is indicated for patients with severe respiratory and/or circulatory failure. The standard technique to visualize the extent of pulmonary damage during ECMO is computed tomography (CT).
Purpose: This single-center, retrospective study investigated whether pulmonary blood flow (PBF) measured with echocardiography can assist in assessing the extent of pulmonary damage and whether echocardiography and CT findings are associated with patient outcomes.
Severe cases of acute respiratory distress syndrome (ARDS) may require prolonged (>28 d) extracorporeal membrane oxygenation (ECMO). In nonresolving disease, recovery is uncertain, and lung transplant may be proposed. This study aims to identify the variables influencing survival and to describe the functional status of these patients at 6 months.
View Article and Find Full Text PDFArticle Synopsis
- Anticoagulation management during veno-venous extracorporeal membrane oxygenation (VV ECMO) is challenging due to a lack of definitive guidelines, leading to significant bleeding complications.
- A study involving 652 adult patients across 41 centers analyzed anticoagulation practices and bleeding events, finding that unfractionated heparin was the most commonly used anticoagulant and that bleeding occurred in 52.5% of patients.
- Results showed that higher activated partial thromboplastin time (aPTT) levels were linked to an increased risk of bleeding, suggesting that future research could investigate whether lower aPTT targets might help minimize these complications.
Extracorporeal membrane oxygenation (ECMO) is a life-supportive treatment in neonatal patients with refractory lung and/or heart failure. Intracranial hemorrhage (ICH) is a severe complication and reliable predictors are warranted. The aims of this study were to explore the incidence and possible predictors of ICH in ECMO-treated neonatal patients.
View Article and Find Full Text PDFRefractory septic shock is associated with a high risk of death. Circulatory support in the form of veno-arterial extracorporeal membrane oxygenation (VA ECMO) may function as a bridge to recovery, allowing for the treatment of the source of the sepsis. Whilst VA ECMO has been accepted as the means of hemodynamic support for children, in adults, single center observational studies show survival rates of only 70-90% for hypodynamic septic shock.
View Article and Find Full Text PDFBackground: The objective of this animal study was to evaluate the hemodynamic performance of a new centrifugal pump for extra-corporeal membrane oxygenation (ECMO) support in neonates.
Methods: Six healthy swines were supported with veno-venous ECMO with the New Born ECMOLife centrifugal pump (Eurosets, Medolla, Italy) at different flow rates: 0.25, 0.
Article Synopsis
- Existing research on RBC transfusion in VA ECMO patients is limited, mostly consisting of small-scale studies that hinder broader understanding.
- This study involved an international survey and retrospective data collection from 16 centers to assess transfusion practices and outcomes in VA ECMO patients.
- Results showed that a high percentage of patients (89%) received RBC transfusions, with factors like lower hemoglobin and longer ECMO duration influencing the need for transfusions, but overall survival did not significantly differ based on transfusion status.
Plasma Transfusion and Procoagulant Product Administration in Extracorporeal Membrane Oxygenation: A Secondary Analysis of an International Observational Study on Current Practices.
Crit Care Explor
August 2023
Article Synopsis
- The study examines the use of various blood products (plasma, fibrinogen concentrate, TXA, and PCC) in patients on extracorporeal membrane oxygenation (ECMO) to achieve better blood clotting balance.
- It analyzes data from a multicenter retrospective study involving adult patients on VA-ECMO and VV-ECMO, identifying complications related to bleeding and thrombosis.
- Results indicate a higher use of transfusions in patients with bleeding complications, revealing trends in treatment that suggest a need for reevaluation of current transfusion practices in ECMO patients.
The interaction of thrombocytopenia, hemorrhage, and platelet transfusion in venoarterial extracorporeal membrane oxygenation: a multicenter observational study.
Crit Care
August 2023
Article Synopsis
- Thrombocytopenia (low platelets) and bleeding are common problems for patients on a special machine called VA ECMO that helps with heart and lung issues.
- A study looked at 419 patients and found that almost all of them developed low platelets, with many having severe cases, and more than half needed platelet transfusions.
- The research showed that having severe low platelets makes it much more likely to need a platelet transfusion, especially if the patient is also bleeding.
Background: In this retrospective study, we report the effectiveness and safety of a dedicated extracorporeal carbon dioxide removal (ECCOR) device in critically ill patients.
Methods: Adult patients on mechanical ventilation due to acute respiratory distress syndrome (ARDS) or decompensated chronic obstructive pulmonary disease (dCOPD), who were treated with a dedicated ECCOR device (CO2RESET, Eurosets, Medolla, Italy) in case of hypercapnic acidemia, were included. Repeated measurements of CO removal (VCO) at baseline and 1, 12, and 24 h after the initiation of therapy were recorded.
Article Synopsis
- The study aimed to analyze current mechanical ventilation (MV) settings for pediatric acute respiratory distress syndrome (P-ARDS) during extracorporeal membrane oxygenation (ECMO) across six European centers from 2009 to 2019.
- A cohort of 255 children was examined, focusing on pre-ECMO conditions, MV settings on various ECMO days, the use of adjunct therapies, and outcomes like ECMO duration and survival rates.
- Findings revealed that higher levels of PEEP and specific pressure settings were significantly linked to increased mortality, highlighting varied MV practices and their impact on patient outcomes during ECMO treatments.
Effect of flow rate ratio and positioning on a lighthouse tip ECMO return cannula.
Biomech Model Mechanobiol
December 2023
Extracorporeal membrane oxygenation is a life-saving support therapy in the case of cardiopulmonary refractory failure. Its use is associated to complications due to the presence of artificial surfaces and supraphysiological stress conditions. Thus, knowledge of the fluid structures associated to each component can give insight into sources of blood damage.
View Article and Find Full Text PDFVenovenous extracorporeal membrane oxygenation (ECMO) can be performed with two single lumen cannulas (SLCs) or one dual-lumen cannula (DLC) where low recirculation fraction ([Formula: see text]) is a key performance criterion. DLCs are widely believed to have lower [Formula: see text], though these have not been directly compared. Similarly, correct positioning is considered critical although its impact is unclear.
View Article and Find Full Text PDFIntroduction: An analysis on the ECLS use for patients with respiratory or cardiac support in COVID-19 based on an international response to EuroELSO survey, aims to generate a more comprehensive understanding of ECLS role during the recent viral pandemic.
Methods: EuroELSO announced the survey at the 10th annual congress in London, May 2022. The survey covered 26 multiple-choice questions.
Purpose: This scoping review aims to identify and describe knowledge gaps and research priorities in veno-arterial extracorporeal membrane oxygenation (VA-ECMO).
Methods: An expert panel was recruited consisting of eight international experts from different backgrounds. First, a list of priority topics was made.
In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study.
Lancet Respir Med
February 2023
Article Synopsis
- The study investigates in-hospital mortality and post-discharge outcomes for patients with COVID-19 who received ECMO during the pandemic's first wave (March 1 - Sept 13, 2020).
- Conducted by the European Extracorporeal Life Support Organization, it included 1215 patients from 21 countries and focused on various patient-related factors affecting survival rates.
- Findings revealed a 50% in-hospital mortality rate, with factors like age, pre-ECMO complications, and delays in ECMO initiation linked to higher mortality.
To determine the incidence and identify predictors of brain infarctions (BI) in neonatal patients treated with extracorporeal membrane oxygenation (ECMO). We performed a retrospective cohort study at ECMO Centre Karolinska, Stockholm, Sweden. Logistic regression models were used to identify BI predictors.
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