Echocardiographic Findings in Critically Ill COVID-19 Patients Treated With and Without Extracorporeal Membrane Oxygenation.

Objectives: To describe echocardiographic findings among mechanically ventilated patients with COVID-19 acute respiratory distress syndrome, comparing those with and without venovenous extracorporeal membrane oxygenation (VV ECMO) support.

Design: Single-center, retrospective cohort study.

Setting: Intensive care unit (ICU) of a quaternary academic center.

Venovenous Extracorporeal Membrane Oxygenation Candidacy Decision-Making: Lessons and Hypotheses From a Single-Center Observational Analysis.

Background: Use of venovenous extracorporeal membrane oxygenation (ECMO) is increasing, but candidacy selection processes are variable and subject to bias.

Research Question: What are the reasons behind venovenous ECMO candidacy decisions, and are decisions made consistently across patients?

Study Design And Methods: Prospective observational study of all patients, admitted or outside hospital referrals, considered for venovenous ECMO at a tertiary referral center. Relevant clinical data and reasons for candidacy determination were cross-referenced with other noncandidates and candidates and were assessed qualitatively.

Outcomes of patients with respiratory failure declined for extracorporeal membrane oxygenation: a prospective observational study.

Purpose: Descriptive information on referral patterns and short-term outcomes of patients with respiratory failure declined for extracorporeal membrane oxygenation (ECMO) is lacking.

Methods: We conducted a prospective single-centre observational cohort study of ECMO referrals to Toronto General Hospital (receiving hospital) for severe respiratory failure (COVID-19 and non-COVID-19), between 1 December 2019 and 30 November 2020. Data related to the referral, the referral decision, and reasons for refusal were collected.

Management of the Critically Ill Patient with Pulmonary Arterial Hypertension and Right Heart Failure.

Right ventricular (RV) failure is a recognized complication of pulmonary hypertension (PH). Pregnancy and surgery represent unique challenges to the patient with PH and require input from an interprofessional team. Approach to treatment must embrace sound physiologic principles that are based on optimization of RV preload, contractility, and afterload to improve cardiac function and tissue perfusion before the onset of multiorgan dysfunction.

Complications Associated With Venovenous Extracorporeal Membrane Oxygenation-What Can Go Wrong?

Objectives: Despite increasing use and promising outcomes, venovenous extracorporeal membrane oxygenation (V-V ECMO) introduces the risk of a number of complications across the spectrum of ECMO care. This narrative review describes the variety of short- and long-term complications that can occur during treatment with ECMO and how patient selection and management decisions may influence the risk of these complications.

Data Sources: English language articles were identified in PubMed using phrases related to V-V ECMO, acute respiratory distress syndrome, severe respiratory failure, and complications.

Point-of-Care Ultrasound: A Case Series of Potential Pitfalls.

• Integration of POCUS findings in the clinical context is crucial. • Valvular abnormalities may not be identified by POCUS. • Valvular disease should not be excluded based solely on a POCUS.

When is tamponade not an echocardiographic diagnosis… Or is it ever?

Although cardiac tamponade remains a clinical diagnosis, echocardiography is an essential tool to detect fluid in the pericardial space. Interpretation of echocardiographic findings and assessment of physiologic and hemodynamic consequences of a pericardial effusion require a thorough understanding of pathophysiologic processes. Certain echocardiographic signs point toward the presence of cardiac tamponade: a dilated inferior vena cava (IVC), collapse of the cardiac chambers, an inspiratory bulge of the interventricular septum into the left ventricle (LV) (the "septal bounce"), and characteristic respiratory variations of Doppler flow velocity recordings.

Monitoring during extracorporeal membrane oxygenation.

Purpose Of Review: Extracorporeal membrane oxygenation (ECMO) offers advanced mechanical support to patients with severe acute respiratory and/or cardiac failure. Ensuring an adequate therapeutic approach as well as prevention of ECMO-associated complications, by means of timely liberation, forms an essential part of standard ECMO care and is only achievable through continuous monitoring and evaluation. This review focus on the cardiorespiratory monitoring tools that can be used to assess and titrate adequacy of ECMO therapy; as well as methods to assess readiness to wean and/or discontinue ECMO support.

How I Select Which Patients With ARDS Should Be Treated With Venovenous Extracorporeal Membrane Oxygenation.

ARDS is a lethal form of acute respiratory failure, and because no specific treatments exist, supportive care remains the primary management strategy in these patients. Extracorporeal membrane oxygenation (ECMO) has emerged as an intervention in patients with severe ARDS to facilitate gas exchange and the delivery of more lung protective ventilation. Over the past 20 years, improvements in ECMO technology have increased its safety and transportability, making it far more available to this patient population globally.