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http://dx.doi.org/10.1136/tsaco-2020-000610DOI Listing

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Background: Cardiopulmonary failure refractory to medical management after moderate-to-high-risk congenital cardiac surgery may necessitate mechanical support with veno-arterial extracorporeal membrane oxygenation (ECMO). On the extreme, ECMO can also be initiated in the setting of cardiac arrest (extracorporeal cardiopulmonary resuscitation, ECPR) unresponsive to conventional resuscitative measures.

Methods: This was a single-center retrospective cohort study of patients ( = 510) aged <3 years old who underwent cardiac surgery with cardiopulmonary bypass with a RACHS-1 score ≥3 between 2011 and 2014.

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Article Synopsis
  • - This study investigates two strategies for initiating venoarterial extracorporeal membrane oxygenation (VA-ECMO) during lung transplantation (LTx) for patients with severe lung diseases, comparing an 'on-demand' approach versus a 'systematic' pre-emptive method.
  • - The trial will include adult patients needing bilateral LTx, excluding those with severe pre-existing conditions, and aims to identify which initiation strategy results in more ventilator-free days post-surgery.
  • - Outcomes will be assessed not only on ventilator-free days but also on various health metrics, like vital status at different intervals, while following ethical standards for patient care and data sharing.
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A 64-year-old patient required emergency surgery with high risk of intubation failure, without any possibility to perform neither a direct transtracheal access nor VV-ECMO canulation. The patient was managed thanks to a VA-ECMO despite the absence of cardiac function impairment. This report describes perioperative challenges and management of this unconventional case with favorable outcome.

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ECMO as a bridge to cardiac surgery: stabilizing unstable patients for a definitive procedure.

Indian J Thorac Cardiovasc Surg

July 2023

Section of Cardiac Surgery, Evanston Northshore Health System, Chicago, IL USA.

Introduction: Extracorporeal membrane oxygenation (ECMO) in adults has been used in post-cardiotomy patients who decline hemodynamically. Cardiogenic shock in patients with potential surgically correctable cardiac conditions are at significantly higher risk for post-operative morbidity and mortality. We present experience with a pre-emptive approach of ECMO institution pre-operatively to stabilize patients with cardiogenic shock.

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Background: Extracorporeal cardiopulmonary resuscitation (ECPR) represents last-line salvage therapy for poisoning-induced cardiac arrest but no review has focused on this specific area.

Objective: This scoping review sought to evaluate the survival outcomes and characteristics of published cases of ECPR for toxicological arrest, with the aim of highlighting the potential and limitations of ECPR in toxicology.Eligibility Criteria.

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