Outcomes of ECMO support with polypropylene membrane during pandemic times: a retrospective cohort study.
Complications
ECMO
Poly-methylpentene membranes
Polypropylene membranes
SARS-CoV-2
Journal
BMC pulmonary medicine
ISSN: 1471-2466
Titre abrégé: BMC Pulm Med
Pays: England
ID NLM: 100968563
Informations de publication
Date de publication:
19 Jan 2024
19 Jan 2024
Historique:
received:
13
05
2023
accepted:
06
11
2023
medline:
20
1
2024
pubmed:
20
1
2024
entrez:
19
1
2024
Statut:
epublish
Résumé
The SARS-CoV-2 pandemic resulted in shortages of supplies, which limited the use of extracorporeal membrane oxygenation (ECMO) support. As a contingency strategy, polypropylene (PP) oxygenation membranes were used. This study describes the clinical outcomes in patients on ECMO with PP compared to poly-methylpentene (PMP) oxygenation membranes. Retrospective cohort of patients in ECMO support admitted between 2020 and 2021. A total of 152 patients with ECMO support were included, 71.05% were men with an average age of 42 (SD 9.91) years. Veno-venous configuration was performed in 75.6% of cases. The PP oxygenation membranes required more changes 22 (63.1%), than the PMP Sorin® 24 (32,8%) and Euroset® 15 (31,9%) (p.0.022). The main indication for membrane change was low oxygen transfer for PP at 56.2%, Sorin® at 50%, and Euroset® at 14.8%. Renal replacement therapy was the most frequent complication with PP membrane in 22 patients (68.7%) Sorin® 25 patients (34.2%), and Euroset® 15 patients (31.9%) (p 0.001) without statistically significant differences in mortality. PP oxygenation membranes was a useful and feasible strategy. It allowed a greater disponibility of ECMO support for critically ill in a situation of great adversity during the SARS-CoV-2 pandemic.
Sections du résumé
BACKGROUND
BACKGROUND
The SARS-CoV-2 pandemic resulted in shortages of supplies, which limited the use of extracorporeal membrane oxygenation (ECMO) support. As a contingency strategy, polypropylene (PP) oxygenation membranes were used. This study describes the clinical outcomes in patients on ECMO with PP compared to poly-methylpentene (PMP) oxygenation membranes.
METHODS
METHODS
Retrospective cohort of patients in ECMO support admitted between 2020 and 2021.
RESULTS
RESULTS
A total of 152 patients with ECMO support were included, 71.05% were men with an average age of 42 (SD 9.91) years. Veno-venous configuration was performed in 75.6% of cases. The PP oxygenation membranes required more changes 22 (63.1%), than the PMP Sorin® 24 (32,8%) and Euroset® 15 (31,9%) (p.0.022). The main indication for membrane change was low oxygen transfer for PP at 56.2%, Sorin® at 50%, and Euroset® at 14.8%. Renal replacement therapy was the most frequent complication with PP membrane in 22 patients (68.7%) Sorin® 25 patients (34.2%), and Euroset® 15 patients (31.9%) (p 0.001) without statistically significant differences in mortality.
CONCLUSION
CONCLUSIONS
PP oxygenation membranes was a useful and feasible strategy. It allowed a greater disponibility of ECMO support for critically ill in a situation of great adversity during the SARS-CoV-2 pandemic.
Identifiants
pubmed: 38243231
doi: 10.1186/s12890-023-02753-5
pii: 10.1186/s12890-023-02753-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
41Informations de copyright
© 2024. The Author(s).
Références
Ranney ML, Griffeth V, Jha AK. Critical Supply Shortages The Need for Ventilators and Personal Protective Equipment during the Covid-19 Pandemic. N Engl J Med. 2020;382(18):e41. https://doi.org/10.1056/NEJMp2006141 .
doi: 10.1056/NEJMp2006141
pubmed: 32212516
Ling RR, Ramanathan K, Sim JJL, Wong SN, Chen Y, Amin F, et al. Evolving outcomes of extracorporeal membrane oxygenation during the first 2 years of the COVID-19 pandemic: a systematic review and meta-analysis. Crit Care. 2022;26(1):1–13. https://doi.org/10.1186/s13054-022-04011-2 .
doi: 10.1186/s13054-022-04011-2
Shekar K, Badulak J, Peek G, Boeken U, Dalton HJ, Arora L, Extracorporeal Life Support Organization Coronavirus Disease, et al. Interim guidelines: a consensus document from an International Group of Interdisciplinary Extracorporeal Membrane Oxygenation Providers. ASAIO J. 2019;2020:707–21.
Pourasghari H, Tavolinejad H, Soleimanpour S, Abdi Z, Arabloo J, Bragazzi NL, et al. Hospitalization, major complications and mortality in acute myocardial infarction patients during the COVID-19 era: a systematic review and meta-analysis. IJC Hear Vasc. 2022;41(March):101058. https://doi.org/10.1016/j.ijcha.2022.101058 .
doi: 10.1016/j.ijcha.2022.101058
Tsangaris A, Alexy T, Kalra R, Kosmopoulos M, Elliott A, Bartos JA, Yannopoulos D. Overview of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) Support for the Management of Cardiogenic Shock. Front Cardiovasc Med. 2021;8:686558. https://doi.org/10.3389/fcvm.2021.686558 .
Ratnaningsih E, Aryanti PT, Himma NF, Wardani AK, Khoiruddin K, Kadja GT, Prasetya N, Wenten IG. Membrane Oxygenator for Extracorporeal Blood Oxygenation. J Eng Technol Sci. 2021;53(5):210502. https://doi.org/10.5614/j.eng.technol.sci.2021.53.5.2 .
Himma NF, Sofiatun A, Nicholaus P, Wenten IG. “Advances in preparation, modification, and application of polypropylene membrane.” J Polymer Eng. 2016;36:329–62.
Jabur GN, Sidhu K, Willcox TW, Mitchell SJ. Clinical evaluation of emboli removal by integrated versus non-integrated arterial filters in new generation oxygenators. Perfusion. 2016;31(5):409–17. https://doi.org/10.1177/0267659115621614 . Epub 2015 Dec 6.
Peek GJ, Killer HM, Reeves R, Sosnowski AW, Firmin RK. Early experience with a polymethyl pentene oxygenator for adult extracorporeal life support. ASAIO J. 2002;48(5):480–2.
doi: 10.1097/00002480-200209000-00007
pubmed: 12296566
Gannon WD, Stokes JW, Francois SA, Patel YJ, Pugh ME, Benson C, et al. Association between availability of extracorporeal membrane oxygenation and mortality in patients with COVID-19 eligible for extracorporeal membrane oxygenation: a natural experiment. Am J Respir Crit Care Med. 2022;205(11):1354–7.
doi: 10.1164/rccm.202110-2399LE
pubmed: 35212255
pmcid: 9873115
Harris PA, Taylor R, Thielke R, Payne J, Nathaniel Gonzalez JGC. Research electronic data capture (REDCap) - a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inf. 2009;42(2):377–81.
doi: 10.1016/j.jbi.2008.08.010
Tonna JE, Abrams D, Brodie D, Greenwood JC, Rubio Mateo-Sidron JA, Usman A, Fan E. Management of Adult Patients Supported with Venovenous Extracorporeal Membrane Oxygenation (VV ECMO): Guideline from the Extracorporeal Life Support Organization (ELSO). ASAIO J. 2021;67(6):601–10. https://doi.org/10.1097/MAT.0000000000001432 .
Use of LivaNova ECMO / CPB Devices for Respiratory Support during the COVID- 19 / SARS-CoV-2 positive patients FAQs. 2020;
Salazar LA, Uribe JD, Poveda Henao CM, Santacruz CM, Giraldo Bejarano E, Bautista DF, Rey JA, Giraldo-Ramírez ND. Consenso ECMO colombiano para paciente con falla respiratoria grave asociada a COVID-19. Acta Colombiana de Cuidado Intensivo. 2020;21:272–82.
Messai E, Bouguerra A, Guarracino F, Bonacchi M. Low blood arterial oxygenation during Venovenous extracorporeal membrane oxygenation: proposal for a rational algorithm-based management. J Intensive Care Med. 2016;31(8):553–60.
doi: 10.1177/0885066616649134
pubmed: 27271548
Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med. 1998;26(11):1793–800.
doi: 10.1097/00003246-199811000-00016
pubmed: 9824069
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818–29.
doi: 10.1097/00003246-198510000-00009
pubmed: 3928249
Schmidt M, Bailey M, Sheldrake J, Hodgson C, Aubron C, Rycus PT, et al. Predicting survival after extracorporeal membrane oxygenation for severe acute respiratory failure. The respiratory extracorporeal membrane oxygenation survival prediction (RESP) score. Am J Respir Crit Care Med. 2014;189(11):1374–82.
doi: 10.1164/rccm.201311-2023OC
pubmed: 24693864
Amin F, Lombardi J, Alhussein M, Posada JD, Suszko A, Koo M, et al. Predicting survival after VA-ECMO for refractory cardiogenic shock: validating the SAVE score. CJC open. 2021;3(1):71–81.
doi: 10.1016/j.cjco.2020.09.011
pubmed: 33458635
He T, He J, Wang Z, Cui Z. Modification strategies to improve the membrane hemocompatibility in extracorporeal membrane oxygenator (ECMO). Adv Compos Hybrid Mater. 2021;4(4):847–64. https://doi.org/10.1007/s42114-021-00244-x .
doi: 10.1007/s42114-021-00244-x
pubmed: 33969267
pmcid: 8091652
Yeager T, Roy S. Evolution of gas permeable membranes for extracorporeal membrane oxygenation. Artif Organs. 2017;41(8):700–9.
doi: 10.1111/aor.12835
pubmed: 28105685
Barbaro RP, MacLaren G, Boonstra PS, Iwashyna TJ, Slutsky AS, Fan E, et al. Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the extracorporeal life support organization registry. Lancet. 2020;396(10257):1071–8.
doi: 10.1016/S0140-6736(20)32008-0
pubmed: 32987008
pmcid: 7518880
Diaz RA, Graf J, Zambrano JM, Ruiz C, Espinoza JA, Bravo SI, et al. Extracorporeal membrane oxygenation for COVID-19-associated severe acute respiratory distress syndrome in Chile: a Nationwide incidence and cohort study. Am J Respir Crit Care Med. 2021;204(1):34–43.
doi: 10.1164/rccm.202011-4166OC
pubmed: 33823118
pmcid: 8437120
Lasso Apráez MD, JI. Interpretación de los gases arteriales en Bogotá (2.640 msnm) basada en el nomograma de Siggaard-Andersen. Una propuesta para facilitar y unificar la lectura. Rev Colomb Neumol. 2014;26(1):25–36.
doi: 10.30789/rcneumologia.v26.n1.2014.56
Burgueño P, González C, Sarralde A, Gordo F. Issues to resolve with the use of extracorporeal membrane oxygenation during interfacility transportation. Med Int. 2019;43(2):90–102.
Kim K, Leem AY, Kim SY, Chung KS, Park MS, Kim YS, et al. Complications related to extracorporeal membrane oxygenation support as a bridge to lung transplantation and their clinical significance. Hear Lung. 2022;2013(56):148–53. https://doi.org/10.1016/j.hrtlng.2022.07.008 .
doi: 10.1016/j.hrtlng.2022.07.008
Gupta S, Coca SG, Chan L, Melamed ML, Brenner SK, Hayek SS, et al. AKI treated with renal replacement therapy in critically ill patients with COVID-19. J Am Soc Nephrol. 2021;32(1):161–76.
doi: 10.1681/ASN.2020060897
pubmed: 33067383
Villa G, Katz N, Ronco C. Extracorporeal membrane oxygenation and the kidney. CardioRenal Med. 2015;6(1):50–60.
doi: 10.1159/000439444
pubmed: 27194996
pmcid: 4698639
Thongprayoon C, Cheungpasitporn W, Lertjitbanjong P, Aeddula NR, Bathini T, Watthanasuntorn K, Srivali N, Mao MA, Kashani K. Incidence and Impact of Acute Kidney Injury in Patients Receiving Extracorporeal Membrane Oxygenation: A Meta-Analysis. J Clin Med. 2019;8(7):981. https://doi.org/10.3390/jcm8070981 .
Mitra S, Ling RR, Tan CS, Shekar K, MacLaren G, Ramanathan K. Concurrent Use of Renal Replacement Therapy during Extracorporeal Membrane Oxygenation Support: A Systematic Review and Meta-Analysis. J Clin Med. 2021;10(2):241. https://doi.org/10.3390/jcm10020241 .
Haneya A, Diez C, Philipp A, Bein T, Mueller T, Schmid C, et al. Impact of acute kidney injury on outcome in patients with severe acute respiratory failure receiving extracorporeal membrane oxygenation. Crit Care Med. 2015;43(9):1898–906.
doi: 10.1097/CCM.0000000000001141
pubmed: 26066017
Lo Coco V, Lorusso R, Raffa GM, Malvindi PG, Pilato M, Martucci G, et al. Clinical complications during veno-arterial extracorporeal membrane oxigenation in post-cardiotomy and non post-cardiotomy shock: still the achille’s heel. J Thorac Dis. 2018;10(12):6993–7004.
doi: 10.21037/jtd.2018.11.103
pubmed: 30746245
pmcid: 6344687
Schmidt M, Hajage D, Lebreton G, Monsel A, Voiriot G, Levy D, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome associated with COVID-19: a retrospective cohort study. Lancet Respir Med. 2020;8(11):1121–31.
doi: 10.1016/S2213-2600(20)30328-3
pubmed: 32798468
pmcid: 7426089
Ramanathan K, Shekar K, Ling RR, Barbaro RP, Wong SN, Tan CS, et al. Extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis. Crit Care. 2021;25(1):211.
doi: 10.1186/s13054-021-03634-1
pubmed: 34127027
pmcid: 8201440
Makhoul M, Keizman E, Carmi U, Galante O, Ilgiyaev E, Matan M, et al. Outcomes of extracorporeal membrane oxygenation (ECMO) for COVID-19 patients: a multi-institutional analysis. Vaccines. 2023;11(1):1–11.
Karagiannidis C, Slutsky AS, Bein T, Windisch W, Weber-Carstens S, Brodie D. Complete countrywide mortality in COVID patients receiving ECMO in Germany throughout the first three waves of the pandemic. Crit Care. 2021;25(1):1–2. https://doi.org/10.1186/s13054-021-03831-y .
doi: 10.1186/s13054-021-03831-y