Abstract:
OBJECTIVE:When patients deteriorate after decannulation from extracorporeal membrane oxygenation (ECMO), a second run of extracorporeal support may be considered. However, repeat cannulation can be difficult and poor outcomes associated with multiple ECMO runs are a concern. The aim of this study was to evaluate outcomes and identify factors associated with survival and mortality in cases of multiple runs of extracorporeal membrane oxygenation. DESIGN:Retrospective cohort analysis of the Extracorporeal Life Support Organization Registry. SETTING:The Extracorporeal Life Support Organization's registry was queried for neonates, children, and adults receiving 2 or more runs of ECMO during the same hospitalization, for any indication, from 1998 to 2015. PATIENTS:1,818 patients from the Extracorporeal Life Support Organization Registry. RESULTS:Of the 1,818 patients, 1,648 underwent 2 runs and 170 underwent 3 or more runs of ECMO. The survival to discharge rate was 36.7% for 2 runs and 29.4% for 3 or more runs. No significant differences in survival were detected in analysis by decade of ECMO run (p = 0.21). Pediatric patients had less mortality than adults (OR: 0.45, 95%CI: 0.24-0.82). Cardiac support on the first run portrayed worse mortality than pulmonary support regardless of final run indication (OR:1.38, 95%CI: 1.09-1.75). Across all age groups, patients receiving pulmonary support on the last run tended to have higher survival rates regardless of support type on the first run. The only first run complication independently predictive of mortality on the final run was renal complications (OR: 1.60, 95%CI: 1.28-1.99). CONCLUSIONS:Though the use of multiple runs of ECMO is growing, outcomes remain poor for most cohorts. Survival decreases with each additional run. Patients requiring additional runs for a pulmonary indication should be considered prime candidates. Renal complications on the first run significantly increases the risk of mortality on subsequent runs, and as such, careful consideration should be applied in these cases.
journal_name
J Intensive Care Medjournal_title
Journal of intensive care medicineauthors
Cooper DS,Thiagarajan R,Henry BM,Byrnes JW,Misfeldt A,Frischer J,King E,Gao Z,Rycus P,Marino BSdoi
10.1177/0885066620981903subject
Has Abstractpub_date
2020-12-22 00:00:00pages
885066620981903eissn
0885-0666issn
1525-1489pub_type
杂志文章abstract:BACKGROUND:Agitation is common in the intensive care unit (ICU). Although antipsychotics are frequently used as first-line therapy, chlorpromazine has fallen out of favor due to risk of cardiovascular complications and severe hypotension. Although chlorpromazine is used anecdotally, there is a lack of data regarding it...
journal_title:Journal of intensive care medicine
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abstract:OBJECTIVE::To analyze the management and outcome of patients with refractory respiratory failure complicating severe Legionella pneumonia rescued with extracorporeal membrane oxygenation (ECMO) in our Center. DESIGN AND SETTING::Observational study of patients with refractory respiratory failure treated with ECMO in H...
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abstract::Patients admitted to the cardiac intensive care unit (CICU) are often in shock and require hemodynamic support. Identifying and addressing the pathophysiology mechanisms operating in an individual patient is crucial to achieving a successful outcome, while initiating circulatory support therapy to restore adequate tis...
journal_title:Journal of intensive care medicine
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abstract::Controlled donation after circulatory determination of death (cDCDD) concerns donation after withdrawal of life-sustaining therapy (W-LST). We examine the ethical issues raised by W-LST in the cDCDD context in the light of a review of cDCDD protocols and the ethical literature. Our analysis confirms that W-LST procedu...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
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abstract::Video laryngoscopy has demonstrated utility in airway management. For the present case series, we report the use of video laryngoscopy to evaluate the airway of critically ill, mechanically ventilated patients, as a means to reduce the risk of immediate postextubation stridor by assessing the degree of laryngeal edema...
journal_title:Journal of intensive care medicine
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journal_title:Journal of intensive care medicine
pub_type: 杂志文章,实务指引
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journal_title:Journal of intensive care medicine
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journal_title:Journal of intensive care medicine
pub_type: 杂志文章,meta分析
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journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
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journal_title:Journal of intensive care medicine
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journal_title:Journal of intensive care medicine
pub_type: 杂志文章,meta分析
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更新日期:2018-08-01 00:00:00
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更新日期:2020-02-01 00:00:00
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journal_title:Journal of intensive care medicine
pub_type: 杂志文章,多中心研究
doi:10.1177/0885066616677710
更新日期:2018-06-01 00:00:00
abstract::A systematic review of the literature was conducted to determine if the administration of methylene blue in humans improves hemodynamic status and/or outcome in patients with septic shock. Studies were identified from MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials database. The review included...
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pub_type: 杂志文章,评审
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journal_title:Journal of intensive care medicine
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journal_title:Journal of intensive care medicine
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journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
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更新日期:2019-11-01 00:00:00
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journal_title:Journal of intensive care medicine
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doi:10.1177/0885066614538910
更新日期:2015-05-01 00:00:00
abstract::The ideal diagnostic approach for ventilator-associated pneumonia currently is based on invasive procedures to obtain respiratory tract cultures. Given the lack of consensus and relatively poor acceptance of full bronchoscopic bronchoalveolar lavage (BAL) and protected specimen brush (PSB), less invasive procedures ha...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
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更新日期:2006-01-01 00:00:00
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journal_title:Journal of intensive care medicine
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更新日期:2010-11-01 00:00:00
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journal_title:Journal of intensive care medicine
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更新日期:2020-11-01 00:00:00
abstract:BACKGROUND:Admission to an intensive care unit (ICU) specialized for brain and spine injury patients is associated with improved outcome. We investigated the effects of the first dedicated, combined neurological and neurosurgical ICU (NeuroICU) in Korea on patient outcomes. METHODS:The first dedicated NeuroICU in Kore...
journal_title:Journal of intensive care medicine
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更新日期:2019-02-01 00:00:00
abstract:BACKGROUND:Diagnosing acute kidney injury (AKI) stage 3 in critically ill patients may help physicians in making treatment decisions. This diagnosis relies chiefly on urinary output and serum creatinine, which may be of limited value. This study aimed to explore the diagnostic performance of renal resistive index (RRI)...
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更新日期:2020-12-01 00:00:00