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Refractory hypoxemia (RH) during venovenous extracorporeal membrane oxygenation (VV ECMO) support is a complex problem that limits the benefit of this therapy. The need for sustained deep sedation and delays in active rehabilitation are considered as a direct consequence of RH. Changing from VV ECMO to a configuration that returns the flow to pulmonary artery, such as venopulmonary extracorporeal membrane oxygenation (VPa ECMO) may decrease recirculation and improve systemic oxygen delivery. We present a retrospective report that describes the impact of VPa ECMO on oxygenation during sedation withdrawal in 41 patients who received VV ECMO for coronavirus disease 2019 (COVID-19). We evidenced that arterial oxygen pressure (PaO 2 ) increased from 68 to 112.3 mm Hg ( p = 0.001) with a reduction of ECMO flow (5.7-4.8 L/m; p = 0.001). Other findings included lower rates of depth sedation (Richmond Agitation Sedation Scale [RASS] ≤3, 37-63%; p = 0.007) and lower requirement inotropic support assessed by LVIS score (4.7-1.1; p = 0.005). Discharge survival was 54% with a sustained benefit until day 79. This cannulation strategy improved effectively PaO 2 in this cohort, it may be an alternative in patients with RH in VV ECMO.

Competing Interests: Disclosure: The authors have no conflicts of interest to report.

Titel:	Venopulmonary Artery Extracorporeal Life Support (VPa ECMO): A Novel Strategy for Refractory Hypoxemia Complicating VV ECMO.
Autor/in / Beteiligte Person:	Salazar-Rojas, LA ; García Gómez, DI ; Pinzon Martinez, YV ; Lasso Perdomo, JP ; Soto Ramirez, JC ; Gorgadze, T ; Mendoza Monsalve, MA ; Vasquez Rincon, RF ; Castillo Blanco, MA ; Pizarro Gomez, CE ; Bermon Angarita, A
Zeitschrift:	ASAIO journal (American Society for Artificial Internal Organs : 1992), Jg. 70 (2024-05-01), Heft 5, S. 365
Veröffentlichung:	Hagerstown, MD : Lippincott Williams & Wilkins ; <i>Original Publication</i>: Philadelphia, PA : Published for the Society by J.B. Lippincott Co., c1992-, 2024
Medientyp:	academicJournal
ISSN:	1538-943X (electronic)
DOI:	10.1097/MAT.0000000000002125
Schlagwort:	Humans Retrospective Studies Male Female Middle Aged Adult Pulmonary Artery Aged Extracorporeal Membrane Oxygenation methods Hypoxia etiology Hypoxia therapy COVID-19 complications COVID-19 therapy
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article Language: English [ASAIO J] 2024 May 01; Vol. 70 (5), pp. 365-370. <i>Date of Electronic Publication: </i>2024 Jan 23. MeSH Terms: Extracorporeal Membrane Oxygenation* / methods ; Hypoxia* / etiology ; Hypoxia* / therapy ; COVID-19* / complications ; COVID-19* / therapy ; Humans ; Retrospective Studies ; Male ; Female ; Middle Aged ; Adult ; Pulmonary Artery ; Aged References: Combes A, Hajage D, Capellier G, et al.; EOLIA Trial Group, REVA, and ECMONet: Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med. 378: 1965–1975, 2018. ; Peek GJ, Mugford M, Tiruvoipati R, et al.; CESAR Trial Collaboration: Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): A multicentre randomised controlled trial. Lancet. 374: 1351–1363, 2009. ; Barbaro RP, MacLaren G, Boonstra PS, et al.; Extracorporeal Life Support Organization: Extracorporeal membrane oxygenation for COVID-19: Evolving outcomes from the international Extracorporeal Life Support Organization Registry. Lancet. 398: 1230–1238, 2021. ; Montisci A, Maj G, Zangrillo A, Winterton D, Pappalardo F: Management of refractory hypoxemia during venovenous extracorporeal membrane oxygenation for ARDS. ASAIO J. 61: 227–236, 2015. ; Haji JY, Mehra S, Doraiswamy P: Awake ECMO and mobilizing patients on ECMO. Indian J Thorac Cardiovasc Surg. 37: 309–318, 2021. ; Nunes LB, Mendes PV, Hirota AS, et al.; ECMO Group: Severe hypoxemia during veno-venous extracorporeal membrane oxygenation: Exploring the limits of extracorporeal respiratory support. Clinics (Sao Paulo). 69: 173–178, 2014. ; 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. 31: 553–560, 2016. ; Patel B, Arcaro M, Chatterjee S: Bedside troubleshooting during venovenous extracorporeal membrane oxygenation (ECMO). J Thorac Dis. 11: S1698–S1707, 2019. ; Conrad SA, Wang D: Evaluation of recirculation during venovenous extracorporeal membrane oxygenation using computational fluid dynamics incorporating fluid-structure interaction. ASAIO J. 67: 943–953, 2021. ; Bunge JJH, Diaby S, Valle AL, et al.: Safety and efficacy of beta-blockers to improve oxygenation in patients on veno-venous ECMO. J Crit Care. 53: 248–252, 2019. ; Bartlett RH: Physiology of gas exchange during ECMO for respiratory failure. J Intensive Care Med. 32: 243–248, 2017. ; Napp LC, Bauersachs J, Napp LC, Bauersachs J: Triple cannulation ECMO. Extracorporeal Membrane Oxygenation: Advances in Therapy. United States of America, Firstenberg MS., 2016. ; Lorusso R, Raffa GM, Heuts S, et al.: Pulmonary artery cannulation to enhance extracorporeal membrane oxygenation management in acute cardiac failure. Interact Cardiovasc Thorac Surg. 30: 1–8, 2020. ; Badu B, Cain MT, Durham LA, et al.: A dual-lumen percutaneous cannula for managing refractory right ventricular failure. ASAIO J. 66: 915–921, 2020. ; Ivins-O’Keefe KM, Cahill MS, Mielke AR, et al.: Percutaneous pulmonary artery cannulation to treat acute secondary right heart failure while on veno-venous extracorporeal membrane oxygenation. ASAIO J. 68: 1483–1489, 2022. ; Cain MT, Smith NJ, Barash M, et al.: Extracorporeal membrane oxygenation with right ventricular assist device for COVID-19 ARDS. J Surg Res. 264: 81–89, 2021. ; Bertini P, Guarracino F, Falcone M, et al.: ECMO in COVID-19 patients: A systematic review and meta-analysis. J Cardiothorac Vasc Anesth. 36: 2700–2706, 2022. ; Maybauer MO, Capoccia M, Maybauer DM, Lorusso R, Swol J, Brewer JM: The ProtekDuo in ECMO configuration for ARDS secondary to COVID-19: A systematic review. Int J Artif Organs. 46: 93–98, 2023. ; Paternoster G, Bertini P, Innelli P, et al.: Right ventricular dysfunction in patients with COVID-19: A systematic review and meta-analysis. J Cardiothorac Vasc Anesth. 35: 3319–3324, 2021. ; Liaquat A, Mohammad S, Mohammad N, et al.: Right ventricular dysfunction in COVID-19 patients and its impact on mortality. Int Arch Cardiovasc Dis. 6: 051, 2022. ; El Banayosy AM, El Banayosy A, Brewer JM, et al.: The ProtekDuo for percutaneous V-P and V-VP ECMO in patients with COVID-19 ARDS. Int J Artif Organs. 45: 1006–1012, 2022. ; Maybauer MO, Koerner MM, Swol J, Banayosy AE, Maybauer DM: The novel ProtekDuo ventricular assist device: Configurations, technical aspects, and present evidence. Perfusion. 38: 887–893, 2023. ; Medtronic: Extracorporeal life support (ECLS). U.S. product catalog , 2022. Grant Information: Convocatoria 753 -2016 MINCIENCIAS Entry Date(s): Date Created: 20240123 Date Completed: 20240501 Latest Revision: 20240501 Update Code: 20240502

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Venopulmonary Artery Extracorporeal Life Support (VPa ECMO): A Novel Strategy for Refractory Hypoxemia Complicating VV ECMO.