Relevant reading, listening or viewing – curated by the creator of Tiny Perfusion Letter, Luc Puis
Every week, we collect 10 or 20 articles from the peer-reviewed literature that we think will be of interest to the perfusionist community. Feel free to comment on the findings or suggest entries for the newsletter by emailing the Editor – Luc Puis.
This week is all about extracorporeal membrane oxygenation (ECMO).
One factor determining outcome in ECMO is patient selection, especially in COVID-19 patients. A team at the Vanderbilt UMC in Nashville reported using a multidisciplinary consensus council to establish eligibility for ECMO.
A different approach is to find out what the risk for mortality is. ECMO specialists from (again) Vanderbilt UMC in Nashville and University of Utah Health, Salt Lake City, used data from more than 7000 runs in the ELSO database and found that current risk scores are not working in a population diagnosed with COVID-19.
Is ECMO effective in treating patients with COVID-19 ARDS? While it would seem apparent in many cases, these researchers from Peru concluded after a systematic review that the currently available evidence is insufficient to determine that.
Lastly, in this outcomes section, doctors from South Korea did a meta-analysis on post-cardiotomy ECMO outcomes for neonatal and pediatric patients. They concluded that it was effective and seemed to improve survival, but mortality and morbidity remain high.
We also have three articles on heparin alternatives and coating. One of the products in the running to replace heparin is nafamostat melisate (I hope they find an easier way to pronounce it if it gets on the market…). The bonus is that it is also anti-inflammatory and has anti-viral effects against … SARS-CoV-2. Triple whammy!
A well-known alternative for heparin is, of course, bivalirudin. While it also has its downsides, it “appears to be a potential alternative to heparin in pediatric and adult patients requiring ECMO,” according to a meta-analysis conducted on the matter. That almost sounds like Harry Styles explaining a movie…
Coating is also still big, with this in-vitro study of hydro-gel-based heparin releasing coating on poly-methyl-pentene materials.
Finally, in our ‘Miscellaneous’ section, we have a report on transfusion practices in pediatric ECMO, with the message that we should consider a restrictive RBC and platelet transfusion policy for this group.
Furthermore, we have an extensive review of venting modalities during VA ECMO, with their specific hemodynamic characteristics and complications, explained in great diagrams. A true gem for educators.
To finish off this (ECMO) Roundup, a description of a telesimulation project from Jakarta, Indonesia, enabling education on ECMO to clinicians from a distance, using newer technologies.
Enjoy the read!
- Extracorporeal Membrane Oxygenation Selection by Multidisciplinary Consensus: The ECMO Council
- Predicting Mortality for Patients Eligible for Extracorporeal Membrane Oxygenation for COVID-19
- Efficacy and Safety of Extracorporeal Membrane Oxygenation in Patients under Mechanical Ventilation with COVID-19 and Severe Acute Respiratory Distress Syndrome: A Health Technology Assessment
- The Outcome of Post-cardiotomy Extracorporeal Membrane Oxygenation in Neonates and Pediatric Patients: A Systematic Review and Meta-Analysis
- Use of Nafamostat Mesilate for Anticoagulation during Extracorporeal Membrane Oxygenation: A Systematic Review
- Bivalirudin Vs. Heparin in Paediatric and Adult Patients on Extracorporeal Membrane Oxygenation: A Meta-Analysis
- Investigation of Heparin-Loaded Poly(Ethylene Glycol)-Based Hydrogels as Anti-Thrombogenic Surface Coatings for Extracorporeal Membrane Oxygenation