The use of extracorporeal membrane oxygenation (ECMO) in the treatment of acute respiratory failure patients has demonstrated improvement on patient survivability when compared to conventional treatment using mechanical ventilation. The purpose of this project was to complete a retrospective review of the data acquired over the six years the ECMO program has been operating at BUMCP in order to describe relationships between different anticoagulation strategies and patient outcomes. Data was collected from patients who were over the 18 years of age, treated with the veno-venous modality of ECMO, with an acute respiratory failure, and treated between May 1st, 2010 and June 31, 2016. Several dependent were analyzed seeking to explain potential relationships between different anticoagulation strategies and patient outcomes. Overall, the patients treated with veno-venous ECMO at BUMCP experienced a 55% survival to discharge rate. The group that received no heparin had the lowest survival to discharge rate at 33% which suggests that the use of heparin may be beneficial in ECMO patients. The titrated heparin group had the highest average hemoglobin (10.5 g/dl, SD 1.2) yet required the most units of PRBCs to be transfused (17.9 units, SD 21.6). The average ACT for this group was also highest at 174.8 (SD 24.7) suggesting that more transfusions were required due to bleeding complications from the use of heparin. A higher ACT also was associated with an increased length of stay. The only statistically significant relationship noted in the study was a positive relationship between ACT and hemoglobin level in the titrated heparin group (r = .450, p = .005) suggesting that as the ACT increased so did the patient’s average hemoglobin level. Conclusions: This study found evidence that suggested the use of heparin in ECMO patients may have a positive impact on their survival. Furthermore, patients who were exposed to a set rate of heparin experienced a greater survival to discharge rate and required fewer transfusions of PRBCs during their hospital stay. However, further research is needed to address potential co-morbidities that may have had an impact on patient survival as well as transfusion requirements.

ECMO is out of body oxygenation through an artificial lung in the event of severe respiratory failure where conventional care is not enough. Today the treament is complex, overwhelming and it is hard for staff to get a good overview. The usage of ECMO is increasing stready and therefore the treament needs to be simplified, better structured and fit the right context to become accessible to a larger scope of patients. With a user centered design approach and ethnographic research the ICU environment was studied in two hospitals in Sweden to gather information about ECMO. Interviews were held with doctors, nurses and perfusionists (responsible for the ECMO machine).   The creative work consisted of brainstorms with both designers, clinical experts and engineers. Mock-ups were built combined with sketching and feedback-sessions with clinical experts to create three different concept directions. One direction was taken further due to compactness, flexibility and integration.  The final concept is called Adoxy and creates one compact ECMO system that reduces cables and hides connections for an easier usage and cleaner apperance in a complex environment. The oxygenator (disposible part) placement is easier and more hidden for safety and usability.  The final product comes with two different carts, a ward cart, used internally in the hospital and an transportation cart, used outside of the hospital. The ward cart enables the staff to a safer internal transportation by connecting the EMCO to the patient bed. The transportation cart is lower in profile to fit in an airplane or helicopter.  Priming possibilities of the machine are designed for complete integration to be able to use when needed, otherwise hidden. There is a bigger screen on the ECMO for visibility but it is also connected to a general monitor that will show alarms when they occur. This is to give the nurses a chance to easier prioritize work from a distance and to get a better overview.

One of the most fundamental aspects of extracorporeal membrane oxygenation (ECMO) is maintaining proper anticoagulation management in order to prevent hemorrhagic or thrombotic events. Anticoagulation on ECMO is most commonly achieved with the use of unfractionated heparin to maintain a minimum anticoagulation level as monitored by activated clotting time (ACT). Heparin's main effect is exerted by binding to and potentiating antithrombin III. Many factors may contribute to a sub-therapeutic ATIII level that may decrease the effectiveness of heparin. A retrospective record review was performed on all adult ECMO patients at the University of Arizona Medical Center between 2008 and 2011, in order to determine optimal ATIII levels for maintaining proper anticoagulation. In addition, we investigated correlations between ATIII levels and hemorrhagic and/or thrombotic events. Variables measured include, ACTs, heparin dose, ATIII dose, ATIII levels, blood product use, and adverse events. Thirty-five patients received ATIII over the course of the ECMO run. Six patients did not receive ATIII and they were found to have used significantly more blood products than those who did receive ATIII. Also, heparin dose dropped significantly 24h after the first dose of ATIII. There is a significant positive correlation between the amount of ATIII given per day and the amount of packed red blood cells transfused per day. The results suggest an ideal therapeutic range of ATIII dosing, where lack of or too much ATIII administration can lead to excessive bleeding.

Syfte: Att undersöka intensivvårdssjuksköterskors erfarenheter av att vårda patienter under Extracorporeal Membran Oxygenering (ECMO) behandling. Bakgrund: Intensivvårdssjuksköterskor har som arbetsuppgift att ta hand om kritiskt sjuka patienter. Patienter som har behov av ECMO behandling har ökat och används när ingen annan behandling har visat sig fungera. ECMO är en komplex behandling och ställer höga krav på intensivvårdssjuksköterskor. Det krävs specifika kunskaper och förmågor att handha avancerad apparatur, planera, prioritera och samarbeta runt patienten. Design: En kvalitativ intervjustudie. Metod: Kvalitativa intervjuer med semistrukturerade frågor genomfördes med nio intensivvårdssjuksköterskor på en intensivvårdsavdelning i Sverige 2016. Intervjuerna analyserades genom kvalitativ innehållsanalys. Resultat: Det analyserade materialet resulterade i två kategorier: omständigheter i arbetet för en otrygg och riskfylld vård, förutsättningar i arbetet för en trygg och säker vård. De två  kategorierna resulterade i sju subkategorier. Konklusion: Intensivvårdssjuksköterskors erfarenhet av att vårda patienter med ECMO är att det är en utmanande, krävande och komplex patientgrupp att vårda. Intensivvårdssjuksköterskorna önskar kontinuerlig utbildning och större patientflöde för att minska otryggheten och få en fördjupad kunskap av patientkategorin.

Die extrakorporale Membranoxygenierung ist ein seit Jahrzehnten etabliertes Verfahren, Patienten trotz kardialem und/oder pulmonalem Versagen ein zeitbegrenztes Überleben zu ermöglichen. Obgleich sich an den Grundzügen der Herangehensweise bis heute wenig verändert hat, konnte diese Hochrisikotherapie mithilfe der Entwicklung blutschonenderer Materialien und der Verwendung verbesserter Pumpen und Oxygenatoren zunehmend effizienter gestaltet werden. Durch eine Überlebensanalyse aller ECMO-Patienten der Datenbank der Klinik für Tho-rax-, Herz- und Thorakale Gefäßchirurgie des Universitätsklinikums Würzburg zwischen 2015 und 2018 (172 Fälle) sollten unabhängige Risikofaktoren für ein negatives Outcome der Therapie identifiziert werden. Insbesondere den Laborparametern während der ersten 72 Stunden am System galt hierbei ein besonderes Augenmerk, aber auch Vorerkrankun-gen, Komplikationen, Substitutionen während der Therapie und weitere Parameter wurden für jeden Patienten individuell ermittelt und tabellarisch festgehalten. Insgesamt verstarben davon 125 Patienten (72,7%), 47 Patienten (27,3%) überlebten und konnten entlassen werden. Bei 24 der 125 verstorbenen Patienten (14%) konnte zwar ein Weaning vom System erfolgreich durchgeführt werden (>24h), sie verstarben jedoch während des anschließenden stationären Aufenthaltes. Bei den präinsertionell erhobenen Parametern waren der BMI und der Euroscore II bei verstorbenen Patienten signifikant höher, ebenso wie die Cross-Clamp-Zeit und der SO-FA-Score. Für die Laborwerte an ECMO ergaben sich für den Serumlaktatspiegel und die Throm-bozytenanzahl der Patienten die signifikantesten Unterschiede. Auch andere Laborparame-ter erwiesen sich in beiden Gruppen als signifikant unterschiedlich: Insbesondere der Quick Wert der überlebenden Patienten war zu Beginn signifikant höher. Auch der Fibri-nogenspiegel der Gruppe der überlebenden Patienten lag ab der 12 Stunden Marke signi-fikant höher. Verstorbene Patienten erhielten mehr Blutpräparate als Überlebende. Außerdem führte ein dialysepflichtiges Nierenversagen im Laufe der Therapie zu signifikant schlechterem Out-come. Wider Erwarten waren während der Therapie auftretende Blutungskomplikationen nicht mit schlechterem Outcome assoziiert. Jedoch konnte bei Auftritt von Thromben im Sys-tem, die einen Austausch des Oxygenators/ECMO-Systems nötig machten, sowie Magen-Darm-Ischämien und Kompartmentsyndrom ein klarer Überlebensnachteil erfasst werden. Abschließend ließ sich mittels multivariater logistischer Regression zeigen, dass der SO-FA-Score, der Serumlaktatspiegel und die Thrombozytenanzahl sowie eine adjuvante I-ABP Implantation und der Bedarf einer Nierenersatztherapie den größten Einfluss auf das Überleben der Patienten hatten. / Extracorporeal Life Support is a well established therapy for high risk patients with heart and/or lung failure. Although ECMO has increased a lot in number of cases, as well as in centres worldwide within the past few years, mortality still remains high. The aim was to identify risk factors which led to a negative outcome on ECMO. This retro-perspective study includes all patients from 01.01.2015 - 31.12.2018 that received va-ECMO support after cardiac surgery at the "Heart and thoracal surgery centre" (HTC) of the University-hospital in Würzburg (UKW). Out of those 172 patients, 47 patients (27,3%) survived and 125 patients (72,7%) died during the therapy. Regarding all parameters before ECMO-Insertion, high Body-Mass-Index (BMI), long "Cross-Clamp" time of the aorta during the operation (X-Clamp), as well as high SOFA-Score and high Euroscore II, were associated with significant higher mortality. SOFA-Score, in comparison with Euroscore II, turned out to be more reliable, concerning outcome prediction. During the first 72 hours on ECMO, non-survivors had significant higher lactate-levels and lower platelet count than survivers. Additional usage of intraaortic balloon pump (IABP) was associated with better survival, whereas renal failure leading to dialysis was mostly identified among non-survivors. "Bleeding" was the most frequently occuring complication, even though it didn't have any impact on the patient's outcome. Non-survivors showed overall more clotting events, especially in the oxygentor and the extracorporeal system itself and needed significant more substitution of blood preserves than patients that survived the therapy.

No description available.

Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is a life saving therapy for critically ill patients experiencing a heart and lung failure. During this therapy, a common complication is limb ischemia in the leg where the return cannula reintroduces the oxygenated blood to the patient. The hemodynamics leading to limb ischemia during V-A ECMO therapy is not yet understood. This work uses computational fluid dynamics to model the interacting blood flows from the V-A ECMO return cannula and the native cardiac output in the abdominal aorta and iliac bifurcation. A two-element Windkessel (WK) model is used to model the downstream vasculature. In total, five simulations of four cardiac cycles are conducted, where either one WK model parameter or the aorta inflow boundary condition (BC) is altered. Results suggest that the outflow distribution between the iliac arteries is dependent on the WK model parameters, but it is independent of the inflow BC imposed at the aorta inlet. Increasing the resistance value of the WK model leads to an increase of pressure in the domain relative to the 0.8 L/min baseline case and increases the outflow through the non-cannulated iliac artery. The opposite effect is reached when decreasing the resistive value or increasing the compliance value. The velocity field close to the aortic bifurcation, where the return cannula flow is redirected, shows large variations and complex, three-dimensional flow structures. At the aorta inlet, the velocity field is sensitive to the aorta inflow BC. In the XY -plane, areas of high sensitivity are located in areas with high unsteady flow motion. The sensitivity analysis of the velocity field in the XY -plane seems to be independent of the BCs. The pressure field is sensitive to the BC since the pressure in the domain is dependent on the WK model parameters. This work can be a starting point to further investigate the influence of a change in BCs on the flow structures and the outflow distribution between the iliac arteries. Those results can develop a framework stating the factors with an increased patient’s risk for developing limb ischemia. / Veno-arteriell extrakorporeal membranoxygenering (V-A ECMO) är en behandling som kan rädda liv på patienter med kraftigt nedsatt hjärt- och lungfunktion. En vanlig komplikation under behandlingen är ischemi i benet där kanylen återför oxygenerat blod till patienten. Hemodynamiken bakom ischemi under V-A ECMO är illa förstådd idagsläget. I det här arbetet används beräkningsströmningsdynamik för att modellera interaktionen mellan blodflödet från returkanylen och blodflödet från patientens hjärta i bukaortan bifurkation med iliak artärerna. En Windkesselmodell (WK) med två element används för att modellera kärlen nedströms från illiakartärerna. Sammanlagt utförs fem simulationer av fyra hjärtcykler, vari antingen en av WK-parametrarna eller randvillkoret för aortans inflöde ändras. Resultatet tyder på att utflödet distribueras mellan iliak artärer beroende på WK parametrarna, men oberoende av randvillkoret för aortans inflöde. Med ett flöde på 0.8 L{min vid ursprungsläget ökas trycket i området och utflödet genom iliak artären utan kanyl om resistansen i WK-modellen ökas, och motsatt effekt nås genom att sänka resistansen eller genom att öka modellens värde för artärernas följsamhet. Hastighetsfältet kring aortabifurkation, där återflödet byter riktning, visar starka och komplexa tre-dimensionella variationer. Hastighetsfältet i ingången till aortan är känsligt för randvillkoret för aortans inflöde. I XY -planet finns områden med hög känslighet där flödet är högostadigt. Hastighetsfältets känslighet i XY -planet verkar vara oberoende av randvillkoren. Tryckfältet är känsligt för randvillkoren då trycket i området beror på WK-modellens parametrar. Det här arbetet kan vara en utgångspunkt för framtida studier i randvillkorens effekt på flödesstrukturer och utflödesdistribution mellan iliak artärer. Resultaten från sådana studier kan användas för att bygga upp en förståelse för hur olika faktorer påverkar en patients risk för ischemi under V-A ECMO behandling.

The presented dissertation concerns of extracorporeal membrane oxygenation (ECMO) in adults within the University hospital in Pilsen. The ECMO has been used in Pilsen from 2011. The first part (theoretical one) illustrates in general the ECMO, a life saving method for a treatment of failured lungs or heart. The sites of cannulation, the management and monitoring of ECMO patient are then described. Possible complications as a result of ECMO application and its settlement are mentioned. The second part consists of a retrospective insight, which shows data of 43 ECMO patients for a period of three years 2011- 2013 in the University Hospital Pilsen and a questionary survey. The survey involves 83 non- medical healthcare workers, who are in charge of the ECMO patients, at three intensive care and resuscitation units where the ECMO is used. It finds out what do the medics know about the method. The outcome of this dissertation is a guideline of nursing care of an adult patient on ECMO and most common difficult situations and solutions, that could be faced in the course of nursing an ECMO patient. KEY WORDS ECMO support, heart failure, pulmonary failure, complication, knowledge

Le choc cardiogénique est une pathologie grave pouvant mettre rapidement le pronostic vital du patient en jeu. Malgré de nombreux progrès réalisés dans sa prise en charge, la mortalité liée à cette affection reste très élevée. Une des avancées importantes dans le traitement du choc cardiogénique développée ces dernières années est l’ECMO. Mais force est de constater, que malgré la restauration d’un flux circulatoire adéquat, nous restons confrontés à une mortalité élevée chez ces malades. La première partie de cette thèse est un rappel des principaux concepts du choc cardiogénique de l’ECMO ainsi qu’un rappel des effets de l’hypothermie. Nous rapportons dans la deuxième partie notre recherche expérimentale chez le cochon qui a permis de mettre en évidence un effet bénéfique de l’hypothermie sur la fonction cardiaque et sur la réactivité vasculaire chez les animaux en choc cardiogénique traités par une ECMO. Dans la troisième partie, nous discutons et analysons nos résultats en essayant d’apporter des explications physiologiques / Cardiogenic shock is still considered as a severe medical condition. Despite much progress in the treatment of the cardiogenic shock, this disease is still associated with a high mortality. An important advance in the treatment of the cardiogenic shock is the use of ECMO. However, despite the restoration of a proper circulatory flow, we are still facing significant mortality in these patients. The first part of this manuscript is a reminder of the main concepts of the cardiogenic shock and ECMO and the concept of hypothermia. In the second part, we report the results of our experimental research who highlighted a beneficial effect of hypothermia in cardiac function and vascular reactivity in animals in cardiogenic shock treated by ECMO. In the third part we discuss our results and we try to rapport physiological explications of our results

INTRODUCTION: ECMO is an increasingly popular method of support used in cases with severe respiratory or circulatory failure. Treatment is often associated with significant immobilization of the patient, which may take up to several weeks, resulting in deterioration of physical fitness, extending lenght of hospitalization, and a return back to normal life is very difficult. In recent years, however, efforts have been made to enable mobilization even to those patients who may be conscious, in order to maintain their muscle power. OBJECTIVES AND METHODOLOGY: The aim of this thesis was to obtain information about nurses' experience with mobilisation of patients treated by extracorporal membrane oxygenation, to evaluate an occurrence of the most frequent barriers that prevent them from mobilizing paticents and to evaluate differences in nursing attitude among the addressed workplaces. The research was carried out in the form of a questionnaire of my own creation. The research sample consisted of nurses working in Intensive Care Units under cardiocenters in the Czech Republic where the ECMO method is used. RESULTS: Mobilization and active rehabilitation of patients with peripheral ECMO is very rare practice in the Czech Republic. In 4 out of 6 departments respondents reported that patients with ECMO are...