Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO...
Transcript of Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO...
![Page 1: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/1.jpg)
Extracorporeal Life Support
Montreal 2019
![Page 2: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/2.jpg)
Disclosure
• Dr Bartlett is consultant to MC3 and Cytosorbents
• No conflict related to this presentation
![Page 3: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/3.jpg)
SR, 6yo
![Page 4: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/4.jpg)
SR 2/6/2011
SR 6yo healthy girl H1N1 influenza and streptococcal pneumonitis Septic shock, 3 pressors SaO2 60 ,PCO2 50 on Maximal ventilator settings She is dying: Mechanical Life Support?
![Page 5: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/5.jpg)
CO2 Production
Ventilation CO2 Clearance
![Page 6: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/6.jpg)
![Page 7: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/7.jpg)
![Page 8: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/8.jpg)
![Page 9: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/9.jpg)
Severe cardiopulmonary failure (inadequate oxygen delivery)
DO2:VO2 < 2
• Treatment: • 100% O2 • Pplat>25 • Vasopressors • Inotropes • Anesthesia and paralysis
![Page 10: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/10.jpg)
CO2 Production
Ventilation CO2 Clearance
![Page 11: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/11.jpg)
Severe cardiopulmonary failure (inadequate oxygen delivery)
DO2:VO2 < 2
• Treatment: ECLS • 100% O2 Spontaneous breathing • Pplat>25
• Vasopressors No vasopressors • Inotropes
• Anesthesia, paralysis Awake, ambulatory
![Page 12: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/12.jpg)
Phil Drinker PhD Drinker and Bartlett 4 day ECC in dogs 1968
ECLS: Lab Development
![Page 13: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/13.jpg)
Ted Kolobow and Warren Zapol, 1969
ECLS: Lab development
![Page 14: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/14.jpg)
First cardiac case First newborn case(Esperanza) 1971 1972 1975
ECLS: First Clinical Cases
First sucessful case, ARDS
![Page 15: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/15.jpg)
University of Michigan Medical Center
Michigan ECMO Courses 1980-1990 Cannulating and managing ECMO in sheep
ECMO worldwide 1985--
1975-1980, UCI
![Page 16: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/16.jpg)
Extracorporeal Life Support ( ECLS, ECMO)
Support of heart or lung function with mechanical devices which:
•is temporary (days to weeks), •can be partial or total, •avoids ongoing iatrogenic injury, •and sustains life while bridging to organ recovery or replacement.
![Page 17: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/17.jpg)
Indications for ECLS
• Acute, severe, cardiac or pulmonary
failure unresponsive to optimal management, with recovery expected in 2-4 weeks
![Page 18: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/18.jpg)
Venoarterial ECMO in a neonate
![Page 19: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/19.jpg)
Veno-venous ECLS with a double lumen cannula
![Page 20: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/20.jpg)
Original ECMO Registry Report 1988
![Page 21: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/21.jpg)
![Page 22: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/22.jpg)
ELSO Member Centers 2018
![Page 23: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/23.jpg)
23
Overall Patient Outcomes 1971-2018
ELSO Registry January 2019
Total Runs Survived ECLS Survived to DCNeonatal
Pulmonary 31,591 27,779 87% 23,119 73%Cardiac 8,252 5,684 68% 3,529 42%ECPR 1,864 1,315 70% 775 41%
PediatricPulmonary 9,487 6,797 71% 5,573 58%
Cardiac 11,377 8,155 71% 5,980 52%ECPR 4,361 2,628 60% 1,858 42%
AdultPulmonary 19,482 13,453 69% 11,565 59%Cardiac 19,627 11,628 59% 8,381 42%ECPR 6,190 2,580 41% 1,827 29%
Total 112,231 80,019 71% 62,607 55%
![Page 24: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/24.jpg)
24
Overall Outcomes 2014-2018
ELSO Registry January 2019
Total Runs Survived ECLS Survived to DCNeonatal
Pulmonary 3,956 3,295 83% 2,686 67%Cardiac 2,335 1,664 71% 1,150 49%ECPR 745 508 68% 315 42%
PediatricPulmonary 2,960 2,210 74% 1,868 63%Cardiac 3,920 2,978 75% 2,277 58%ECPR 1,997 1,200 60% 877 43%
AdultPulmonary 13,413 9,325 69% 8,156 60%Cardiac 14,580 8,627 59% 6,366 43%ECPR 4,691 1,965 41% 1,399 29%
Total 48,597 31,772 65% 25,094 51%
![Page 25: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/25.jpg)
25
Runs by Year
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Adult ECPR
Ped ECPR
Neo ECPR
Adult Card
Ped Card
Neo Card
Adult Pulm
Ped Pulm
Neo Pulm
ELSO Registry January 2019
![Page 26: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/26.jpg)
26
Cum
ulative Runs An
nual
Run
s
Neonatal Respiratory Cases
ELSO Registry January 2019
![Page 27: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/27.jpg)
27 0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
0
100
200
300
400
500
600
700
Annual runs Cumulative Runs
Annu
al R
uns
Cum
ulative Runs
Pediatric Respiratory Cases
ELSO Registry January 2019
![Page 28: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/28.jpg)
28
0
5000
10000
15000
20000
25000
0
500
1000
1500
2000
2500
3000
3500
Annual Runs
Adult Respiratory Cases
Annu
al R
uns
Cum
ulative Runs
ELSO Registry January 2019
![Page 29: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/29.jpg)
29
0
2000
4000
6000
8000
10000
12000
0
100
200
300
400
500
600
700
800
900
1000
Annual Runs
Pediatric Cardiac Cases By Year
Annu
al R
uns
Cum
ulative Runs
ELSO Registry January 2019
![Page 30: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/30.jpg)
30
Adult Cardiac Cases By Year
0
5000
10000
15000
20000
25000
0
500
1000
1500
2000
2500
3000
3500
4000
Annual Runs Cumulative Runs
Annu
al R
uns
Cum
ulative Runs
ELSO Registry January 2019
![Page 31: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/31.jpg)
31
Adult ECPR Cases
Annu
al R
uns
Cum
ulative Runs
ELSO Registry January 2019
![Page 32: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/32.jpg)
ECMO I, 1990-2008 ECMO II, 2008 -
![Page 33: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/33.jpg)
ECLS Techniques • Cardiac Support, ECPR, EDCD
V-A access via neck, groin V-A access for postop cardiac failure
• Respiratory Support VA or VV access via neck or groin VV Double lumen cannulas
• ECLS Management Lung and cardiac rest and recovery Hemoglobin 12-15 gm/dL Weaning ECMO specialists and nurses Routine ICU procedure
![Page 34: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/34.jpg)
Patient Management: ECMO II
ECMO I ECMO II Sedation, Paralysis
Awake, Spontaneous breathing
Intubated Tracheostomy Rest vent settings CPAP, extubate? Specialist 24/7 ICU Nurse, ECMO Team
role Lung recruitment? Watch and wait Bleeding: major Bleeding: minor
![Page 35: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/35.jpg)
Cardiac ECLS algorithm
Day2-3: CNS OK? Cardiac Function returning? NO: Transplant candidate? YES: Bridge to recovery Yes: Donor list ,bridge to VAD No: Futility: Stop, Organ donation?
![Page 36: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/36.jpg)
VA support, no cardiac function Bridge to LVAD, then cardiac recovery
![Page 37: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/37.jpg)
![Page 38: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/38.jpg)
Cardiac VA support Special considerations
• Some cardiac function ( pulsatility) Lung function/ harlequin syndrome
• No cardiac function Vent left side, septostomy, Impella • Leg perfusion
before leaving the bedside • Femoral vs proximal perfusion subclavian, carotid • Central access post cardiotomy, high flow sepsis
![Page 39: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/39.jpg)
U.K. Neonatal ECMO Study(1993-95)
180 Patients Randomized
90 Conventional 90 ECMO
41% surv. - p <.01 - 72% surv
1 year disability 28% both groups
Clinical Research 13 prospective trials of ECMO in respiratory failure
![Page 40: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/40.jpg)
ECLS in ARDS (CESAR) Prospective Randomized Trial 2007
0.00
0.25
0.50
0.75
1.00
0 50 100 150 200Analysis time (days)
Conventional ECMO
Kaplan-Meier survival estimates, by allocation
Giles Peek CESAR 2007
![Page 41: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/41.jpg)
Noah. H1N1 ECMO vs control. Matched pairs trial JAMA 2011, 366:1659
![Page 42: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/42.jpg)
EOLIA trial 2012-2018 Alain Combes NEJM 2018
• Severe ARDS (1015 pts) Randomize ( 249 pts) Early ECMO ( 1.5d) Conventional Care+ late ECMO
Survival: 65% Survival: 58%
Late ECMO (6d)
Survival 43%
![Page 43: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/43.jpg)
Day 1-2:VV Blood Flow max, sedated, Vent P 20/10. rate 5, FiO2 30% Goal SaO2>80%, PaCO2 40mmHg, DO2>3xVO2 Day 3+: Awake, Spontaneous breathing, CPAP VV Blood Flow lowest to meet goals Trach or extubate, watch and wait Day 14-21: Lung recovery: Wean VV blood flow to meet goals When <50% support trial off on low vent settings Off ECMO,wean vent
Respiratory Support algorithm
![Page 44: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/44.jpg)
Irreversible lung injury, no recovery with ECLS after:
• 7 days ( 1975-80) • 14 days (1980-1990) • 21 days (1990-2000) • 28 days 2000-2008, with some exceptions
• 2008-2012, new circuits, ECMOII • 2012-2017 lung recovery or transplant after
months of no lung function.
![Page 45: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/45.jpg)
Palle Palmer, Stockholm 1997 Why should ECMO patients be asleep?
![Page 46: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/46.jpg)
Tidal volumes long run ECMO
40 yo, viral ARDS, Awake alert on ECMO, total consolidation for 50 days courtesy of Palle Palmer, Karolinska
![Page 47: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/47.jpg)
Ambulatory VV bridge to XP: Hoopes, Why should ECMO patients be in bed?
![Page 48: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/48.jpg)
Lung recovery or replacement after prologed ECMO support
• Registry: Hundreds of cases >21d, adult and pediatric
• Pediatric: ( Brogan): 289 cases > 21d, 38% survival
• Univ Maryland (Kon): 11 cases >21d, 72% survival • Shock-Trauma, Baltimore 27 cases >21d, 87% survival • Case reports:
35,38,42,45,50,52,59,65,67, 73,104,107,117,155,193, 605 days
![Page 49: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/49.jpg)
Redefining irreversible lung injury
• Lung has unexpected regenerative capacity, during prolonged mechanical support,
• Recovery can take months • Late follow up: minimal disability • New scientific opportunities ( How, why,
when,) • New practical problems, RV support, long ICU stay, expense (where?)
![Page 50: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/50.jpg)
Late Recovery in Acute Lung Disease with ECMO (A New Phenomenon)
• Pathophysiology: O2, RV Failure, CO2 equally important • Clinical trials: Late recovery (1-2 years) vs. transplant
• ECMO out of ICU: Wearable artificial lungs • Application: Late recovery in ECMO cases > 1 month • Vascular access: VV ECMO, RA→PA (pump), PA-LA • Paracorporeal with transcutaneous conduits • Devices: 1.5 m2, 6 L/min blood flow, • Duration: 2 Months-2 Years
![Page 51: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/51.jpg)
ECLS Research: Implantable Lungs, 2000--
MICHIGAN OSAKA MICHIGAN
![Page 52: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/52.jpg)
Ambulatory Lung Assist PA-LA implantation, 5 weeks, bridging to transplant Alois Philippe, Regensberg, 2007
![Page 53: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/53.jpg)
ECLS 605 days with full recovery VA, VV, RA-PA, 15 months ECCOR, 2 months s
RA-PA vascular access. Bart Griffith Kris Nelson, JASAIO 2018
![Page 54: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/54.jpg)
Livanova- Tandemlife “Protek Duo”
Wearable Artificial Lung with VV access RA double lumen cannula or RA-PA
![Page 55: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/55.jpg)
Portable RA-PA Total support Univ Pittsburgh Univ Maryland
![Page 56: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/56.jpg)
ECMO 2025: Respiratory
Acute Lung Failure Chronic Lung Failure ICU ICU recovery 50% ECMO 7d ECMO 1d recovery 50% LUNG FAILURE CENTER ECMO Extubate,ambulate Recovery 21d 50% Home, Implant Late recovery 30% Transplant Destintion
![Page 57: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/57.jpg)
ECLS FUTURE: Respiratory Support Acute Respiratory Failure Neonatal, Prematurity Acute RDS, pediatric and adult Status asthmaticus, Airway Post transplant Chronic Respiratory Failure Pediatric BPD, CDH Bridge to transplant
Acute to chronicECMO(months) Lung Centers , home ECMO, Wearable lungs ,ESLD/COPD palliation
![Page 58: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/58.jpg)
ECMO FUTURE: Circulation support ( VA)
Acute Cardiac Failure Post Op MI, Myocarditis, Toxins, PE ECPR for cardiac arrest Acute Circulatory Failure Septic shock, anaphyllaxis Trauma, hemorrhage Organ Donation and Transplantation EDCD Organ perfusion, organ banks
![Page 59: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/59.jpg)
ECMO III( 2025)Patient Mangement
• Awake breathing extubated • Indications 50% mortality risk based on
algorithms for cardiac , respiratory failure • No systemic anticoagulation • Automation, servo regultion • Cardiac, Shock: bridge to recevery, ECPR, EDCD, bridge to VAD • Respiratory: ECMO bridge to recovery,
Lung centers, home ECMO, implant lungs
![Page 60: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/60.jpg)
Future of ECLS Technology
• Simple, automated devices
• Modular components • No systemic
anticoagulation
• Ex vivo organ perfusion, Organ banks
• Lung Failure Units
Applications • ARDS algorithm • Awake patients • Bridge to lung
transplant • DCD Organs • ECPR • Sepsis • Placenta • Implantable Chronic
Lungs
![Page 61: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/61.jpg)
SR 3/2/ 11
EC32 ECMO Day 32
![Page 62: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/62.jpg)
SR 3/11/11
ECMO Day 40
![Page 63: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/63.jpg)
SR Going home 3/29/11
![Page 64: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/64.jpg)
SR 3/28/11
![Page 65: Extracorporeal Life Support - McGill University...23 Overall Patient Outcomes 1971-2018 ELSO Registry January 2019 Total Runs Survived ECLS Survived to DC Neonatal Pulmonary 31,591](https://reader033.fdocuments.us/reader033/viewer/2022042310/5ed75af410199002b7561274/html5/thumbnails/65.jpg)