Veno-Venous Extracorporeal Life Support in Hemodynamically Unstable Patients with ARDS

Jacob T. Gutsche; Mark E. Mikkelsen; Fenton H. McCarthy; Todd A. Miano; William J. Vernick; Harish Ramakrishna; Prakash A. Patel; Yianni Augoustides; Wilson Y. Szeto; Nimesh D. Desai; Meghan B. Lane-Fall; Matthew L. Williams

doi:10.1213/ANE.0000000000001646

Veno-Venous Extracorporeal Life Support in Hemodynamically Unstable Patients with ARDS

Jacob T. Gutsche, Mark E. Mikkelsen, Fenton H. McCarthy, Todd A. Miano, William J. Vernick, Harish Ramakrishna, Prakash A. Patel, Yianni Augoustides, Wilson Y. Szeto, Nimesh D. Desai, Meghan B. Lane-Fall, Matthew L. Williams

Anesthesiology

Research output: Contribution to journal › Article › peer-review

12 Scopus citations

Abstract

When clinicians consider extracorporeal life support (ECLS) for acute respiratory distress syndrome (ARDS) patients with hemodynamic instability, both veno-arterial (VA) and veno-venous (VV) ECLS are therapeutic possibilities. We analyzed 17 patients with ARDS on inotropic or vasopressor support requiring ECLS for refractory hypoxemia. After implementing VV ECLS, pressor requirements (based on norepinephrine equivalents) were significantly lower in all patients (P =.0001 for overall comparison across time points). None of the 17 patients required conversion from VV ECLS to VA ECLS (95% confidence interval 0%-20.0%). In this sample of 17 patients with substantial baseline vasopressor support and hypoxemic respiratory failure, initiation of VV ECLS was associated with reduced pressor requirements. Such a strategy may help avoid complications of VA ECLS in patients with both respiratory and hemodynamic failure.

Original language	English (US)
Pages (from-to)	846-848
Number of pages	3
Journal	Anesthesia and analgesia
Volume	124
Issue number	3
DOIs	https://doi.org/10.1213/ANE.0000000000001646
State	Published - Mar 1 2017

ASJC Scopus subject areas

Anesthesiology and Pain Medicine

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Gutsche, J. T., Mikkelsen, M. E., McCarthy, F. H., Miano, T. A., Vernick, W. J., Ramakrishna, H., Patel, P. A., Augoustides, Y., Szeto, W. Y., Desai, N. D., Lane-Fall, M. B., & Williams, M. L. (2017). Veno-Venous Extracorporeal Life Support in Hemodynamically Unstable Patients with ARDS. Anesthesia and analgesia, 124(3), 846-848. https://doi.org/10.1213/ANE.0000000000001646

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title = "Veno-Venous Extracorporeal Life Support in Hemodynamically Unstable Patients with ARDS",

abstract = "When clinicians consider extracorporeal life support (ECLS) for acute respiratory distress syndrome (ARDS) patients with hemodynamic instability, both veno-arterial (VA) and veno-venous (VV) ECLS are therapeutic possibilities. We analyzed 17 patients with ARDS on inotropic or vasopressor support requiring ECLS for refractory hypoxemia. After implementing VV ECLS, pressor requirements (based on norepinephrine equivalents) were significantly lower in all patients (P =.0001 for overall comparison across time points). None of the 17 patients required conversion from VV ECLS to VA ECLS (95% confidence interval 0%-20.0%). In this sample of 17 patients with substantial baseline vasopressor support and hypoxemic respiratory failure, initiation of VV ECLS was associated with reduced pressor requirements. Such a strategy may help avoid complications of VA ECLS in patients with both respiratory and hemodynamic failure.",

author = "Gutsche, {Jacob T.} and Mikkelsen, {Mark E.} and McCarthy, {Fenton H.} and Miano, {Todd A.} and Vernick, {William J.} and Harish Ramakrishna and Patel, {Prakash A.} and Yianni Augoustides and Szeto, {Wilson Y.} and Desai, {Nimesh D.} and Lane-Fall, {Meghan B.} and Williams, {Matthew L.}",

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AU - Gutsche, Jacob T.

AU - Mikkelsen, Mark E.

AU - McCarthy, Fenton H.

AU - Miano, Todd A.

AU - Vernick, William J.

AU - Ramakrishna, Harish

AU - Patel, Prakash A.

AU - Augoustides, Yianni

AU - Szeto, Wilson Y.

AU - Desai, Nimesh D.

AU - Lane-Fall, Meghan B.

AU - Williams, Matthew L.

PY - 2017/3/1

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N2 - When clinicians consider extracorporeal life support (ECLS) for acute respiratory distress syndrome (ARDS) patients with hemodynamic instability, both veno-arterial (VA) and veno-venous (VV) ECLS are therapeutic possibilities. We analyzed 17 patients with ARDS on inotropic or vasopressor support requiring ECLS for refractory hypoxemia. After implementing VV ECLS, pressor requirements (based on norepinephrine equivalents) were significantly lower in all patients (P =.0001 for overall comparison across time points). None of the 17 patients required conversion from VV ECLS to VA ECLS (95% confidence interval 0%-20.0%). In this sample of 17 patients with substantial baseline vasopressor support and hypoxemic respiratory failure, initiation of VV ECLS was associated with reduced pressor requirements. Such a strategy may help avoid complications of VA ECLS in patients with both respiratory and hemodynamic failure.

AB - When clinicians consider extracorporeal life support (ECLS) for acute respiratory distress syndrome (ARDS) patients with hemodynamic instability, both veno-arterial (VA) and veno-venous (VV) ECLS are therapeutic possibilities. We analyzed 17 patients with ARDS on inotropic or vasopressor support requiring ECLS for refractory hypoxemia. After implementing VV ECLS, pressor requirements (based on norepinephrine equivalents) were significantly lower in all patients (P =.0001 for overall comparison across time points). None of the 17 patients required conversion from VV ECLS to VA ECLS (95% confidence interval 0%-20.0%). In this sample of 17 patients with substantial baseline vasopressor support and hypoxemic respiratory failure, initiation of VV ECLS was associated with reduced pressor requirements. Such a strategy may help avoid complications of VA ECLS in patients with both respiratory and hemodynamic failure.

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Veno-Venous Extracorporeal Life Support in Hemodynamically Unstable Patients with ARDS

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