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

Research output: Contribution to journalArticle

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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 languageEnglish (US)
JournalAnesthesia and Analgesia
DOIs
StateAccepted/In press - Oct 4 2016

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Extracorporeal Membrane Oxygenation
Adult Respiratory Distress Syndrome
Respiratory Insufficiency
Hemodynamics
Norepinephrine
Confidence Intervals

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Gutsche, J. T., Mikkelsen, M. E., McCarthy, F. H., Miano, T. A., Vernick, W. J., Ramakrishna, H., ... Williams, M. L. (Accepted/In press). Veno-Venous Extracorporeal Life Support in Hemodynamically Unstable Patients With ARDS. Anesthesia and Analgesia. https://doi.org/10.1213/ANE.0000000000001646

Veno-Venous Extracorporeal Life Support in Hemodynamically Unstable Patients With ARDS. / Gutsche, Jacob T.; Mikkelsen, Mark E.; McCarthy, Fenton H.; Miano, Todd A.; Vernick, William J.; Ramakrishna, Harish; Patel, Prakash A.; Augoustides, Yianni; Szeto, Wilson Y.; Desai, Nimesh D.; Lane-Fall, Meghan B.; Williams, Matthew L.

In: Anesthesia and Analgesia, 04.10.2016.

Research output: Contribution to journalArticle

Gutsche, JT, Mikkelsen, ME, McCarthy, FH, Miano, TA, Vernick, WJ, Ramakrishna, H, Patel, PA, Augoustides, Y, Szeto, WY, Desai, ND, Lane-Fall, MB & Williams, ML 2016, 'Veno-Venous Extracorporeal Life Support in Hemodynamically Unstable Patients With ARDS', Anesthesia and Analgesia. https://doi.org/10.1213/ANE.0000000000001646
Gutsche, Jacob T. ; Mikkelsen, Mark E. ; McCarthy, Fenton H. ; Miano, Todd A. ; Vernick, William J. ; Ramakrishna, Harish ; Patel, Prakash A. ; Augoustides, Yianni ; Szeto, Wilson Y. ; Desai, Nimesh D. ; Lane-Fall, Meghan B. ; Williams, Matthew L. / Veno-Venous Extracorporeal Life Support in Hemodynamically Unstable Patients With ARDS. In: Anesthesia and Analgesia. 2016.
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