ECMO

Kevin Lumowa
 List of articles (use only studies)
• Reference 1
• Malfertheiner MV, Philipp A, Lubnow M, Zeman F, Enger TB, Bein T, Lunz D, et al.
Hemostatic Changes During Extracorporeal Membrane Oxygenation: A Prospective
Randomized Clinical Trial Comparing Three Different Extracorporeal Membrane
Oxygenation Systems. Crit Care Med 2016;44(4):747-754
• Reference 2
• Mauri T, Grasseli G, Suriano G, Eronia N, Spadaro S, Turrini C, Patroniti N, et al. Control of
Respiratory Drive and Effort in Extracorporeal Membrane Oxygenation Patients Recovering
from Severe Acute Respiratory Distress Syndrome. Anesthesiology 2016;125(1):159-167
 Background of the topic
• ECMO has been a common strategy for ensuring and maintaining
adequate gas exchange in patients suffering from severe acute respiratory
distress syndrome (ARDS) when conventional therapy is not enough.

• Patients on ECMO are typically not on it for very long. ECMO doesn’t
necessarily treat the disease or injury, it just helps support the patient long
enough for treatment to take effect on the underlying disease.
Article 1 critique (Mauri et al 2016, Control of
Respiratory Drive…)
• Purpose: Evaluate the effects of different levels of extracorporeal carbon
dioxide removal in patients recovering from sever ARDS undergoing pressure
support ventilation (PSV) and neutrally adjusted ventilatory assist (NAVA)

• Some studies showed that the amount of CO2 removed extracorporeally

might control spontaneous breathing. However, in the early stages of ECMO,
the respiratory drive appears to be quite high, rather independent from PaCO2
and pH.
 Methods
• Eight patients undergoing venovenous ECMO were all connected to
mechanical ventilators that could deliver both PSV and NAVA. There were two
crossover phases that were randomized for the ventilation mode (PSV or
NAVA)
• The variables measured in this study were (Vt, RR, expired Ve, Peak airway
pressure, Peak Eadi value, highest muscle pressure, P L-max, and muscle
pressure time product to assess patients’ WOB.
• These values were selected to help reflect a change in respiratory function/drive
Article 1 results
 Article 2 critique (Malfertheiner et al 2016;
Hemostatic changes…)
• Purpose: Compare the impact of different extracorporeal membrane
oxygenation systems on blood hemostasis in adults during veno-venous
extracorporeal membrane oxygenation therapy.

• Bleeding, thrombosis, and hemolysis are common causes of

morbidity/mortality in patients on vvECMO therapy despite the
technology constantly improving. These events are constantly monitored
to make sure they don’t get severe.
 Article 2
• Eighteen patients were randomized into three different ECMO systems. All
patients had eight blood samples taken throughout the study.
• Outcome variables: complete blood count, free hemoglobin (fHb), lactate
dehydrogenase (LDH), creatinine kinase, creatinine, aspartate aminotransferase,
a Quick test, activated partial thromboplastin time (APTT), D-dimer, fibrinogen,
anti-thrombin, C-reactive protein (CRP), and interleukin (IL-)6 and IL-8.
• These variables were chosen to monitor hemostasis, anticoagulation, hemolysis,
and inflammatory parameters.
Article 2 results
 Compare and Contrast
Article 1 Article 2
• Authors found that the amount of CO2 • Among the different ECMO systems, there
removed by the membrane lung influences were no differences found with the blood
respiratory drive and effort in patients on flows. In conclusion, the authors
ECMO. recommended all three ECMO systems
equally for long-term use
• Strengths: both studies described in great detail their methodologies were and made great use of
figures and tables to explain all their variables
• Weaknesses: Both studies had very small sample sizes, but just barely enough to be able to show
statistical significance, which neither of them did.