Journal of Artificial Organs

The main goal of the present study was to demonstrate the influence of draining cannulas’ position and high-flow extracorporeal CO 2 removal ( ECCO 2 R) configuration on recirculation and extracorporeal decarboxylation. This single-center retrospective study was conducted between January 2018 and May 2024. All patients who received a high-flow ECCO 2 R (extracorporeal blood flow ≥ 2 L/min) were included. Four configurations each used an ECMO device, two single-lumen cannulas, and an ipsilateral cannulation site: CENTRAL DRAINAGE configurations ( central jugular-jugular and central femoro-femoral ), DISTAL DRAINAGE configurations ( distal jugular-jugular and distal femoro-femoral ). Recirculation coefficient and CO 2 elimination were assessed between these configurations. The influence of the configuration and recirculation coefficient on CO 2 elimination was studied by multivariable mixed linear model. Eighteen patients were treated with high-flow ECCO 2 R. Extracorporeal blood flows (median of 2.6 L/min [IQR, 2.0‒2.6 L/min]) were comparable between the configurations ( P = 0.33), although values higher than 2.5 L/min were observed in CENTRAL DRAINAGE configurations. Median CO 2 elimination was 110 mL(STPD)/min (IQR, 83‒149 mL(STPD)/min). Recirculation coefficient was significantly higher with the DISTAL DRAINAGE configurations (59% [IQR, 51‒71%] versus 9% [IQR, 15‒22%], respectively; P < 0.001). Consequently, CO 2 elimination was significantly lower with the DISTAL DRAINAGE configurations (58 mL(STPD)/min [IQR, 44‒72 mL(STPD)/min] versus 122 mL(STPD)/min [IQR, 96‒159 mL(STPD)/min], respectively; P = 0.003). Both DISTAL DRAINAGE configurations and high recirculation coefficient were significantly associated in multivariable analysis with a reduction in CO 2 elimination ( P < 0.001). We evaluated four different configurations of high-flow ECCO 2 R using single-lumen cannulas allowing either a central or a distal drainage. A central drainage configuration gave better rheological conditions and lower recirculation, leading to better extracorporeal decarboxylation.

PURPOSE: Pre-cannulation ventilation duration is often considered in selecting candidates for venovenous extracorporeal membrane oxygenation, but its relationship with the subsequent support trajectory is uncertain. We examined associations with first liberation, death before liberation, and time on support. METHODS: We analyzed a nationwide Japanese registry of patients receiving venovenous extracorporeal membrane oxygenation for COVID-19-related acute respiratory distress syndrome. First liberation and death before liberation were treated as competing transitions over 90 days. Cause-specific Cox models were stratified by epidemic period and adjusted for age, sex, and body mass index. Expected time on support was calculated from state-occupancy probabilities. RESULTS: Among 1,420 patients, the adjusted hazard ratio for first liberation relative to 0-1 days was 0.87 (95% confidence interval 0.72-1.05) for 2-3 days, 0.65 (0.54-0.78) for 4-7 days, 0.41 (0.32-0.52) for 8-14 days, and 0.58 (0.34-0.98) for at least 15 days. The association was strongest during the first 14 days. Death before liberation, which does not represent overall mortality because follow-up after liberation was short, showed no monotonic gradient below 15 days. Expected time on support was 26.9 days after more than 7 days of ventilation and 18.4 days after 7 days or less. CONCLUSIONS: Among selected recipients, longer pre-cannulation ventilation, particularly 8-14 days, was associated with slower early liberation and longer support. It may inform the anticipated course and resource requirements after cannulation, but does not define a candidacy threshold.

Veno-arterial (V-A) and veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) are frequently employed in the management of cardiopulmonary failure in critically ill patients. Utilization, however, is controversial in the Jehovah's Witness (JW) population as temporary mechanical circulatory support (tMCS) typically is associated with blood loss requiring transfusions. Despite this fact, use of ECMO is still feasible in this population while avoiding blood transfusions and there have been few reported cases in the literature. However, its use as part of cardiopulmonary resuscitation is limited. Multiple strategies have been employed to limit blood loss and maximize endogenous hematopoiesis to assist in maintaining normal physiology while utilizing tMCS. Though these tactics are most useful when applied in the preintervention setting, they are applicable in the emergency setting including extracorporeal cardiopulmonary resuscitation (ECPR). This can be achieved with conscientious cannulation technique and circuit management. Presented here is a case report of the successful use of V-A ECMO in the resuscitation for a JW, avoiding blood product transfusions. The protocol utilized to eliminate the need for blood transfusions is also discussed. This approach adds to the growing body of evidence emphasizing that the use of tMCS as part of bloodless medicine practice is feasible, even in the emergency setting.