#ecls — Public Fediverse posts

Thrombolysis before VA #ECMO cannulation in high-risk pulmonary embolism
🔍 72 high-risk PE pts; 43% underwent pre-ECMO thrombolysis
🩸incidence of moderate-to-severe bleeding notably elevated in both groups
🪦 no difference in 90-day survival if systemic thrombolysis or not
🗓️ long-term QoL acceptable; no chronic thromboembolic pulmonary hypertension
Recent systemic thrombolysis, as a single parameter, should not be considered contraindication for #ECLS in this population
🔓 https://rdcu.be/dLOBk

Consumptive coagulopathy during #ECLS
🔎 close monitoring & follow up pivotal during the #ECMO run
⛔️ giving platelets/clotting factors to fix numbers often worsens underlying process
🩸 low doses of anticoagulants may protect both circuit (vs thrombotic complications) & patient (vs bleeding & thrombosis)
⛔️ bleeding complications should NOT always prompt complete cessation of UFH
Detailed underlying pathophysiological process & physiological rationale free to read #FOAMcc
🔓 https://rdcu.be/dLmXO

📢 June issue of Intensive Care Medicine is now available!!
💦 European Society of Intensive Care Medicine (ESICM) fluid therapy guidelines
🗺️ critical care in LMICs
🩸emergency chemotherapy for hematological patients in #ICU
🫘 #RRT in PedsICU
🧫 #sepsis & bloodstream infection
🫁 proning in #ECMO
🫁 Pes
🫀 #ECLS in cardiogenic shock
🧠 neuromonitoring
& more! Full texts free to read #FOAMcc if you follow the links we share in our social media posts... enjoy!
📎 https://bit.ly/ICMJun2024

Cardiogenic shock in 2024:
🫀 #extracorporeal life support #ECLS
🫀 left ventricular unloading strategies in #ECMO
strategies & evidence from recent trials (& beyond)
Free to read #FOAMcc #FOAMecmo on @ICM
🔓 https://rdcu.be/dHzLz

⏱️ #ARDS? first 24 h should be time stamped:
1️⃣ 🔍 first 3h of non-invasive/invasive respiratory support: rule in diagnosis
2️⃣ ⚖️ first 12h: decide to continue NIV or institute IMV
3️⃣ 🫁 first 6h: implement low Vt strategies & optimization based on Pplat & DP
4️⃣ 🫁 first 12h: Initiate/optimize PEEP
5️⃣ 🛌 first 12-24h: prone eligible pts
6️⃣ 🩸 first 3-6h: #ECLS in patients meeting EOLIA criteria, depending on severity + response to previous interventions + risk/benefit profile
🔓 https://rdcu.be/dGXCI

Prone positioning on #ECMO for severe #ARDS??
🚦PRO: Performed in experienced/highly specialized centers, PP feasible/safe promising option
🔓 https://rdcu.be/dGIMf
🚦CON: according to PRONECMO trial results, PP during #ECLS did not yield significant benefits vs supine position.
🔓 https://rdcu.be/dGILB
🚦NOT SURE: How to reconcile the results of high-quality, negative RCT with preexisting favorable observational data?
🔓 https://rdcu.be/dGINm
All free to read #FOAMcc #FOAMecmo on @ICM

Safe ventilation in #ARDS?? Elusive... justifying use of #ECLS. Challenge is to treat lung disease effectively while mitigating injury risks. Free to read #FOAMcc on @ICM
🔓 https://rdcu.be/dGq5p

In reply to
🔓 https://rdcu.be/dGq6n

All refers to editorial on VILI
🔓https://rdcu.be/dGq6G

Challenge for the ones of you used to #ECMO support
🫀62y, refractory VFib #OHCA in the ED
🩸extracorporeal cardiopulmonary resuscitation initiation
Which kind of cannulation was performed to provide veno-arterial #ECLS??
#FOAMcc #FOAmecmo on @ICM
📸 https://rdcu.be/dy588

Age & associated outcomes among pts receiving VA #ECMO, (Bayesian) analysis of ELSO Registry:
🏥 > 15K pts/440 centers
📈 increasing age strongly associated with higher mortality or complications
📈 statistically higher risk emerging as early as 40 y
🔓 https://rdcu.be/dqhb5

With editorial:
🍂 How old is too old for #ECLS in cardiogenic shock? In the age of #machinelearning medicine remains art of probability & science of uncertainty.
🔓 https://rdcu.be/dqhbq

All free to read #FOAMcc #FOAMecmo

#ECLS for #ARDS, systematic review & meta-analysis focused on long-term patients' outcomes:
📖 1 RCT + 31 observational studies included; lack of high-quality data: limited overall quality of evidence
⚠️ major sequelae common: 49% of survivors returning to work, 23% need home assistance
⚖️ #ECMO vs conventional mechanical ventilation? no significant difference in HRQoL, cognitive function, mental health, functional status, respiratory symptoms #FOAMcc #FOAMecmo on @ICM
🔓https://rdcu.be/dw7XC

Bleeding complications during #ECMO support, due to endogenous hyperfibrinolysis rather than excessive anticoagulation?
🩸 #ECLS circuits may stimulate release of endothelial plasminogen activator
🩸 D-dimer longitudinal dynamics most direct surrogate marker of overall fibrinolytic activity through plasmin generation on fibrin, preceding hemorrhagic complication
➡️ Bleeding patients with increasing D-dimers might benefit from plasminogen-targeted antifibrinolytic treatment
🖇️ https://rebrand.ly/kxabhaf

ESICM guidelines on acute respiratory distress syndrome, from definition & phenotyping to respiratory support strategies:
🫁 #ARDS definition
🫁 phenotyping
🫁 high‑flow nasal oxygen #HFNO
🫁 CPAP/NIV
🫁 low tidal volume ventilation
🫁 PEEP & recruitment maneuvers
🫁 prone positioning
🫁 neuromuscular blocking agents
🫁 extracorporeal life support #ECMO #ECLS #ECCO2r
Open access #FOAMcc on @yourICM
🖇️ https://bit.ly/43J1OCe

Out‑of‑hospital cardiac arrest? Science continues to evolve: here 6 additional trials that have potential to influence guidelines & clinical practice
💉 COCA trial: Calcium for #OHCA
⚡️ DOSE VF trial: double sequential external
defibrillation for refractory Vfib
🩸 INCEPTION trial: early #ECLS initiation
💨 EXACT trial: reduction of O2 after CA
❄️ TTM2 trial: targeted hypothermia vs targeted normothermia
🩸 BOX Trial: BP & oxygenation targets in post-resuscitation care
🖇️ https://bit.ly/3ZXLBGW