ECMO Membrane Lung Failure due to Hypertriglyceridemia: A Case Report and Review of the Literature

The deleterious effects of high serum lipid content on the membrane lung (ML) during extracorporeal membrane oxygenation (ECMO) are sparsely documented, and the threshold of lipemia-induced membrane failure is poorly described. We present a case of a patient on venovenous ECMO who developed ML failure after 7 days due to moderate to severe hypertriglyceridemia (700–800 mg/dL). ML failure was exhibited by impaired gas exchange and high transmembrane pressures, and there was notable lipemic layering in the circuit immediately after decannulation. This case demonstrates that in addition to patients with extreme lipemia, ML failure can also occur in patients with moderate to severe hypertriglyceridemia. Hypertriglyceridemia should be suspected in patients with high transmembrane pressures and ML failure not attributable to thrombosis, and these patients may require frequent ML changes if a prolonged ECMO run is required

Extracorporeal Membrane Oxygenation for COVID-19:Updated 2021 Guidelines from the Extracorporeal Life Support Organization

Disclaimer: This is an updated guideline from the Extracorporeal Life Support Organization (ELSO) for the role of extracorporeal membrane oxygenation (ECMO) for patients with severe cardiopulmonary failure due to coronavirus disease 2019 (COVID-19). The great majority of COVID-19 patients (>90%) requiring ECMO have been supported using venovenous (V-V) ECMO for acute respiratory distress syndrome (ARDS). While COVID-19 ECMO run duration may be longer than in non-COVID-19 ECMO patients, published mortality appears to be similar between the two groups. However, data collection is ongoing, and there is a signal that overall mortality may be increasing. Conventional selection criteria for COVID-19-related ECMO should be used; however, when resources become more constrained during a pandemic, more stringent contraindications should be implemented. Formation of regional ECMO referral networks may facilitate communication, resource sharing, expedited patient referral, and mobile ECMO retrieval. There are no data to suggest deviation from conventional ECMO device or patient management when applying ECMO for COVID-19 patients. Rarely, children may require ECMO support for COVID-19-related ARDS, myocarditis, or multisystem inflammatory syndrome in children (MIS-C); conventional selection criteria and management practices should be the standard. We strongly encourage participation in data submission to investigate the optimal use of ECMO for COVID-19

Extracorporeal Membrane Oxygenation for COVID-19: Updated 2021 Guidelines from the Extracorporeal Life Support Organization

Disclaimer: This is an updated guideline from the Extracorporeal Life Support Organization (ELSO) for the role of extracorporeal membrane oxygenation (ECMO) for patients with severe cardiopulmonary failure due to coronavirus disease 2019 (COVID-19). The great majority of COVID-19 patients (>90%) requiring ECMO have been supported using venovenous (V-V) ECMO for acute respiratory distress syndrome (ARDS). While COVID-19 ECMO run duration may be longer than in non-COVID-19 ECMO patients, published mortality appears to be similar between the two groups. However, data collection is ongoing, and there is a signal that overall mortality may be increasing. Conventional selection criteria for COVID-19-related ECMO should be used; however, when resources become more constrained during a pandemic, more stringent contraindications should be implemented. Formation of regional ECMO referral networks may facilitate communication, resource sharing, expedited patient referral, and mobile ECMO retrieval. There are no data to suggest deviation from conventional ECMO device or patient management when applying ECMO for COVID-19 patients. Rarely, children may require ECMO support for COVID-19-related ARDS, myocarditis, or multisystem inflammatory syndrome in children (MIS-C); conventional selection criteria and management practices should be the standard. We strongly encourage participation in data submission to investigate the optimal use of ECMO for COVID-19

Position Paper on Global ECMO Education and Educational Agenda for the Future: A Statement from the Extracorporeal Life Support Organization ECMOed Taskforce

This is the author accepted version of the article at https://doi.org/10.1097/ccm.0000000000004158. Copyright © 2020 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.Objective The purpose of this position paper is two-fold: first, to describe the state of extracorporeal membrane oxygenation (ECMO) education worldwide, noting current limitations and challenges; and second, to put forth an educational agenda regarding opportunities for an international collaborative approach towards standardization. Design and Setting In 2018, the Extracorporeal Life Support Organization Education (ECMOed) Taskforce organized two structured, face-to-face meetings and conducted a review of published literature on ECMO education. Taskforce members generated a consensus statement using an iterative consensus process through teleconferences and electronic communication. Measurements and Main Results The ECMOed Taskforce identified seven educational domains that would benefit from international collaborative efforts. Of primary importance, the taskforce outlined actionable items regarding: (1) the creation of a standardized ECMO curriculum; (2) defining criteria for an ECMO course as a vehicle for delivering the curriculum; (3) outlining a mechanism for evaluating the quality of educational offerings; (4) utilizing validated assessment tools in the development of ECMO practitioner certification; and (5) promoting high-quality educational research to guide ongoing educational and competency assessment development. Conclusions Significant variability and limitations in global ECMO education exist. In this position paper, we outline a road map for standardizing international ECMO education and practitioner certification. Ongoing high-quality educational research is needed to evaluate the impact of these initiatives.Peer reviewe