Abstract
It has been more than a year since EuroELSO and Perfusion Journal declared their common will to cooperate officially, and associated editors representing EuroELSO have joined Editorial board of Perfusion. This cooperation has already brought fruitful results in several highly cited articles related to extracorporeal membrane oxygenation/life support (ECMO/ECLS) and undoubtedly will continue. This topic is actual and attractive, yielding 24,000 records in PubMed in past 10 years corresponding to increasing use of this advanced technology, enormously boosted by the COVID-19 pandemic. ECMO simply became a daily used intervention in critically ill patients, and needs permanent evaluation in research and clinical practice. Perfusion Journal is an optimal environment, and welcomes scientific publications on extracorporeal therapies.
The current issue brings several noteworthy manuscripts related to both ECMO and other burning topics; let me comment on selected ones.
A review article on temperature management in cardiopulmonary bypass by LP Browne provides a comprehensive overview of how to manage temperature while under CPB and concludes by stating the practice of temperature management being changed with the awareness of new research. Lower target temperatures are recommended for rewarming, ensuring a lower temperature gradient and a longer mean rewarming time. 1 The topic of temperature management, namely, the targeted temperature management is though extremely actual due to recently published results of the TTM2 trial, evaluating temperature management in patients post cardiac arrest. 2 The trial has shown similar results for mild hypothermia compared to avoidance of fever, and the result immediately became a topic of hot discussions.
Kaluza et al. touched the issue of restricted resources’ situations in a manuscript on using a roller pump for establishing extra-corporal membrane oxygenation for times of crisis. In vitro study has clearly shown that roller pumps with silicone tubing but not PVC tubing may, under close attention, be used for running ECMO circuits, though silicone tubing may endure the roller pump shear forces for up to 1 week and thus, repeated tubing repositioning may be a solution. 3
ECPR (extracorporeal cardiopulmonary resuscitation) is a topic of an article by Djordjevic et al. from Cologne, Germany. 4 Authors reported on their first results and outcomes of a newly established ECPR program in a large population area. A reasonable neurologically favorable survival of 18% has been reported for cardiac arrests of 60 mins in duration. The topic of ECPR is more than actual and increasing number of ECMO centers starts to provide ECPR service. Therefore, though not large, similar studies are of interest to share experience and help to overcome baby illnesses when starting such a program. ECPR is enormously demanding for institutions and especially to nursing staff, but excellent results may be achieved with a well-functioning system. Our group has very recently published a randomized controlled trial encompassing ECPR which clearly showed its enormous potential to rescue patients that might have been pronounced dead without an ECPR availability. 5
And finally, our group presented an extraordinary case report in the current issue on dual veno-arterial ECMO in a patient with refractory hyperdynamic septic shock. 6 This report nicely shows the type of thinking necessary for running a comprehensive ECMO program—an out-of-the-box approach. The patient suffered a severe septic shock, septic cardiomyopathy with low cardiac output syndrome, and high lactates, and was placed on VA ECMO and improved slightly. I assume, majority of treating physicians might have resigned and pronounced the case as futile. We have extensively discussed possible options and realized that treating a severe septic shock needs a lot of flow. Therefore, we implanted another jugulo-axillary veno-arterial ECMO, thus increasing extracorporeal flow to values not achievable by just one device, and the patient survived. More than luckily, such a good outcome in a desperately sick individual, but such unbelievable results, makes ECMO and its providers mutually close friends to fight with conservatively futile situations.
I wish you a pleasant reading and look forward to hosting you in London for an Annual EuroELSO Congress on ECLS and adjunct therapies.