Pub Date : 2019-12-04DOI: 10.5772/intechopen.85614
J. S. Enciso, K. Hong
Survival to discharge in patients presenting with cardiogenic shock who are managed using extracorporeal membrane oxygenation (ECMO) remains low at ~50%. This speaks to the acuity and severity of individuals being placed on ECMO, as well as the time dependent risk for complications associated with this therapy. Although some patients are able to be weaned from ECMO to either recovery, left ventricular assist device or heart transplantation, other individuals do not survive after device removal, suggesting that current protocols may not be identifying individuals with enough intrinsic cardiac recovery to maintain adequate end-organ perfusion. The decision to wean an individual from ECMO is complex and entails several factors that are dynamic and evolving daily while on full circulatory support. Objective clinical, hemodynamic and biological markers are needed to be controlled prior to trialing device weans but many times the decision relies on clinical experience and intuition. The purpose of this chapter will be to: (1) outline the survival and risks associated with ECMO which encourages early weaning trials and (2) identify patient factors related to either successful weaning or early referral for durable mechanical support or transplant.
{"title":"ECMO Weaning Strategies to Optimize Outcomes","authors":"J. S. Enciso, K. Hong","doi":"10.5772/intechopen.85614","DOIUrl":"https://doi.org/10.5772/intechopen.85614","url":null,"abstract":"Survival to discharge in patients presenting with cardiogenic shock who are managed using extracorporeal membrane oxygenation (ECMO) remains low at ~50%. This speaks to the acuity and severity of individuals being placed on ECMO, as well as the time dependent risk for complications associated with this therapy. Although some patients are able to be weaned from ECMO to either recovery, left ventricular assist device or heart transplantation, other individuals do not survive after device removal, suggesting that current protocols may not be identifying individuals with enough intrinsic cardiac recovery to maintain adequate end-organ perfusion. The decision to wean an individual from ECMO is complex and entails several factors that are dynamic and evolving daily while on full circulatory support. Objective clinical, hemodynamic and biological markers are needed to be controlled prior to trialing device weans but many times the decision relies on clinical experience and intuition. The purpose of this chapter will be to: (1) outline the survival and risks associated with ECMO which encourages early weaning trials and (2) identify patient factors related to either successful weaning or early referral for durable mechanical support or transplant.","PeriodicalId":362303,"journal":{"name":"Advances in Extracorporeal Membrane Oxygenation - Volume 3","volume":"61 10","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120989259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-07DOI: 10.5772/intechopen.85702
J. Aultman, M. Firstenberg
Extracorporeal membrane oxygenation (ECMO) is an established therapy for the management of acute cardiopulmonary failure. A substantial concern when considering ECMO therapy is whether the patient will recover enough function to be weaned from support and survive to discharge. The concept of “a bridge to nowhere” is where a patient is supported on a therapy for which there is no hope for recovery and would, by definition, immediately die if support is discontinued—a somewhat unique concept in clinical medicine, but often considered when considering short-term mechanical support for acute heart and/or lung failure. Much like initiating mechanical ventilator support in patients who have no chance of meaningful recovery, there are concerns about embarking on or continuing with ECMO support in patients in whom recovery is unlikely. The purpose of this chapter is to review the ethical foundation and principles to support the clinical decision-making process when there are concerns regarding the initiation, continuation, or withdrawal of this highly invasive, resource-intensive life-support technology. Specific attention will be given to well-established principles of the ethical application of advanced life support and how to appropriately limit offering or continuing therapies for which meaningful outcomes are unlikely or further support is considered futile.
{"title":"Finding a Bridge to Somewhere: An Ethical Framework for Veno-Arterial Extracorporeal Membrane Oxygenation Decisions","authors":"J. Aultman, M. Firstenberg","doi":"10.5772/intechopen.85702","DOIUrl":"https://doi.org/10.5772/intechopen.85702","url":null,"abstract":"Extracorporeal membrane oxygenation (ECMO) is an established therapy for the management of acute cardiopulmonary failure. A substantial concern when considering ECMO therapy is whether the patient will recover enough function to be weaned from support and survive to discharge. The concept of “a bridge to nowhere” is where a patient is supported on a therapy for which there is no hope for recovery and would, by definition, immediately die if support is discontinued—a somewhat unique concept in clinical medicine, but often considered when considering short-term mechanical support for acute heart and/or lung failure. Much like initiating mechanical ventilator support in patients who have no chance of meaningful recovery, there are concerns about embarking on or continuing with ECMO support in patients in whom recovery is unlikely. The purpose of this chapter is to review the ethical foundation and principles to support the clinical decision-making process when there are concerns regarding the initiation, continuation, or withdrawal of this highly invasive, resource-intensive life-support technology. Specific attention will be given to well-established principles of the ethical application of advanced life support and how to appropriately limit offering or continuing therapies for which meaningful outcomes are unlikely or further support is considered futile.","PeriodicalId":362303,"journal":{"name":"Advances in Extracorporeal Membrane Oxygenation - Volume 3","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130429516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-22DOI: 10.5772/INTECHOPEN.85104
J. Weller, Lakshmi Raman, A. Zia, A. McMichael
Anticoagulation during extracorporeal membrane oxygenation (ECMO) is necessary to prevent catastrophic circuit clotting, but significant morbidity and mortality continue to be attributed to hemorrhagic and thrombotic complications. Due to the inflammatory response from the extracorporeal circuit and developmental hemostasis, anticoagulation can be challenging particularly for pediatric patients. Unfractionated heparin (UFH) is the gold standard anticoagulant used in ECMO, but there is an expanding area of research evaluating other anticoagulants, such as direct thrombin inhibitors. This chapter provides an overview of anticoagulant options for pediatric patients on ECMO as well as describes the various tests used to monitor and titrate anticoagulation.
{"title":"Anticoagulation in Pediatric Extracorporeal Membrane Oxygenation","authors":"J. Weller, Lakshmi Raman, A. Zia, A. McMichael","doi":"10.5772/INTECHOPEN.85104","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.85104","url":null,"abstract":"Anticoagulation during extracorporeal membrane oxygenation (ECMO) is necessary to prevent catastrophic circuit clotting, but significant morbidity and mortality continue to be attributed to hemorrhagic and thrombotic complications. Due to the inflammatory response from the extracorporeal circuit and developmental hemostasis, anticoagulation can be challenging particularly for pediatric patients. Unfractionated heparin (UFH) is the gold standard anticoagulant used in ECMO, but there is an expanding area of research evaluating other anticoagulants, such as direct thrombin inhibitors. This chapter provides an overview of anticoagulant options for pediatric patients on ECMO as well as describes the various tests used to monitor and titrate anticoagulation.","PeriodicalId":362303,"journal":{"name":"Advances in Extracorporeal Membrane Oxygenation - Volume 3","volume":"240 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127834111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-06-12DOI: 10.5772/INTECHOPEN.85982
A. Botsch, Elizabeth Protain, Amanda R. Smith, R. Szilagyi
Effective care and positive outcomes of the extracorporeal membrane oxygenation (ECMO) patient necessitate optimal interdisciplinary management from the healthcare team, including expert care from specially trained registered nurses (RNs). It is incumbent upon the RN caring for the ECMO patient to excel in both time management and assessment skills, as this population often demands care delivery at the pinnacle of intensive care unit (ICU) acuity. Astute and nuanced monitoring of neurological status, bleeding risk with potential (often massive) transfusions, poor hemodynamics, and integrity of the ECMO pump itself are only the few specialized areas of focus that must share priority with traditional nursing considerations involving the critically ill, such as prevention of pressure injuries and bloodstream infections. These high-intensity medical foci must be balanced with ethical considerations, as the ultimate goal of returning the patient to their normal life is not always possible. These demands highlight the dynamic proficiency of the RN caring for the ECMO patient. The following chapter will highlight the importance of specialized nursing care in the critically ill patient supported with ECMO.
{"title":"Nursing Implications in the ECMO Patient","authors":"A. Botsch, Elizabeth Protain, Amanda R. Smith, R. Szilagyi","doi":"10.5772/INTECHOPEN.85982","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.85982","url":null,"abstract":"Effective care and positive outcomes of the extracorporeal membrane oxygenation (ECMO) patient necessitate optimal interdisciplinary management from the healthcare team, including expert care from specially trained registered nurses (RNs). It is incumbent upon the RN caring for the ECMO patient to excel in both time management and assessment skills, as this population often demands care delivery at the pinnacle of intensive care unit (ICU) acuity. Astute and nuanced monitoring of neurological status, bleeding risk with potential (often massive) transfusions, poor hemodynamics, and integrity of the ECMO pump itself are only the few specialized areas of focus that must share priority with traditional nursing considerations involving the critically ill, such as prevention of pressure injuries and bloodstream infections. These high-intensity medical foci must be balanced with ethical considerations, as the ultimate goal of returning the patient to their normal life is not always possible. These demands highlight the dynamic proficiency of the RN caring for the ECMO patient. The following chapter will highlight the importance of specialized nursing care in the critically ill patient supported with ECMO.","PeriodicalId":362303,"journal":{"name":"Advances in Extracorporeal Membrane Oxygenation - Volume 3","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130205022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-06-05DOI: 10.5772/INTECHOPEN.83658
Abdelaziz Farhat, C. Bowens, R. Thiagarajan, Lakshmi Raman
ECMO, or extracorporeal membrane oxygenation, is an advanced life support technique that provides cardiac and pulmonary support similar to cardiopulmonary bypass. ECPR (extracorporeal cardiopulmonary resuscitation) is the rapid deployment of VA-ECMO when conventional cardiopulmonary resuscitation fails to provide return of spontaneous circulation. Evidence in the literature is sparse, but with expanding reported applications, ECPR has shown promise to improve outcomes of cardiac arrest. ECPR is superior to conventional CPR for both survival and neurologic outcomes. ECPR has been successfully used to manage arrests secondary to cardiac and non-cardiac causes. Arrests secondary to primary cardiac causes have the best overall outcome. Other determinants of outcomes of ECPR include duration of low flow state and on-ECMO complications. A narrow list of ECPR contraindications exists, and includes severe neurologic injury and irreversible primary disease process. Various complications can occur with ECPR, and include mechanical, cardiovascular, pulmonary, hematologic, renal, and neurologic complications. Neurologic complications are the most serious, and significantly affect mortality or quality of life. ECPR is a nascent field, and substantial work remains to be done to optimize its application. Given the small number of patients at each institutional level, this is a field ripe for collaborative work and rewarding results.
{"title":"Extracorporeal Cardiopulmonary Resuscitation","authors":"Abdelaziz Farhat, C. Bowens, R. Thiagarajan, Lakshmi Raman","doi":"10.5772/INTECHOPEN.83658","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.83658","url":null,"abstract":"ECMO, or extracorporeal membrane oxygenation, is an advanced life support technique that provides cardiac and pulmonary support similar to cardiopulmonary bypass. ECPR (extracorporeal cardiopulmonary resuscitation) is the rapid deployment of VA-ECMO when conventional cardiopulmonary resuscitation fails to provide return of spontaneous circulation. Evidence in the literature is sparse, but with expanding reported applications, ECPR has shown promise to improve outcomes of cardiac arrest. ECPR is superior to conventional CPR for both survival and neurologic outcomes. ECPR has been successfully used to manage arrests secondary to cardiac and non-cardiac causes. Arrests secondary to primary cardiac causes have the best overall outcome. Other determinants of outcomes of ECPR include duration of low flow state and on-ECMO complications. A narrow list of ECPR contraindications exists, and includes severe neurologic injury and irreversible primary disease process. Various complications can occur with ECPR, and include mechanical, cardiovascular, pulmonary, hematologic, renal, and neurologic complications. Neurologic complications are the most serious, and significantly affect mortality or quality of life. ECPR is a nascent field, and substantial work remains to be done to optimize its application. Given the small number of patients at each institutional level, this is a field ripe for collaborative work and rewarding results.","PeriodicalId":362303,"journal":{"name":"Advances in Extracorporeal Membrane Oxygenation - Volume 3","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125658911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-06-04DOI: 10.5772/INTECHOPEN.84935
N. Nair, E. Góngora
Extracorporeal membrane oxygenation (ECMO) is a technique used for tempo-rary support of patients with end-stage heart or lung failure. This review will focus on the venoarterial ECMO system and its use as a bridge to other long-term durable devices and/or cardiac transplantation. It can be used as a bridge to decision because it helps to gain time to stabilize the patient for further evaluation for long-term treatment such as durable mechanical circulatory pumps or transplantation. ECMO is evolving as a treatment for patients waiting on the transplant list. Increasing utilization of ECMO in adults has revealed some of the common complications such as bleeding and coagulopathy which impact survival in this patient population. The use of VA ECMO as a technique for rescuing patients from cardiogenic shock is very attractive. However, considering the extensive set of complications and the mortality it brings with it makes it a less attractive option as a direct bridge to cardiac transplant. The literature currently on this subject is very scanty and limited to a few studies of small numbers of patients. Further definitive research is needed for consensus on the role of VA ECMO as a bridge to cardiac transplant.
{"title":"Extracorporeal Membrane Oxygenation as a Bridge to Cardiac Transplantation","authors":"N. Nair, E. Góngora","doi":"10.5772/INTECHOPEN.84935","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.84935","url":null,"abstract":"Extracorporeal membrane oxygenation (ECMO) is a technique used for tempo-rary support of patients with end-stage heart or lung failure. This review will focus on the venoarterial ECMO system and its use as a bridge to other long-term durable devices and/or cardiac transplantation. It can be used as a bridge to decision because it helps to gain time to stabilize the patient for further evaluation for long-term treatment such as durable mechanical circulatory pumps or transplantation. ECMO is evolving as a treatment for patients waiting on the transplant list. Increasing utilization of ECMO in adults has revealed some of the common complications such as bleeding and coagulopathy which impact survival in this patient population. The use of VA ECMO as a technique for rescuing patients from cardiogenic shock is very attractive. However, considering the extensive set of complications and the mortality it brings with it makes it a less attractive option as a direct bridge to cardiac transplant. The literature currently on this subject is very scanty and limited to a few studies of small numbers of patients. Further definitive research is needed for consensus on the role of VA ECMO as a bridge to cardiac transplant.","PeriodicalId":362303,"journal":{"name":"Advances in Extracorporeal Membrane Oxygenation - Volume 3","volume":"193 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124301607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-30DOI: 10.5772/INTECHOPEN.86391
P. Mohite, A. Simon
As utilisation of peripheral extra-corporeal life support (ECLS) is becoming clinical routine, its associated complications become more frequent. Distal limb perfusion in femoral cannulation remains one of the Achille’s heels in patients with peripheral ECLS. Unless detected early, limb ischemia may result in loss of limb and sometimes life. A protocol-based approach, precautions during ECLS implantation and explantation procedures and continuous monitoring of the limb during ECLS support are key elements in preventing this complication. Utilisation of a distal limb perfusion cannula helps in prevention as well as management of limb ischemia; however, it may sometimes cause more damage than help. Management and consequence of limb ischemia essentially depends on its severity at the time of detection as well as time of intervention. This chapter offers a brief review of the burden of limb ischemia, means to prevent and approaches to manage it.
{"title":"Isn’t Limb as Precious as Life?","authors":"P. Mohite, A. Simon","doi":"10.5772/INTECHOPEN.86391","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.86391","url":null,"abstract":"As utilisation of peripheral extra-corporeal life support (ECLS) is becoming clinical routine, its associated complications become more frequent. Distal limb perfusion in femoral cannulation remains one of the Achille’s heels in patients with peripheral ECLS. Unless detected early, limb ischemia may result in loss of limb and sometimes life. A protocol-based approach, precautions during ECLS implantation and explantation procedures and continuous monitoring of the limb during ECLS support are key elements in preventing this complication. Utilisation of a distal limb perfusion cannula helps in prevention as well as management of limb ischemia; however, it may sometimes cause more damage than help. Management and consequence of limb ischemia essentially depends on its severity at the time of detection as well as time of intervention. This chapter offers a brief review of the burden of limb ischemia, means to prevent and approaches to manage it.","PeriodicalId":362303,"journal":{"name":"Advances in Extracorporeal Membrane Oxygenation - Volume 3","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134011865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-14DOI: 10.5772/INTECHOPEN.84838
Dianne McCallister, L. Pilon, Joseph Forrester, Samer Alsaleem, C. Kotaru, J. Hanna, Gregory Hickey, Rachele Roberts, E. Douglass, Matthew Libby, M. Firstenberg
Extra-corporeal membrane oxygenation (ECMO) is a rapidly evolving therapy for acute lung and/or heart failure. ECMO, from a technical standpoint, is con-ceptually simple—however, it can be very challenging to implement therapy at the individual patient level as well as at hospital (or healthcare system) level. ECMO program development involves engagement of key stake-holders including physicians, nursing, and administrative leadership. The goal of this chapter is to outline some of the crucial steps in developing a successful ECMO program including high-lighting the necessary resources, team members and structure, and basic program structure and function.
{"title":"Clinical and Administrative Steps to the ECMO Program Development","authors":"Dianne McCallister, L. Pilon, Joseph Forrester, Samer Alsaleem, C. Kotaru, J. Hanna, Gregory Hickey, Rachele Roberts, E. Douglass, Matthew Libby, M. Firstenberg","doi":"10.5772/INTECHOPEN.84838","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.84838","url":null,"abstract":"Extra-corporeal membrane oxygenation (ECMO) is a rapidly evolving therapy for acute lung and/or heart failure. ECMO, from a technical standpoint, is con-ceptually simple—however, it can be very challenging to implement therapy at the individual patient level as well as at hospital (or healthcare system) level. ECMO program development involves engagement of key stake-holders including physicians, nursing, and administrative leadership. The goal of this chapter is to outline some of the crucial steps in developing a successful ECMO program including high-lighting the necessary resources, team members and structure, and basic program structure and function.","PeriodicalId":362303,"journal":{"name":"Advances in Extracorporeal Membrane Oxygenation - Volume 3","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132910996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-04DOI: 10.5772/INTECHOPEN.84936
L. Morales-Quinteros, A. Artigas
In the past, treatment of acute exacerbations of obstructive disease refractory to medical treatment was invasive mechanical ventilation. As a result of technical improvements, extracorporeal techniques for carbon dioxide removal have aroused as an attractive option to avoid worsening respiratory failure and respiratory acidosis and potentially prevent, shorten the duration of invasive mechanical ventilation (IMV), and serve as rescue therapy in patients with exacerbation of COPD and asthma. In this review, we will present a comprehensive summary of the pathophysiological rationale and evidence of ECCO 2 R in patients with severe exacerbations of these pathologies.
{"title":"Extracorporeal Carbon Dioxide Removal for the Exacerbation of Chronic Hypercapnic Respiratory Diseases","authors":"L. Morales-Quinteros, A. Artigas","doi":"10.5772/INTECHOPEN.84936","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.84936","url":null,"abstract":"In the past, treatment of acute exacerbations of obstructive disease refractory to medical treatment was invasive mechanical ventilation. As a result of technical improvements, extracorporeal techniques for carbon dioxide removal have aroused as an attractive option to avoid worsening respiratory failure and respiratory acidosis and potentially prevent, shorten the duration of invasive mechanical ventilation (IMV), and serve as rescue therapy in patients with exacerbation of COPD and asthma. In this review, we will present a comprehensive summary of the pathophysiological rationale and evidence of ECCO 2 R in patients with severe exacerbations of these pathologies.","PeriodicalId":362303,"journal":{"name":"Advances in Extracorporeal Membrane Oxygenation - Volume 3","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121128431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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