Les Textiles Streaming
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The extracorporeal membrane oxygenation (ECMO) system used in the study by[@JR03022-1] displayed a mean pulmonary artery pressure of 18.3 ± 3.5 mmHg and a mean pulmonary artery occlusion pressure (PAOP) of 15.9 ± 3.5 mmHg during the treatment course, and the patient was weaned from the ECMO system after 12 days of the treatment course. Retrospective analysis of ECMO use in a clinical scenario suggests that a mean PAOP of 18.3 mmHg or more, while on ECMO, warrants arterial decannulation. [@JR03022-2] This value of 18.3 mmHg was confirmed in a second report, also published in 2014, which involved 14 patients with the diagnosis of acute respiratory distress syndrome, in whom the mean PAOP at 24 hours of ECMO was 14.2 ± 2.2 mmHg. [@JR03022-3] In this report, acute venous congestion as a result of bilateral pulmonary edema was observed in all patients. Such a threshold value of 18.3 mmHg would appear to be clinically useful in deciding whether to decannulate patients undergoing ECMO therapy for acute respiratory distress syndrome.
The present study by Sun et al. [@JR03022-1] reported a case of a 40-year-old woman who underwent emergency admission after surgery with the diagnosis of post-cardiac arrest syndrome. Despite a significant improvement in perfusion at the initial levels of cerebral oxygenation, the cerebral oxygenation levels decreased to as low as 30%, and the patient gradually became bradypneic, eventually requiring the support of ECMO. The authors concluded that intraoperative sedative-anesthetic agents (propofol and fentanyl) and a potentially insufficient weaning strategy could have contributed to the development of hypoxic cerebral injury, particularly after the administration of an epinephrine bolus to deal with a severe cardiogenic shock. In a retrospective study of a patient with a history of severe adult respiratory distress syndrome, hepatic, and pulmonary failure following acute pancreatitis and undergoing ECMO support, there was a positive correlation between the degree of acute respiratory distress syndrome and the duration of ECMO treatment. [@JR03022-4] It was concluded that this phenomenon was, at least partially, due to systemic inflammation caused by ECMO. [
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