Extracorporeal Life Support and Extracorporeal Membrane Oxygenation

The technology may be applied in situations with cardiopulmonary resuscitation, andlow flow support may be offered for carbon dioxide removal.

In all these methods, larger cannulae are implanted in larger vessels or the cardiac chambers of the patient. Hence, treatment carries high risk for bleeding, infection and embolization in the patient. Support may be offered in a wide range of time, from a few hours to months (prolonged ECMO).

Projects

Integrative human physiology and interaction with technologies used in extracorporeal life support (ECLS) 

The aims of this project are to increase understanding and to improve devices and methods for extracorporeal membrane oxygenation (ECMO) to reduce complications and improve outcome.

The focus is both on the macro and microscopic levels concerning the interaction of native and extracorporeal flow in the patient when ECMO is applied. Anticoagulation is regularly used in ECMO treatment to prevent clot formation. Clots in the circuit may halt perfusion or lead to thromboembolic events in the patient. Heparin is the most used anticoagulant (95% of centers worldwide). However, reducing the clot tendency increases the bleeding risk in the patient. Thus, in daily clinical practice there is a constant evaluation of the delicate balance between coagulation and anticoagulation. The most common severe adverse events are cerebral bleedings (ICH) or thromboembolic events (ischemic stroke). These are in many cases lethal. 

Both risk factors for ICH and ischemic stroke has been and is continued under investigation. We also evaluate biomarkers for earlier detection and platelet function is a field we aim to investigate. On the macroscopic level recirculation phenomena in venovenous ECMO is investigated both in a clinical perspective but also in ex-vivo models. Further, device flow characteristics are studied for increased knowledge to improve cannulae, connector and pump design for better treatment, i.e., reduced biotrauma and coagulation/inflammation activation in the patient. For this, resolution is increased, and we study each component’s influence on flow properties using several methods in collaboration with the Royal Institute of Technology (KTH), Department of Neuroscience, and ECMO centers abroad. Computer fluid dynamics (CFD), high speed filming, mathematical models and methods with fluorescent dies are used in several projects.

• Cerebral bleeding and thromboembolic complications in ECMO patients
• Feasibility of biomarkers for earlier detection of intracranial events in patients on extracorporeal membrane oxygenation
• Recirculation in veno-venous (VV) extracorporeal membrane oxygenation (ECMO) in vivo and in ex-vivo ECMO flow simulation model
• Ex-vivo investigations of ECMO components for improved clinical treatment
• In-vitro study of the impact of left ventricular assist devices loading on mechanical performance

Clinical perspectives on septic syndromes, right ventricular failure and lung interaction, inflammation: the role for extracorporeal membrane oxygenation

Transport on extracorporeal membrane oxygenation

Sepsis is the most common diagnosis in adults and children submitted to intensive care worldwide. It is also the most common cause for death from infection, accounting for as many deaths in the U.S. as myocardial infarction.

At ECMO Centre Karolinska septic shock is the most common cause for ECMO in the adult and pediatric populations. In neonates ECMO is nowadays more or less acknowledged as standard of treatment in the most severe cases.

However, sepsis in adults and pediatric patients is still controversial in many centers but acceptance is slowly increasing. Patients above 65 years of age is even more questioned to be offered ECMO support, not only in sepsis but also for other less complex diagnoses, e.g. severe pneumonia, acute respiratory distress syndrome, etc. 

Before the H1N1 pandemic in 2009, more than 10% of all adult patients ever treated on ECMO had been treated at our center in Stockholm. Thus, ECMO Centre Karolinska is one of the most experienced units in the world in adult respiratory ECMO.

Besides prospective studies, retrospective investigations from our database on outcome and quality assurance are conducted regarding clinical perspectives but also concerning national and international inter/hospital transports on ECMO.

• Infectious disease follow-up of ECMO patients with septic syndromes
• Adrenal cortical response during Extracorporeal membrane oxygenation in children and adults admitted to Intensive Care.
• Extracorporeal membrane oxygenation in different ages> neonatal, pediatric, adult, and the elderly.
• Refractory septic shock in adults with septic cardiac failure 
• Conversion from venovenous to venoarterial extracorporeal membrane oxygenation in adults.
• The role of lung blood flow on the prognosis in severe pulmonary failure and extracorporeal membrane oxygenation.

Group members