THE American Board of Anesthesiology first offered a certification of special competence in critical care in 1986.1  The role of anesthesiologists in critical care was reviewed in Anesthesiology by Hanson et al. in 2001,2  documenting the skills, tasks, and challenges at that time. The COVID-19 pandemic offers an opportunity to review the changes that have occurred at our institution, Massachusetts General Hospital (Boston, Massachusetts), as well as nationally and internationally, and how the successful use of extracorporeal membrane oxygenation has created a large demand for expertise in cardiothoracic critical care.

We will review the current roles of cardiothoracic anesthesiology intensivists in cardiogenic shock and extracorporeal membrane oxygenation at Massachusetts General Hospital to document an example of a successful multidisciplinary team that has been established in an institution with strong departmental interests. Then, a brief history of extracorporeal membrane oxygenation will document the past role of critical care anesthesiologists and their current role with both venovenous and venoarterial extracorporeal membrane oxygenation. This review will emphasize how the investigation of both cardiac and lung function in these critically ill patients now is essential. Finally, the review will evaluate the early data regarding extracorporeal membrane oxygenation in the COVID-19 crisis.

“Code Blue” and Shock Calls for the Cardiothoracic Intensivist

Our cardiothoracic anesthesiology intensivists manage a 34-bed heart center intensive care unit in a multidisciplinary and cross-specialty model (combined medical and surgical cardiac critical care). The cardiothoracic intensivist is now the first call for cardiogenic shock consults in the hospital.3  Given that there is an approximate 30-min window to decide on extracorporeal life support cannulation during a cardiac arrest, a cardiac intensivist is in-house for these decisions 24/7. At Massachusetts General Hospital, bedside providers are encouraged to use our mobile app (application software; fig. 1) for cardiogenic shock consults for patients who may rapidly require escalation of care and possible mechanical circulatory support. Our cardiothoracic intensivists are then readily accessible through the app for acute airway support, placement of invasive monitors, point-of-care echocardiography/ultrasonography, initiation of a medical management plan (inotropic and vasopressor support), and ultimately a team discussion about extracorporeal life support if necessary. The cardiothoracic intensivist can also initiate the cannulation process (table 1).

Table 1.

Role of the Cardiothoracic Anesthesiology Intensivists (24/7 Care Model)

Role of the Cardiothoracic Anesthesiology Intensivists (24/7 Care Model)
Role of the Cardiothoracic Anesthesiology Intensivists (24/7 Care Model)
Fig. 1.

Massachusetts General Hospital extracorporeal membrane oxygenation consult application.

Fig. 1.

Massachusetts General Hospital extracorporeal membrane oxygenation consult application.

Cardiothoracic anesthesiology intensivists have become experts in both transthoracic and transesophageal echocardiography.4,5  Within critical care, we now have over 10 yr of experience developing protocols/algorithms/guidelines.5  The National Board of Echocardiography now offers a new examination of special competence as well as diplomate status for any physician with subspecialty training in critical care medicine meeting specific criteria. There are also opportunities to sit for the examination of special competence in adult echocardiography and for the examination of special competence in advanced or basic perioperative transesophageal echocardiography (in addition to recertification examinations). These opportunities are important to maintain expertise and certification in echocardiography for the cardiothoracic anesthesiology intensivist. The ability to rapidly and safely use ultrasonography/echocardiography to support the clinical exam and make a diagnosis in the hemodynamically unstable patient has forced medical directors and fellowship directors to make this a key part of the clinical curriculum.6 

The range of consults for cardiogenic shock is quite broad. The successful management of young women in the obstetrical suite during cardiac arrests now involves the cardiothoracic intensivist.3  Similarly, as patients with ventricular assist devices require other procedures, the cardiothoracic intensivist may be called for consultations anywhere in the hospital from endoscopy to the interventional radiology suite. Heart, lung, and liver transplant patients now may also require extracorporeal life support for successful transplant surgery (pre- and postsurgery) and transesophageal echocardiography support during transplant operations.7 

Echocardiography is now frequently used for extracorporeal membrane oxygenation cannulations to identify any contraindications to placement and guide cannula placement, and is part of standardized weaning protocols for extracorporeal membrane oxygenation/mechanical circulatory support.8  Echocardiography is also used for the management of percutaneous ventricular assist devices such as right- and left-side Impella (Abiomed Inc., USA) support in addition to the dual lumen cardiac support Protek Duo (Tandem Life, LivaNova, USA) device. Correct positioning and management of ventricular assist devices are obviously important for the cardiothoracic intensivist and require point-of-care ultrasonography.8  The use of echocardiography in following the progression of disease in the COVID-19 patients has not been defined, but clearly there will be a role.

Evolution of Treatments for Heart Failure and Shock

Just as new medications and interventions have caused an evolution in medical care, we have witnessed the need for even more expertise in anesthesiology critical care practitioners.9  In our program at Massachusetts General Hospital, cardiothoracic anesthesiology intensivists in a cross-specialty model also serve as the attending of record for medical cardiology critical care patients. Advances in patient care have led to survival of sicker patients and the need for more sophisticated physician expertise. Cardiac disease is a syndrome of the elderly, and we expect those over the age of 65 yr to double by 2030.10  Cardiac disease still makes up one third of deaths in the United States.11  In a recent multicentered study by Bohula et al., 41.3% of patients admitted to a cardiac intensive care unit had heart failure listed as part of their presentation. In fact, the primary admission indication to a current cardiac intensive care unit is now respiratory failure and shock in patients with heart failure.12  Septic shock, acute kidney injury, and respiratory failure are just a few of the growing noncardiac diagnoses in “cardiac” patients in the cardiac intensive care unit in a study by Sinha et al. reviewing Medicare data from 2000 to 2013.13 

The understanding and management of downstream organ insufficiency therefore are now part of routine cardiac critical care. The mortality is now also driven by the overlay of these noncardiac conditions with mortality rates exceeding 20% in patients with respiratory failure (24%) and renal replacement therapy (35%).12  This truly challenges the previous cardiac critical care model divided by department/division along clinical service lines and forces a new model of patient- and family-centered care requiring exemplary collaboration and communication. It relies on experts with an understanding of neurophysiology, critical illness myopathy/polyneuropathy, respiratory failure, and renal failure. The evolution of cardiac critical care has therefore continued and become even more significant in terms of specialization needs based on the American Heart Association Scientific Statement of 2012.14  Approximately 34% of patients in a multicenter network of tertiary cardiac intensive care units in North America are now managed with a mechanical device during their intensive care unit stay.15 

Brief History of the Use of Extracorporeal Membrane Oxygenation

The “mechanical heart and lung apparatus” was created in 1951 to provide life support for patients with acute cardiac and respiratory failure, but these “direct contact” oxygenators caused trauma to blood and “rarely could be used for more than a few hours” before creating severe complications.16–18  Membrane oxygenators were tested in animals, and by the mid to late 1960s, there were materials and devices that could be used for “days rather than hours.”19–21  Physicians using a Bramson membrane heart-lung machine provided partial venoarterial and venovenous extracorporeal membrane oxygenation to adults with cardiogenic shock and to patients who were hypoxemic on 100% fraction of inspired oxygen for respiratory failure.22,23  The first survivor of venoarterial extracorporeal membrane oxygenation was a young trauma victim described in 1972.24  Subsequently, partial venoarterial extracorporeal membrane oxygenation was used to support a 2-yr-old boy with cardiogenic shock postcongenital heart surgery25  and was used for neonatal respiratory failure.26  Finally, venoarterial extracorporeal membrane oxygenation with conventional ventilation was compared to conventional ventilation alone in patients with severe acute respiratory failure in the late 1970s; survival rates were very poor in both groups.27  These poor results led to a decrease in research utilizing extracorporeal membrane oxygenation; research did not really resume for another decade.18 

Since 2009, enthusiasm and the use of venovenous extracorporeal membrane oxygenation for acute respiratory failure has grown for multiple reasons, but particularly due to data from a large randomized controlled trial, to a post hoc analysis of the extracorporeal membrane oxygenation for severe acute respiratory distress syndrome trial and its utility in the pandemic of influenza A virus subtype hemagglutinin 1 neuraminidase 1.28–30  Venovenous extracorporeal membrane oxygenation has become an important treatment for acute respiratory failure, a bridge to lung transplant, and an aide in managing pulmonary vascular disease and is thus increasingly utilized in major centers worldwide.31 

Extracorporeal Membrane Oxygenation by Anesthesiology Cardiothoracic Critical Care Specialists

In a previous era, the cannulation, management, and weaning of mechanical circulatory support rested solely on the cardiac surgery team. We have now seen a shift toward a more collaborative team based critical care approach to management.32  In at least five major centers in the United States (Emory University, Atlanta, Georgia; University of Pennsylvania, Philadelphia, Pennsylvania; Massachusetts General Hospital, Boston, Massachusetts; Vanderbilt University, Nashville, Tennessee; and University of Pittsburgh, Pittsburgh, Pennsylvania), critical care cardiothoracic anesthesiologists play a major role in placement of the extracorporeal membrane oxygenation cannula as well as management of these patients. Currently, bedside cannulation is performed with echocardiography guidance for wire and catheter placement for venoarterial and venovenous extracorporeal membrane oxygenation. Critical care cardiothoracic anesthesiologists at our institution have now started to participate in percutaneous venoarterial and venovenous extracorporeal membrane oxygenation cannulation. Venovenous extracorporeal membrane oxygenation decannulation is currently performed by the critical care team, but venoarterial extracorporeal membrane oxygenation decannulation is currently performed by either a cardiac or vascular surgeon at our institution.

Mechanical Ventilation during Venovenous Extracorporeal Membrane Oxygenation

While managing mechanical ventilation has always been an important role for all intensivists, ventilation during extracorporeal membrane oxygenation may be unique and is now being studied in terms of what optimal mechanical ventilation is during extracorporeal membrane oxygenation.33  The use of low tidal volumes during lung protective ventilation can lead to respiratory acidosis, which is treated with either respiratory rates up to 30 per minute in some centers or extracorporeal carbon dioxide removal by venovenous extracorporeal membrane oxygenation.33  The use of venovenous extracorporeal membrane oxygenation in acute respiratory distress syndrome has documented the ability to achieve lower tidal volumes, lower driving pressures, and lower plateau pressures. The extracorporeal membrane oxygenation for a severe acute respiratory distress syndrome trial documented the largest reduction in mortality for patients enrolled who had respiratory acidosis and excessive ventilatory pressures but not those who were most hypoxemic.28  However, the optimal “lung protective” settings during venovenous extracorporeal membrane oxygenation are not known and need to be tested.

The optimal ventilator settings and weaning criteria for the COVID-19 patients is not known. The increased prevalence of patients with obesity in the COVID-19 respiratory failure cohort suggests that esophageal manometry and/or electrical impedance tomography may be helpful in determining optimal positive end-expiratory pressure and for documenting the work of breathing during weaning.34  The utility of extracorporeal membrane oxygenation in this pandemic is just beginning to be explored. The early, preliminary findings regarding venovenous extracorporeal membrane oxygenation in COVID-19 patients are discussed below.

Venovenous Extracorporeal Membrane Oxygenation in COVID-19 Patients

The use and success of venovenous extracorporeal membrane oxygenation in COVID-19 patients will most likely depend on the preparedness of the healthcare system where the patients reside.35  A recent review of extracorporeal membrane oxygenation preparedness for this outbreak suggests key variables are a multidisciplinary team who are trained in the care of extracorporeal membrane oxygenation patients, adequate supplies, clustering of patients with COVID-19 requiring extracorporeal membrane oxygenation, protocols for weaning and decannulation, staff support, ethical consideration, quality assurance, and collaborative research.36  Given the necessary provider expertise and overall resources required for this patient population, it has become quite apparent that it is advantageous to have high-volume COVID-19 critical care regional centers that offer extracorporeal membrane oxygenation to support smaller community programs. Cardiothoracic critical care anesthesiologists sit on review panels helping to decide which patients should be triaged to centers of excellence that offer advanced medical and mechanical therapies like inhaled nitric oxide and extracorporeal membrane oxygenation. Point-of-care ultrasound is recommended to place the cannula but is also recommended for daily surveillance of the lungs, right and left heart, abdomen, and extremities.4,5  The first successfully treated venovenous extracorporeal membrane oxygenation patient with COVID-19 in Washington was published as a case report recently, and authors included pulmonologists, anesthesiologists, infectious disease physicians, hematologists, cardiologists, and cardiac surgeons, suggesting the breadth of organ dysfunction in these patients. The patient required 160 h of extracorporeal membrane oxygenation support and was successfully extubated to room air.37 

COVID-19 and Venoarterial Extracorporeal Membrane Oxygenation

As noted in several very recent publications, patients with underlying cardiovascular disease tend to have a higher mortality,38  and mortality was significantly higher in patients with elevated troponin levels, who also were older and had higher rates of comorbidities.39  A COVID-19–positive patient with myocarditis who does not have the typical respiratory disease may require venoarterial extracorporeal membrane oxygenation, just as we have seen with influenza as well as with parvovirus B-19 infections.40,41  Other manifestations of this infection appear to be acute coronary syndromes, arrhythmias, and exacerbation of heart failure.42  While the focus of this disease has clearly been on acute respiratory distress syndrome, we are now starting to understand that there are significant cardiovascular complications as well. The initiation of inotropic support and venoarterial extracorporeal membrane oxygenation in our program has been based largely on serial echocardiography examinations and invasive cardiac monitoring by the intensivist team. Finally, it is important to remember that more patients die of cardiovascular causes than respiratory failure in influenza epidemics,43  and this may be true for the COVID-19 pandemic.

As more data are collected, the role for venoarterial extracorporeal membrane oxygenation and other mechanical devices will become clearer. Our current cardiothoracic intensivists are part of every respiratory or cardiac hospital shock call for possible extracorporeal membrane oxygenation in patients with COVID-19 (prearrest). As a team, we made the decision not to offer extracorporeal cardiopulmonary resuscitation for this current patient population. In addition to deciding on options for advanced mechanical devices, we also support the other critical care teams (including our general anesthesiology intensivists) with cardiogenic shock management, transthoracic echocardiography/transesophageal echocardiography support if needed, and initiation of extracorporeal membrane oxygenation if warranted. All patients who are placed on venoarterial extracorporeal membrane oxygenation are then managed in our heart center intensive care unit with our specialized cardiothoracic intensivists.

Speculation Regarding Future Roles

The current pandemic leads us to speculate which roles for the cardiothoracic critical care anesthesiologists will grow after the surge. A core group of cardiothoracic critical care anesthesiologists should be utilized to remotely monitor all community hospitals in a network and selectively triage patients who may benefit from the growing field of mechanical assist devices. Cardiothoracic critical care anesthesiologists would be part of the intensive care teams but also the echocardiography teams utilized in hospitals, providing day and night consultations in the operating rooms, in intensive care units, and before discharge. We also expect these experts to offer physical care outside of their primary hospital in the form of mobile shock teams in the future. Cardiothoracic critical care anesthesiologists at the University of Pennsylvania have taken a leading role in this arena by offering a mobile venovenous extracorporeal membrane oxygenation service.44,45  This model will likely continue to expand into larger mobile shock teams as well to care for patients in cardiogenic shock. If venovenous extracorporeal membrane oxygenation is improved and requires less sedation and allows more mobility, it may become the preferred treatment for respiratory failure, rather than mechanical ventilation. There could be a significant increased need for cardiothoracic critical care anesthesiologists for cannulation, oversight, and weaning of respiratory failure patients.

Conclusions

Anesthesiologists involved in cardiothoracic critical care have embraced this new role as experts in the management of cardiogenic shock and extracorporeal membrane oxygenation. The current pandemic highlights that respiratory failure is just one manifestation of the multiorgan failure system commonly seen in today’s critically ill patients. Optimal treatment involves expanding our knowledge and involvement in innovations. The barriers that anesthesiologists face in critical care mentioned by Hanson et al. in 2001 in Anesthesiology still exist.2  Compensation differences for anesthesiologists in the operating room versus those in the intensive care unit, lower representation in critical care medicine as a specialty, and the requirement for continuous night and weekend coverage for patient care in high-intensity critical care programs continue to persist. However, we have made tremendous progress as a specialty, particularly in cardiothoracic critical care as the interest and exposure to this new field of intensive care medicine expands for our programs. Finally, it is imperative that we bring our residents and fellows into this exciting field of cardiothoracic critical care. Currently, both our cardiac anesthesiology and critical care fellows rotate in the heart center intensive care unit during their fellowships. With an attending physician, they respond to all hospital shock calls. Anesthesiology residents are now receiving more exposure to this field than ever before.

Research Support

Support was provided solely from institutional and/or departmental sources.

Competing Interests

The authors declare no competing interests.

References

1.
Grenvik
A
.
Certification of special competence in critical care medicine as a new subspecialty. A status report.
Crit Care Med
.
1978
;
6
:
355
9
2.
Hanson
CW
III
,
Durbin
CG
Jr
,
Maccioli
GA
,
Deutschman
CS
,
Sladen
RN
,
Pronovost
PJ
,
Gattinoni
L
.
The anesthesiologist in critical care medicine: Past, present, and future.
Anesthesiology
.
2001
;
95
:
781
8
3.
Bernstein
SN
,
Cudemus-Deseda
GA
,
Ortiz
VE
,
Goodman
A
,
Jassar
AS
.
Case 33-2019: A 35-year-old woman with cardiopulmonary arrest during cesarean section.
N Engl J Med
.
2019
;
381
:
1664
73
4.
Frankel
HL
,
Kirkpatrick
AW
,
Elbarbary
M
,
Blaivas
M
,
Desai
H
,
Evans
D
,
Summerfield
DT
,
Slonim
A
,
Breitkreutz
R
,
Price
S
,
Marik
PE
,
Talmor
D
,
Levitov
A
.
Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients-Part I: General ultrasonography.
Crit Care Med
.
2015
;
43
:
2479
502
5.
Vieillard-Baron
A
,
Millington
SJ
,
Sanfilippo
F
,
Chew
M
,
Diaz-Gomez
J
,
McLean
A
,
Pinsky
MR
,
Pulido
J
,
Mayo
P
,
Fletcher
N
.
A decade of progress in critical care echocardiography: A narrative review.
Intensive Care Med
.
2019
;
45
:
770
88
6.
Galarza
L
,
Wong
A
,
Malbrain
MLNG
.
The state of critical care ultrasound training in Europe: A survey of trainers and a comparison of available accreditation programmes.
Anaesthesiol Intensive Ther
.
2017
;
49
:
382
6
7.
Vanneman
MW
,
Dalia
AA
,
Crowley
JC
,
Luchette
KR
,
Chitilian
HV
,
Shelton
KT
.
A focused transesophageal echocardiography protocol for intraoperative management during orthotopic liver transplantation.
J Cardiothorac Vasc Anesth
.
2020
.
S1053-0770(20)30089-6
8.
Platts
DG
,
Sedgwick
JF
,
Burstow
DJ
,
Mullany
DV
,
Fraser
JF
.
The role of echocardiography in the management of patients supported by extracorporeal membrane oxygenation.
J Am Soc Echocardiogr
.
2012
;
25
:
131
41
9.
Fuster
V
.
The (r)evolution of the CICU: Better for the patient, better for education.
J Am Coll Cardiol
.
2018
;
72
:
2269
71
10.
Angus
DC
,
Barnato
AE
,
Linde-Zwirble
WT
,
Weissfeld
LA
,
Watson
RS
,
Rickert
T
,
Rubenfeld
GD
;
Robert Wood Johnson Foundation ICU End-Of-Life Peer Group
.
Use of intensive care at the end of life in the United States: An epidemiologic study.
Crit Care Med
.
2004
;
32
:
638
43
11.
Benjamin
EJ
,
Virani
SS
,
Callaway
CW
,
Chamberlain
AM
,
Chang
AR
,
Cheng
S
,
Chiuve
SE
,
Cushman
M
,
Delling
FN
,
Deo
R
,
de Ferranti
SD
,
Ferguson
JF
,
Fornage
M
,
Gillespie
C
,
Isasi
CR
,
Jiménez
MC
,
Jordan
LC
,
Judd
SE
,
Lackland
D
,
Lichtman
JH
,
Lisabeth
L
,
Liu
S
,
Longenecker
CT
,
Lutsey
PL
,
Mackey
JS
,
Matchar
DB
,
Matsushita
K
,
Mussolino
ME
,
Nasir
K
,
O’Flaherty
M
,
Palaniappan
LP
,
Pandey
A
,
Pandey
DK
,
Reeves
MJ
,
Ritchey
MD
,
Rodriguez
CJ
,
Roth
GA
,
Rosamond
WD
,
Sampson
UKA
,
Satou
GM
,
Shah
SH
,
Spartano
NL
,
Tirschwell
DL
,
Tsao
CW
,
Voeks
JH
,
Willey
JZ
,
Wilkins
JT
,
Wu
JH
,
Alger
HM
,
Wong
SS
,
Muntner
P
;
American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee
.
Heart disease and stroke statistics-2018 update: A report from the American Heart Association.
Circulation
.
2018
;
137
:
e67
e492
12.
Bohula
EA
,
Katz
JN
,
van Diepen
S
,
Alviar
CL
,
Baird-Zars
VM
,
Park
JG
,
Barnett
CF
,
Bhattal
G
,
Barsness
GW
,
Burke
JA
,
Cremer
PC
,
Cruz
J
,
Daniels
LB
,
DeFilippis
A
,
Granger
CB
,
Hollenberg
S
,
Horowitz
JM
,
Keller
N
,
Kontos
MC
,
Lawler
PR
,
Menon
V
,
Metkus
TS
,
Ng
J
,
Orgel
R
,
Overgaard
CB
,
Phreaner
N
,
Roswell
RO
,
Schulman
SP
,
Snell
RJ
,
Solomon
MA
,
Ternus
B
,
Tymchak
W
,
Vikram
F
,
Morrow
DA
;
Critical Care Cardiology Trials N: Demographics, Care Patterns, and Outcomes of Patients Admitted to Cardiac Intensive Care Units
.
The Critical Care Cardiology Trials Network Prospective North American Multicenter Registry of Cardiac Critical Illness
JAMA Cardiol
.
2019
;
4
:
928
35
13.
Sinha
SS
,
Sjoding
MW
,
Sukul
D
,
Prescott
HC
,
Iwashyna
TJ
,
Gurm
HS
,
Cooke
CR
,
Nallamothu
BK
.
Changes in primary noncardiac diagnoses over time among elderly cardiac intensive care unit patients in the United States.
Circ Cardiovasc Qual Outcomes
.
2017
;
10
:
e003616
14.
Morrow
DA
,
Fang
JC
,
Fintel
DJ
,
Granger
CB
,
Katz
JN
,
Kushner
FG
,
Kuvin
JT
,
Lopez-Sendon
J
,
McAreavey
D
,
Nallamothu
B
,
Page
RL
II
,
Parrillo
JE
,
Peterson
PN
,
Winkelman
C
;
American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, Council on Clinical Cardiology, Council on Cardiovascular Nursing, and Council on Quality of Care and Outcomes Research
.
Evolution of critical care cardiology: Transformation of the cardiovascular intensive care unit and the emerging need for new medical staffing and training models: A scientific statement from the American Heart Association.
Circulation
.
2012
;
126
:
1408
28
15.
Berg
DD
,
Barnett
CF
,
Kenigsberg
BB
,
Papolos
A
,
Alviar
CL
,
Baird-Zars
VM
,
Barsness
GW
,
Bohula
EA
,
Brennan
J
,
Burke
JA
,
Carnicelli
AP
,
Chaudhry
SP
,
Cremer
PC
,
Daniels
LB
,
DeFilippis
AP
,
Gerber
DA
,
Granger
CB
,
Hollenberg
S
,
Horowitz
JM
,
Gladden
JD
,
Katz
JN
,
Keeley
EC
,
Keller
N
,
Kontos
MC
,
Lawler
PR
,
Menon
V
,
Metkus
TS
,
Miller
PE
,
Nativi-Nicolau
J
,
Newby
LK
,
Park
JG
,
Phreaner
N
,
Roswell
RO
,
Schulman
SP
,
Sinha
SS
,
Snell
RJ
,
Solomon
MA
,
Teuteberg
JJ
,
Tymchak
W
,
van Diepen
S
,
Morrow
DA
.
Clinical practice patterns in temporary mechanical circulatory support for shock in the Critical Care Cardiology Trials Network (CCCTN) Registry.
Circ Heart Fail
.
2019
;
12
:
e006635
16.
Miller
BJ
,
Gibbon
JH
Jr
,
Gibbon
MH
.
Recent advances in the development of a mechanical heart and lung apparatus.
Ann Surg
.
1951
;
134
:
694
708
17.
Lim
MW
.
The history of extracorporeal oxygenators.
Anaesthesia
.
2006
;
61
:
984
95
18.
Featherstone
PJ
,
Ball
CM
.
The early history of extracorporeal membrane oxygenation.
Anaesth Intensive Care
.
2018
;
46
:
555
7
19.
Bramson
ML
,
Osborn
JJ
,
Main
FB
,
O’Brien
MF
,
Wright
JS
,
Gerbode
F
.
A new disposable membrane oxygenator with integral heat exchange.
J Thorac Cardiovasc Surg
.
1965
;
50
:
391
400
20.
Landé
AJ
,
Dos
SJ
,
Carlson
RG
,
Perschau
RA
,
Lange
RP
,
Sonstegard
LJ
,
Lillehei
CW
.
A new membrane oxygenator-dialyzer.
Surg Clin North Am
.
1967
;
47
:
1461
70
21.
Kolobow
T
,
Zapol
W
,
Pierce
J
.
High survival and minimal blood damage in lambs exposed to long term (1 week) veno-venous pumping with a polyurethane chamber roller pump with and without a membrane blood oxygenator.
Trans Am Soc Artif Intern Organs
.
1969
;
15
:
172
7
22.
Hill
JD
,
Bramson
ML
,
Rapaport
E
,
Scheinman
M
,
Osborn
JJ
,
Gerbode
F
.
Experimental and clinical experiences with prolonged oxygenation and assisted circulation.
Ann Surg
.
1969
;
170
:
448
59
23.
Hill
JD
,
Fallat
R
,
Cohn
K
,
Dontigny
L
,
Bramson
ML
,
Osborn
JJ
,
Gerbode
F
.
Clinical cardiopulmonary dynamics during prolonged extracorporeal circulation for acute respiratory insufficiency.
Trans Am Soc Artif Intern Organs
.
1971
;
17
:
355
61
24.
Hill
JD
,
O’Brien
TG
,
Murray
JJ
,
Dontigny
L
,
Bramson
ML
,
Osborn
JJ
,
Gerbode
F
.
Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome). Use of the Bramson membrane lung.
N Engl J Med
.
1972
;
286
:
629
34
25.
Bartlett
RH
,
Gazzaniga
AB
,
Fong
SW
,
Burns
NE
.
Prolonged extracorporeal cardiopulmonary support in man.
J Thorac Cardiovasc Surg
.
1974
;
68
:
918
32
26.
Bartlett
RH
,
Gazzaniga
AB
,
Jefferies
MR
,
Huxtable
RF
,
Haiduc
NJ
,
Fong
SW
.
Extracorporeal membrane oxygenation (ECMO) cardiopulmonary support in infancy.
Trans Am Soc Artif Intern Organs
.
1976
;
22
:
80
93
27.
Zapol
WM
,
Snider
MT
,
Hill
JD
,
Fallat
RJ
,
Bartlett
RH
,
Edmunds
LH
,
Morris
AH
,
Peirce
EC
II
,
Thomas
AN
,
Proctor
HJ
,
Drinker
PA
,
Pratt
PC
,
Bagniewski
A
,
Miller
RG
Jr
.
Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study.
JAMA
.
1979
;
242
:
2193
6
28.
Combes
A
,
Hajage
D
,
Capellier
G
,
Demoule
A
,
Lavoué
S
,
Guervilly
C
,
Da Silva
D
,
Zafrani
L
,
Tirot
P
,
Veber
B
,
Maury
E
,
Levy
B
,
Cohen
Y
,
Richard
C
,
Kalfon
P
,
Bouadma
L
,
Mehdaoui
H
,
Beduneau
G
,
Lebreton
G
,
Brochard
L
,
Ferguson
ND
,
Fan
E
,
Slutsky
AS
,
Brodie
D
,
Mercat
A
;
EOLIA Trial Group, REVA, and ECMONet
.
Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome.
N Engl J Med
.
2018
;
378
:
1965
75
29.
Goligher
EC
,
Tomlinson
G
,
Hajage
D
,
Wijeysundera
DN
,
Fan
E
,
Jüni
P
,
Brodie
D
,
Slutsky
AS
,
Combes
A
.
Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome and posterior probability of mortality benefit in a post hoc Bayesian analysis of a randomized clinical trial.
JAMA
.
2018
;
320
:
2251
9
30.
DeLaney
E
,
Smith
MJ
,
Harvey
BT
,
Pelletier
KJ
,
Aquino
MP
,
Stone
JM
,
Jean-Baptiste
GC
,
Johnson
JH
.
Extracorporeal life support for pandemic influenza: The role of extracorporeal membrane oxygenation in pandemic management.
J Extra Corpor Technol
.
2010
;
42
:
268
80
31.
Brodie
D
,
Slutsky
AS
,
Combes
A
.
Extracorporeal life support for adults with respiratory failure and related indications: A review.
JAMA
.
2019
;
322
:
557
68
32.
Dalia
AA
,
Ortoleva
J
,
Fiedler
A
,
Villavicencio
M
,
Shelton
K
,
Cudemus
GD
.
Extracorporeal membrane oxygenation is a team sport: Institutional survival benefits of a formalized ECMO team
J Cardiothorac Vasc Anesth
.
2018
;
33
:
902
7
33.
Abrams
D
,
Schmidt
M
,
Pham
T
,
Beitler
JR
,
Fan
E
,
Goligher
EC
,
McNamee
JJ
,
Patroniti
N
,
Wilcox
ME
,
Combes
A
,
Ferguson
ND
,
McAuley
DF
,
Pesenti
A
,
Quintel
M
,
Fraser
J
,
Hodgson
CL
,
Hough
CL
,
Mercat
A
,
Mueller
T
,
Pellegrino
V
,
Ranieri
VM
,
Rowan
K
,
Shekar
K
,
Brochard
L
,
Brodie
D
.
Mechanical ventilation for acute respiratory distress syndrome during extracorporeal life support. Research and practice.
Am J Respir Crit Care Med
.
2020
;
201
:
514
25
34.
Florio
G
,
Redaelli
S
,
Shelton
K
,
Droghi
MT
,
Santiago
R
,
Marrazzo
F
,
Kacmarek
R
,
Berra
L
.
Interpretation of transpulmonary pressure measurements in a patient with acute life-threatening pulmonary edema.
Am J Respir Crit Care Med
.
2018
;
198
:
e114
5
35.
Ramanathan
K
,
Antognini
D
,
Combes
A
,
Paden
M
,
Zakhary
B
,
Ogino
M
,
MacLaren
G
,
Brodie
D
,
Shekar
K
.
Planning and provision of ECMO services for severe ARDS during the COVID-19 pandemic and other outbreaks of emerging infectious diseases.
Lancet Respir Med
.
2020
;
8
:
518
26
36.
Bartlett
RH
,
Ogino
MT
,
Brodie
D
,
McMullan
DM
,
Lorusso
R
,
MacLaren
G
,
Stead
CM
,
Rycus
P
,
Fraser
JF
,
Belohlavek
J
,
Salazar
L
,
Mehta
Y
,
Raman
L
,
Paden
ML
.
Initial ELSO guidance document: ECMO for COVID-19 patients with severe cardiopulmonary failure.
ASAIO J
.
2020
;
66
:
472
4
37.
Hartman
ME
,
Hernandez
RA
,
Patel
K
,
Wagner
TE
,
Trinh
T
,
Lipke
AB
,
Yim
ET
,
Pulido
JN
,
Pagel
JM
,
Youssef
SJ
,
Mignone
JL
.
COVID-19 respiratory failure: Targeting inflammation on VV-ECMO support.
ASAIO J
.
2020
;
10
1097
38.
Mehra
MR
,
Desai
SS
,
Kuy
S
,
Henry
TD
,
Patel
AN
.
Cardiovascular disease, drug therapy, and mortality in Covid-19.
New Eng J Med
.
2020
.
2007621
39.
Guo
T
,
Fan
Y
,
Chen
M
,
Wu
X
,
Zhang
L
,
He
T
,
Wang
H
,
Wan
J
,
Wang
X
,
Lu
Z
.
Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19).
JAMA Cardiol
.
2020
.
201017
40.
Inciardi
RM
,
Lupi
L
,
Zaccone
G
,
Italia
L
,
Raffo
M
,
Tomasoni
D
,
Cani
DS
,
Cerini
M
,
Farina
D
,
Gavazzi
E
,
Maroldi
R
,
Adamo
M
,
Ammirati
E
,
Sinagra
G
,
Lombardi
CM
,
Metra
M
.
Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19).
JAMA Cardiol
.
2020
;
10
:
1096
41.
Fung
G
,
Luo
H
,
Qiu
Y
,
Yang
D
,
McManus
B
.
Myocarditis.
Circ Res
.
2016
;
118
:
496
514
42.
Madjid
M
,
Safavi-Naeini
P
,
Solomon
SD
,
Vardeny
O
.
Potential effects of coronaviruses on the cardiovascular system: A review.
JAMA Cardiol
.
2020
;
10
:
1286
43.
Madjid
M
,
Casscells
SW
.
Of birds and men: Cardiologists’ role in influenza pandemics.
Lancet
.
2004
;
364
:
1309
44.
Gutsche
J
,
Vernick
W
,
Miano
TA
;
Penn Lung Rescue
.
One-year experience with a mobile extracorporeal life support service.
Ann Thorac Surg
.
2017
;
104
:
1509
15
45.
Gutsche
JT
,
Vernick
WJ
.
Cardiac and critical care anesthesiologists may be ideal members of the mobile ECMO team.
J Cardiothorac Vasc Anesth
.
2016
;
30
:
1439
40