SACM - United Kingdom
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Item Restricted Effectiveness and Safety of Nitric Oxide in Paediatric ECMO Circuits: A Systematic Review.(Saudi Digital Library, 2025) Alamri, Ahmed Ali; Alqarni, Abdullah Abdulgani; Wang, Justin Qi YueeIntroduction: Extracorporeal membrane oxygenation (ECMO) supports neonates and children with severe cardiac or respiratory failure, but clot formation in the circuit remains a major complication. Nitric oxide (NO), with known antiplatelet and vasodilatory effects, is being explored as an adjunct to reduce thrombosis. This systematic review aimed to evaluate the effectiveness and safety of NO delivered via ECMO sweep gas in paediatric populations. Methods: This PROSPERO-registered systematic review searched Medline, PubMed, and TRIP for published studies on nitric oxide (NO) delivered via ECMO sweep gas in paediatric patients. The primary outcome was circuit clotting. Eligible designs included RCTs, cohort, pilot, and relevant animal studies. References were screened in EndNote, with duplicates removed. Quality was assessed using the Newcastle–Ottawa Scale for clinical studies and SYRCLE’s Risk of Bias tool for animal studies. Results: Four studies were included: three clinical and one preclinical. The addition of nitric oxide (NO) to the sweep gas in the ECMO circuit was associated with fewer clotting events, fewer circuit changes, and reduced use of fresh frozen plasma (FFP). Red blood cell and platelet transfusion requirements did not differ significantly between the NO-treated patients and the control group. Methaemoglobin levels were slightly elevated in the NO group but remained within safe clinical limits. Conclusion: NO may improve ECMO circuit performance and reduce clotting without increasing bleeding risk. However, existing studies are limited by small sample sizes and a lack of randomised controlled trials. Further high-quality trials are needed to confirm its clinical benefit.65 0Item Restricted Objective and Subjective Long-Term Cognitive Outcomes in COVID-19 Survivors Managed with ECMO: A Case Series(Royal Holloway, University of London, 2024) Alanazi, Abeer; Crabtree, AnnaCOVID-19 has been associated with significant health complications, including cognitive impairments, particularly among patients requiring intensive care interventions. A subset of these patients, especially those needing extracorporeal membrane oxygenation (ECMO), face heightened vulnerability due to prolonged Intensive Care Unit (ICU) stay and extended ECMO duration, placing them at an increased risk of developing post intensive care syndrome (PICS), a multifaceted condition that affects cognitive and psychological functions among other health- related domains. This study aims to investigate the cognitive screening outcomes and characteristics of cognitive impairments among COVID-19 survivors managed with ECMO, enhancing our understanding of cognitive outcomes in this high-risk group. Eighty-five COVID-19 patients who had been treated with ECMO were contacted after their ICU admission. The Telephone Montreal Cognitive Assessment (T-MoCA) was employed to detect cognitive impairment. Neuropsychological assessment was completed with ten survivors. A case series design was employed to characterise the cognitive profile of these ten COVID-19 survivors. The mean T-MoCA score for the 49 cohort was 16.20 (SD = 2.93), indicating cognitive impairment among COVID-19 survivors managed with ECMO. T-MoCA scores for the ten patients who completed neuropsychological assessments ranged from 10 to 19, with a mean score of 16.2 (SD = 2.94). The case series analysis demonstrated impairments across domains of attention, working memory, processing speed, and memory. Cognitive impairments are evident in COVID-19 survivors managed with ECMO, presenting cognitive profiles similar to those documented in acute respiratory distress syndrome (ARDS) patients (non-COVID-19). Key words: ICU, COVID-19, ECMO, Cognitive Impairment, PICS13 0Item Restricted ECMO in Management of Patients With ARDS in The Intensive Care Unit, Systematic Review(2022) Ahmed, Asiri; Zolfaghari, ParjamPurpose: The purpose of this study was to evaluate the efficacy of venovenous extracorporeal membrane oxygenation (ECMO) in comparison to conventional therapy in patients diagnosed with severe acute respiratory distress syndrome (ARDS). Methods: I carried out a systematic review of randomised controlled trials (RCTs) that were carried out after January 1st 2000, with the purpose of comparing extracorporeal membrane oxygenation (ECMO) to conventional therapy in patients with severe ARDS. Results: I were able to locate two randomised controlled trials (CESAR and EOLIA), and I merged the data from 429 patients. On day 90, 77 of the 214 patients in the ECMO-group (36%) and 103 of the 215 patients in the control group (48%) had passed away. 36 (17%) of the control patients required emergency cardiopulmonary bypass (ECMO) (35 in EOLIA and 1 in CESAR). The treatment failure at 90 days was defined as death in the ECMO-group and either death or crossover to ECMO in the control group. Patients who were randomly assigned to get ECMO had a greater number of days in which they survived outside of the intensive care unit and were free of respiratory, cardiovascular, renal, and neurological failure. The only meaningful treatment-covariate interaction found in subgroups was a decreased death rate with ECMO in patients who had failure of two organs or less at the time of randomization. Conclusions: In patients with severely severe ARDS, neither the EOLIA study nor the CESAR study were able to successfully demonstrate that ECMO resulted in a significant improvement in the mortality rate after 60 days.34 0