We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Patients are the centre and the core of our system. We are professionals committed to quality care and our organizational structure breaks down the traditional boundaries between departments and professional groups, with an exclusive model of knowledge areas.
Would you like to know what your stay at Vall d'Hebron will be like? Here you will find all the information.
The commitment of Vall d'Hebron University Hospital to innovation allows us to be at the forefront of medicine, providing first class care adapted to the changing needs of each patient.
Patient with ECMO during rehabilitation in the ICU.
Extracorporeal membrane oxygenation (ECMO) replaces lung function and therefore allows patients to be active even if their lungs are not functioning.
Extracorporeal membrane oxygenation (ECMO) is a technique that improves the survival of patients with respiratory dysfunction in intensive care units. It is a complex procedure and the most severe cases may require long periods with ECMO, even for months. A multicenter study led by the Shock, Organ Dysfunction and Resuscitation research group at Vall d'Hebron Research Institute (VHIR) has shown that keeping ECMO patients awake, active and doing rehabilitation can improve their prognosis. This is a study in collaboration with the Pitié-Salpêtrière Hospital in Paris, the Karolinska Institute in Stockholm and the São João University Hospital in Porto and published in the journal Annals of the American Thoracic Society.
Since the beginning of the pandemic, Vall d'Hebron has been a reference in the use of ECMO in more than 125 patients with COVID-19. As these are very seriously ill patients, they are often sedated. "Despite this, even if their lungs are not functioning, it is possible to wake them up and perform active rehabilitation because the ECMO allows gas exchange as in breathing. In addition, the support can be adjusted according to the needs of each patient at each moment and increased while exercising", says Dr. Jordi Riera, director of the adult ECMO program at Vall d'Hebron University Hospital and principal investigator of the research group on Shock, Organ Dysfunction and Resuscitation at VHIR.
To understand the factors influencing the prognosis of ECMO patients and the benefits of the wake-up strategy, the research team conducted a study of 120 patients with COVID-19 respiratory dysfunction and ECMO requirements for more than 28 days. Among the results was the observation that, in patients who were cooperative and underwent rehabilitation and physiotherapy at some point during ECMO support, survival at six months was 78.8% and required less rehabilitation after discharge. In contrast, survival dropped to 41.4% in the most inactive cases.
"If they are awake, patients can interact with their relatives, which has cognitive and emotional benefits. In addition, if healthcare professionals can communicate with patients, a more accurate diagnosis can be made based on the symptoms they are explaining and, therefore, therapy can be better adjusted", argues Dr. Riera. This improvement in survival is also explained by the fact that waking patients up minimizes some complications. For example, they have fewer infections, thanks to the ability to cough, and less lung damage associated with ventilation is observed.
The study also observed that younger age favors survival. In addition, further research is needed to identify the characteristics of patients who require lung transplantation after COVID-19 as the only therapeutic option. The investigators emphasize that, despite requiring ECMO for one month, full recovery without the need for oxygen after support is possible.
It should be noted that the retrospective analysis only included patients who were on ECMO for more than 28 days and with the perspective of improvement, since mortality is higher in the most critical cases during the first weeks. Furthermore, despite being focused on patients with COVID-19, the researchers believe that these results could be generalizable to patients with respiratory dysfunction due to other causes.
More research to improve prognosis of ECMO patients
Vall d'Hebron is one of the world's leading centers in the use of ECMO due to the high number of patients treated. The quality of care stands out due to the adherence to the recommendations of international organizations, but also the participation in international research networks to improve survival and quality of life of patients.
Among these studies with Vall d'Hebron's participation is a paper recently published in American Journal of Respiratory and Critical Care Medicine as part of the PROTECMO study. This is an analysis of 652 patients from 41 centers focused on the risk of thrombus and bleeding associated with ECMO. Indeed, anticoagulation therapy is necessary while on support to prevent thrombus formation due to blood contact with an external surface, but guidelines are needed for the management of this treatment, as bleeding complications are common and transfusion is not without risk.
The risk of infections during ECMO is also an area of research interest. In this regard, the international study INFECMO has been launched. The trial, led by IRCCS Ca' Granda Ospedale Maggiore Policlinico in Milan and with the participation of Vall d'Hebron, seeks to understand the factors related to infections and the efficacy of different antibiotics for the treatment of this type of patient. Dr. Riera is the coordinator of the working group on infections in EuroELSO, the international reference society in ECMO.
The research shows that, in patients who are under sedation throughout the process, survival at six months is 41.4%, while in patients who are awake it is 78.8%.
Intensive Care Medicine, General Hospital
The acceptance of these terms implies that you give your consent to the processing of your personal data for the provision of the services you request through this portal and, if applicable, to carry out the necessary procedures with the administrations or public entities involved in the processing. You may exercise the mentioned rights by writing to web@vallhebron.cat, clearly indicating in the subject line “Exercise of LOPD rights”. Responsible entity: Vall d’Hebron University Hospital (Catalan Institute of Health). Purpose: Subscription to the Vall d’Hebron Barcelona Hospital Campus newsletter, where you will receive news, activities, and relevant information. Legal basis: Consent of the data subject. Data sharing: If applicable, with VHIR. No other data transfers are foreseen. No international transfer of personal data is foreseen. Rights: Access, rectification, deletion, and data portability, as well as restriction and objection to its processing. The user may revoke their consent at any time. Source: The data subject. Additional information: Additional information can be found at https://hospital.vallhebron.com/es/politica-de-proteccion-de-datos.