Acute and Critical Care

Review Article

Pulmonary
Awakening in extracorporeal membrane oxygenation as a bridge to lung transplantation: Su Hwan Lee; Acute Crit Care. 2022;37(1):26-34. Published online February 22, 2022; DOI: https://doi.org/10.4266/acc.2022.00031

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Although the rate of lung transplantation (LTx), the last treatment option for end-stage lung disease, is increasing, some patients waiting for LTx need a bridging strategy for LTx due to the limited number of available donor lungs. For a long time, mechanical ventilation has been employed as a bridge to LTx because the outcome of using extracorporeal membrane oxygenation (ECMO) as a bridging strategy has been poor. However, the outcome after mechanical ventilation as a bridge to LTx was poor compared with that in patients without bridges. With advances in technology and the accumulation of experience, the outcome of ECMO as a bridge to LTx has improved, and the rate of ECMO use as a bridging strategy has increased over time. However, whether the use of ECMO as a bridge to LTx can achieve survival rates similar to those of non-bridged LTx patients remains controversial. In 2010, one center introduced awake ECMO strategy for LTx bridging, and its use as a bridge to LTx has been showing favorable outcomes to date. Awake ECMO has several advantages, such as maintenance of physical activity, spontaneous breathing, avoidance of endotracheal intubation, and reduced use of sedatives and analgesics, but it may cause serious problems. Nonetheless, several studies have shown that awake ECMO performed by a multidisciplinary team is safe. In cases where ECMO or mechanical ventilation is required due to unavoidable exacerbation in patients awaiting LTx, the application of awake ECMO performed by an appropriately trained ECMO multi-disciplinary team can be useful.

Citations

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Delirium in critically ill COVID-19 patients: incidence, predictors, and outcomes in invasive mechanical ventilation with versus without ECMO support
Stella Seeger, Ismail Dalyanoglu, Johannes Nienhaus, Esma Yilmaz, Luis Jaime Vallejo Castano, Anna Maria Markser, Bernhard Korbmacher, Artur Lichtenberg, Hannan Dalyanoglu
Journal of Cardiothoracic Surgery.2026;[Epub] CrossRef
Innovative Approaches in Tracheal Resection and Anastomosis Surgery: Integrating Extracorporeal Membrane Oxygenation for Enhanced Safety
Joohyung Son, Bong Soo Son, Jong Myung Park, Jeong Su Cho, Yeongdae Kim, Hoseok I, Do Hyung Kim
Yonsei Medical Journal.2025; 66(5): 289. CrossRef
Sedation management and processed EEG-based solutions during venovenous extracorporeal membrane oxygenation: a narrative review of key challenges and potential benefits
Lajos Szentgyorgyi, Samuel Henry Howitt, Heather Iles-Smith, Bhuvaneswari Krishnamoorthy
Journal of Artificial Organs.2025; 28(3): 293. CrossRef
The Path Forward: A Review on Enhanced Recovery After Cardiothoracic Transplantation
Irene Bello, Laurens J. Ceulemans, Cristiano Amarelli
Transplant International.2025;[Epub] CrossRef
Development and application of a novel framework for mobility & rehabilitation under support of extracorporeal life support: The MUSECLS framework
Aaron H. Thrush, Samantha Tylor, Praveen Kumar Ghisulal, Vivek Kakar
Perfusion.2025;[Epub] CrossRef
Evolution of extracorporeal membrane oxygenation: historical milestones and advanced developments
Lajos Szentgyorgyi, Salman Pervaiz Butt, Bhuvaneswari Krishnamoorthy
The Journal of ExtraCorporeal Technology.2025; 57(4): 243. CrossRef
Extracorporeal membrane oxygenation as a bridge to lung transplantation: Practice patterns and patient outcomes
Hannah J. Rando, Jonathon P. Fanning, Sung-Min Cho, Bo S. Kim, Glenn Whitman, Errol L. Bush, Steven P. Keller
The Journal of Heart and Lung Transplantation.2024; 43(1): 77. CrossRef
Anesthetic considerations for perioperative ECMO in lung transplantation
Julien Fessler, Jaromir Vajter, Archer Kilbourne Martin
Best Practice & Research Clinical Anaesthesiology.2024; 38(1): 58. CrossRef
Nurses’ Interventions in Minimizing Adult Patient Vulnerability During Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation: An Integrative Review
Nuno Costa, Helga Rafael Henriques, Candida Durao
SAGE Open Nursing.2024;[Epub] CrossRef
Long-Term Follow-Up of Patients Needing Extracorporeal Membrane Oxygenation Following a Critical Course of COVID-19
Samuel Genzor, Pavol Pobeha, Martin Šimek, Petr Jakubec, Jan Mizera, Martin Vykopal, Milan Sova, Jakub Vaněk, Jan Praško
Life.2023; 13(4): 1054. CrossRef
Dangers in using beta-blockers in patients with venovenous extracorporeal membrane oxygenation
Diego Rodríguez Álvarez, Elena Pérez-Costa, Juan José Menéndez Suso
Acute and Critical Care.2022; 37(4): 683. CrossRef

Original Articles

Liver
The role of bilirubin to albumin ratio as a predictor for mortality in critically ill patients without existing liver or biliary tract disease: Ji Soo Choi, Kyung Soo Chung, Eun Hye Lee, Su Hwan Lee, Sang Hoon Lee, Song Yee Kim, Ji Ye Jung, Young Ae Kang, Moo Suk Park, Young Sam Kim, Joon Chang, Ah Young Leem; Acute Crit Care. 2020;35(1):24-30. Published online February 29, 2020; DOI: https://doi.org/10.4266/acc.2019.00738

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Abstract PDF

Background
Hyperbilirubinemia and hypoalbuminemia are frequently appeared and associated with poor prognosis in critically ill patients. We aim to evaluate the association between the bilirubin to albumin ratio and prognosis in intensive care unit (ICU) patients. Methods: This was a retrospective study of 731 patients who were admitted to the medical intensive care unit (MICU) at a tertiary-care center from July 2015 to September 2017. We analyzed the bilirubin to albumin ratio on admission to the MICU, including clinical characteristics and other examinations. Results: The overall 28-day survival of MICU patients was 69.1%. On univariate analysis, Acute Physiology and Chronic Health Evaluation (APACHE) II score (P<0.001), Sequential Organ Failure Assessment score (P<0.001), Simplified Acute Physiology Score II score (P<0.001), Creactive protein (P=0.015), and bilirubin/albumin ratio (P<0.001) were associated with mortality of ICU patients. The receiver operating characteristic curves for ICU patients mortality between bilirubin to albumin ratio and APACHE II score were not statistically significant (P=0.282). On multivariate analysis, higher APACHE II score (hazard ratio [HR], 1.05; 95% CI, 1.03 to 1.06; P<0.001) and bilirubin to albumin ratio (HR, 1.65; 95% CI, 1.23 to 2.20; P=0.001) were independently related to the ICU patient mortality. Conclusions: A higher bilirubin to albumin ratio was related to the unfavorable prognosis and mortality in critically ill patients.

Citations

Citations to this article as recorded by

Fetal and Neonatal Complications Associated With Acute Fatty Liver of Pregnancy
Shumaila J Ahmed, Sahar Mudassar, Sana Ali, Narmin Faryal, Tatheer Hasan, Samiha Samad
Cureus.2026;[Epub] CrossRef
Secondary Hepatic Dysfunction in Critically Ill Children: Prognostic Associations Beyond PRISM III and PELOD-2 Scores
Tuğba Gürsoy Koca, Abdulkerim Elmas, Ümüt Altuğ, Gürbüz Akçay, Hanife Bayramoğlu, Mustafa Akçam
Journal of Clinical Medicine.2026; 15(3): 1133. CrossRef
Development and evaluation of predictive performance of “organ failure assessment by ratio score” to predict sepsis mortality in Indian intensive care unit patients: An observational study
Vinay Gandhi Mukkelli, Puneet Khanna, Bikash R. Ray, Rahul Kumar Anand, Vimi Rewari, Ganga Prasad
Indian Journal of Anaesthesia.2026; 70(2): 326. CrossRef
Serum Bilirubin Levels and Mortality Risk: Evaluation of Prognostic Use in a High-Risk Intensive Care Population
Abdullah Şen, Mahmut Yaman, Tahir Fırat Zadeoğlu, Ercan Gündüz, Murat Orak, Cahfer Güloğlu, Şilan Göger Ülgüt, Sema Belek, Berçem Tugay Günel, Mehmet Üstündağ
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LivXAI-Net: An explainable AI framework for liver disease diagnosis with IoT-based real-time monitoring support
Deepak Kumar, Brijesh Bakariya, Chaman Verma, Zoltan Illes
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Bilirubin is not an independent predictor of mortality in patients admitted to intensive care with sepsis – A prospective, single-center cohort from South India
Jophin John, V. Arul Selvan, A. Senthil Vadivu, T. Ravishankar
International Journal of Critical Illness and Injury Science.2025; 15(4): 150. CrossRef
The bilirubin-to-albumin ratio as a potential prognostic biomarker for all-cause mortality in patients with acute decompensated cirrhosis: A prospective study
Hien Viet Quang Nguyen, Thang Viet Luong, Trung Nguyen Tran, Hai Nguyen Ngoc Dang, Hans L. Tillmann
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Toxicological Evaluation of Kaempferol and Linearolactone as Treatments for Amoebic Liver Abscess Development in Mesocricetus auratus
Luis Varela-Rodríguez, Fernando Calzada, José Velázquez-Domínguez, Verónica Hernández-Ramírez, Hugo Varela-Rodríguez, Elihú Bautista, Mayra Herrera-Martínez, Diana Pichardo-Hernández, Rodrigo Castellanos-Mijangos, Bibiana Chávez-Munguía, Patricia Talamás-
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Role of serum bilirubin-to-albumin ratio as a prognostic index in critically ill children
You Min Kang, Ga Eun Kim, Mireu Park, Jong Deok Kim, Min Jung Kim, Yoon Hee Kim, Kyung Won Kim, Myung Hyun Son, Soo Yeon Kim
Clinical and Experimental Pediatrics.2023; 66(2): 85. CrossRef
Association between total bilirubin/Albumin ratio and all-cause mortality in acute kidney injury patients: A retrospective cohort study
Ximei Huang, Yunhua Huang, Min Chen, Lin Liao, Faquan Lin, Eranga Sanjeewa Wijewickrama
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The value of albumin-related ratios in predicting disease severity and mortality in acute cholangitis
Bayram YEŞİL, Bünyamin SEVİM
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Hepatic dysfunction in critically ill patients
Jeong Hoon Yang
Acute and Critical Care.2020; 35(1): 44. CrossRef

Rapid response system
A Pilot Study of the Effectiveness of Medical Emergency System Implementation at a Single Center in Korea: Su Hwan Lee, Ah Young Leem, Youngok Nho, Young Ah Kim, Kyung Duck Kim, Young Sam Kim, Se Kyu Kim, Kyung Soo Chung; Korean J Crit Care Med. 2017;32(2):133-141. Published online May 16, 2017; DOI: https://doi.org/10.4266/kjccm.2016.01011

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Background
An automatic alarm system was developed was developed for unexpected vital sign instability in admitted patients to reduce staffing needs and costs related to rapid response teams. This was a pilot study of the automatic alarm system, the medical emergency system (MES), and the aim of this study was to determine the effectiveness of the MES before expanding this system to all departments.
Methods
This retrospective, observational study compared the performance of patients admitted to the pulmonary department at a single center using patient data from three 3-month periods (before implementation of the MES: December 2013-February 2014; after implementation of the MES: December 2014-February 2015 and December 2015-February 2016).
Results
A total of 571 patients were admitted to the pulmonary department during the three observation periods. During this pilot study, the MES automatically issued 568 alarms for 415 admitted patients. There was no significant difference in the rate of cardiopulmonary resuscitation (CPR) before and after application of the MES. The mortality rate also did not change. However, it appeared that CPR was prevented in four patients admitted from the general ward to the intensive care unit (ICU) during MES implementation. The median length of hospital stay and median length of ICU stay were not significantly different before and after MES implementation.
Conclusions
Although we did not find a significant improvement in outcomes upon MES implementation, the CPR rate and mortality rate did not increase despite increased comorbidities. This was a small pilot study, and, based on these results, we believe that the MES may have significant effects in longer-term and larger-scale studies.

Citations

Citations to this article as recorded by

Society of Critical Care Medicine Guidelines on Recognizing and Responding to Clinical Deterioration Outside the ICU: 2023
Kimia Honarmand, Randy S. Wax, Daleen Penoyer, Geoffery Lighthall, Valerie Danesh, Bram Rochwerg, Michael L. Cheatham, Daniel P. Davis, Michael DeVita, James Downar, Dana Edelson, Alison Fox-Robichaud, Shigeki Fujitani, Raeann M. Fuller, Helen Haskell, Ma
Critical Care Medicine.2024; 52(2): 314. CrossRef
Rapid response systems in Korea
Bo Young Lee, Sang-Bum Hong
Acute and Critical Care.2019; 34(2): 108. CrossRef

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