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Hileman BA, Martucci G, Subramanian H. Metabolic support for patients on extra-corporeal membrane oxygenation. Curr Opin Crit Care 2024; 30:305-310. [PMID: 38841988 DOI: 10.1097/mcc.0000000000001162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW The purpose of the review is to summarize recent research on metabolic support during extracorporeal membrane oxygenation. In this review, we cover the evidence on nutritional supplementation, both the route of supplementation, timing of initiation of supplementation as well as quantities of supplementation needed. In addition, we discuss the recent trend in awake extracorporeal membrane oxygenation (ECMO) and its benefits to patients. RECENT FINDINGS As ECMO use continues to increase over the last few years, for both cardiovascular as well as respiratory failure, the need to optimize the metabolic states of patients has arisen. Increasing evidence has pointed towards this hitherto unexplored domain of patient care having a large impact on outcomes. Additionally, strategies such as awake ECMO for select patients has allowed them to preserve muscle mass which could aid in a faster recovery. SUMMARY There is a role of optimal metabolic support in the early recovery of patients on ECMO that is currently under-recognized. Future directions of research that aim to improve post ECMO outcomes must focus on this area.
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Affiliation(s)
| | - Gennaro Martucci
- Department of Anesthesia and Intensive Care, ISMETT, Palermo, Italy
| | - Harikesh Subramanian
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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2
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Parlow S, Fernando SM, Pugliese M, Qureshi D, Talarico R, Sterling LH, van Diepen S, Herridge MS, Price S, Brodie D, Fan E, McIsaac DI, Di Santo P, Jung RG, Slutsky AS, Scales DC, Combes A, Hibbert B, Thiele H, Tanuseputro P, Mathew R. Resource Utilization and Costs Associated With Cardiogenic Shock Complicating Myocardial Infarction: A Population-Based Cohort Study. JACC. ADVANCES 2024; 3:101047. [PMID: 39050814 PMCID: PMC11268098 DOI: 10.1016/j.jacadv.2024.101047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 03/18/2024] [Accepted: 04/23/2024] [Indexed: 07/27/2024]
Abstract
Background Cardiogenic shock due to acute myocardial infarction (AMI-CS) is associated with significant short- and long-term morbidity and mortality. Despite this, little is known about associated cost. Objectives The purpose of this study was to evaluate the health care costs and resource use associated with AMI-CS using administrative data from the province of Ontario, Canada. Methods This was a retrospective cohort study of adult patients with AMI-CS from April 2009 to March 2019. One-year costs following index admission were reported at an individual level. We used generalized linear models to identify factors associated with increased cost. We stratified patients by revascularization strategy to compare cost in each group and examined total cost at a patient level per individual fiscal year. Results We included 9,789 consecutive patients with AMI-CS across 135 centers in Ontario (mean age 70.5 years; 67.7% male). Mortality in-hospital was 30.2%, and mortality at 2 years was 45.9%. The median inpatient cost per patient was $23,912 (IQR: $12,234-$41,833) with a median total 1-year cost of $37,913 (IQR: $20,113-$66,582). The median 1-year cost was $17,730 (IQR: $9,323-$38,379) for those who died in hospital, and $45,713 (IQR: $29,688-$77,683) for those surviving to discharge, with $12,719 (IQR: $4,262-$35,275) occurring after discharge. Patients who received coronary artery bypass grafting incurred the highest cost among revascularization groups. No significant differences were observed in cost per fiscal year from 2009 to 2019. Conclusions AMI-CS is associated with significant health care costs, both during the index hospitalization and following discharge. To optimize cost-effectiveness, future therapies should aim to reduce disability in addition to improving mortality.
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Affiliation(s)
- Simon Parlow
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Shannon M. Fernando
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Critical Care, Lakeridge Health Corporation, Oshawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michael Pugliese
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Danial Qureshi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Robert Talarico
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Lee H. Sterling
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sean van Diepen
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Margaret S. Herridge
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Susanna Price
- Adult Intensive Care Unit, Royal Brompton & Harefield Hospitals, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Daniel Brodie
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Daniel I. McIsaac
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard G. Jung
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Arthur S. Slutsky
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Damon C. Scales
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Alain Combes
- Sorbonne Université, Institute of Cardiometabolism and Nutrition, Paris, France
- Service de Médecine Intensive-Réanimation, Hôpitaux Universitaires Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris, France
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Rebecca Mathew
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - LOTUS-ICU Research Group
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Critical Care, Lakeridge Health Corporation, Oshawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Adult Intensive Care Unit, Royal Brompton & Harefield Hospitals, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Sorbonne Université, Institute of Cardiometabolism and Nutrition, Paris, France
- Service de Médecine Intensive-Réanimation, Hôpitaux Universitaires Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris, France
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig and Leipzig Heart Science, Leipzig, Germany
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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3
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Schiffer W, Sweitzer NK, Jung C. Winning hearts and minds: the impact of illness severity and pre-morbid mental health on wellbeing after acute myocardial infarction with cardiogenic shock. Intensive Care Med 2024; 50:931-933. [PMID: 38771365 DOI: 10.1007/s00134-024-07481-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 05/04/2024] [Indexed: 05/22/2024]
Affiliation(s)
- Walter Schiffer
- Division of Cardiovascular Medicine, Washington University in St. Louis, St. Louis, MO, USA.
| | - Nancy K Sweitzer
- Division of Cardiovascular Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Cardiovascular Research Institute Duesseldorf (CARID), Düsseldorf, Germany
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4
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Fernando SM, Qureshi D, Talarico R, Vigod SN, McIsaac DI, Sterling LH, van Diepen S, Price S, Di Santo P, Kyeremanteng K, Fan E, Needham DM, Brodie D, Bienvenu OJ, Combes A, Slutsky AS, Scales DC, Herridge MS, Thiele H, Hibbert B, Tanuseputro P, Mathew R. Mental health sequelae in survivors of cardiogenic shock complicating myocardial infarction. A population-based cohort study. Intensive Care Med 2024; 50:901-912. [PMID: 38695924 DOI: 10.1007/s00134-024-07399-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/21/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE Cardiogenic shock secondary to acute myocardial infarction (AMI-CS) is associated with substantial short- and long-term morbidity and mortality. However, there are limited data on mental health sequelae that survivors experience following discharge. METHODS We conducted a retrospective, population-based cohort study in Ontario, Canada of critically ill adult (≥ 18 years) survivors of AMI-CS, admitted to hospital between April 1, 2009 and March 31, 2019. We compared these patients to AMI survivors without shock. We captured outcome data using linked health administrative databases. The primary outcome was a new mental health diagnosis (a composite of mood, anxiety, or related disorders; schizophrenia/psychotic disorders; and other mental health disorders) following hospital discharge. We secondarily evaluated incidence of deliberate self-harm and death by suicide. We compared patients using overlap propensity score-weighted, cause-specific proportional hazard models. RESULTS We included 7812 consecutive survivors of AMI-CS, from 135 centers. Mean age was 68.4 (standard deviation (SD) 12.2) years, and 70.3% were male. Median follow-up time was 767 days (interquartile range (IQR) 225-1682). Incidence of new mental health diagnosis among AMI-CS survivors was 109.6 per 1,000 person-years (95% confidence interval (CI) 105.4-113.9), compared with 103.8 per 1000 person-years (95% CI 102.5-105.2) among AMI survivors without shock. After propensity score adjustment, there was no difference in the risk of new mental health diagnoses following discharge [hazard ratio (HR) 0.99 (95% CI 0.94-1.03)]. Factors associated with new mental health diagnoses following AMI-CS included female sex, pre-existing mental health diagnoses, and discharge to a long-term hospital or rehabilitation institute. CONCLUSION Survivors of AMI-CS experience substantial mental health morbidity following discharge. Risk of new mental health diagnoses was comparable between survivors of AMI with and without shock. Future research on interventions to mitigate psychiatric sequelae after AMI-CS is warranted.
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Affiliation(s)
- Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Department of Critical Care, Lakeridge Health Corporation, Oshawa, ON, Canada.
| | - Danial Qureshi
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- ICES, Toronto, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Robert Talarico
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Toronto, ON, Canada
| | - Simone N Vigod
- ICES, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Women's College Hospital and Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Daniel I McIsaac
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Toronto, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lee H Sterling
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Sean van Diepen
- Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- VIGOUR Centre, University of Alberta, Edmonton, AB, Canada
| | - Susanna Price
- Royal, Brompton & Harefield Hospitals, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Pietro Di Santo
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Kwadwo Kyeremanteng
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Eddy Fan
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Dale M Needham
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel Brodie
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Oscar Joseph Bienvenu
- Department of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alain Combes
- Institute of Cardiometabolism and Nutrition, Sorbonne University, Paris, France
- Service de Médeceine Intensive-Réanimation, Hôpitaux Universitaires Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris, France
| | - Arthur S Slutsky
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Damon C Scales
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Margaret S Herridge
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Benjamin Hibbert
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Toronto, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Rebecca Mathew
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
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5
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Taylor J, Wilcox ME. Physical and Cognitive Impairment in Acute Respiratory Failure. Crit Care Clin 2024; 40:429-450. [PMID: 38432704 DOI: 10.1016/j.ccc.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Recent research has brought renewed attention to the multifaceted physical and cognitive dysfunction that accompanies acute respiratory failure (ARF). This state-of-the-art review provides an overview of the evidence landscape encompassing ARF-associated neuromuscular and neurocognitive impairments. Risk factors, mechanisms, assessment tools, rehabilitation strategies, approaches to ventilator liberation, and interventions to minimize post-intensive care syndrome are emphasized. The complex interrelationship between physical disability, cognitive dysfunction, and long-term patient-centered outcomes is explored. This review highlights the need for comprehensive, multidisciplinary approaches to mitigate morbidity and accelerate recovery.
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Affiliation(s)
- Jonathan Taylor
- Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1232, New York, NY 10029, USA
| | - Mary Elizabeth Wilcox
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
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Fernando SM, Brodie D, Barbaro RP, Agerstrand C, Badulak J, Bush EL, Mueller T, Munshi L, Fan E, MacLaren G, McIsaac DI. Age and associated outcomes among patients receiving venovenous extracorporeal membrane oxygenation for acute respiratory failure: analysis of the Extracorporeal Life Support Organization registry. Intensive Care Med 2024; 50:395-405. [PMID: 38376515 DOI: 10.1007/s00134-024-07343-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/31/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE Venovenous extracorporeal membrane oxygenation (VV-ECMO) can be used to support patients with refractory acute respiratory failure, though guidance on patient selection is lacking. While age is commonly utilized as a factor in establishing the potential VV-ECMO candidacy of these patients, little is known regarding its association with outcome. We studied the association between increasing patient age and outcomes among patients with acute respiratory failure receiving VV-ECMO. METHODS In this registry-based cohort study, we used individual patient data from 144 centres. We included adult patients (≥ 18 years of age) receiving VV-ECMO from 2017 to 2022. The primary outcome was hospital mortality. Secondary outcomes included a composite of complications following initiation of VV-ECMO. We conducted Bayesian analyses to estimate the association between chronological age and outcomes. RESULTS We included 27,811 patients receiving VV-ECMO. Of these, 11,533 (41.5%) died in hospital. For the analysis conducted using weakly informed priors, and as compared to the reference category of age 18-29, the age brackets of 30-39 (odds ratio [OR] 1.17, 95% credible interval [CrI] 1.06-1.31), 40-49 (OR 1.65, 95% CrI 1.49-1.82), 50-59 (OR 2.39, 95% CrI 2.16-2.61), 60-69 (OR 3.29, 95% CrI 2.97-3.67), 70-79 (OR 4.57, 95% CrI 3.90-5.37), and ≥ 80 (OR 8.08, 95% CrI 4.85-13.74) were independently associated with increasing hospital mortality. Similar results were found between increasing age and post-ECMO complications. CONCLUSIONS Among patients receiving VV-ECMO for acute respiratory failure, increasing age is significantly associated with poorer outcomes, and this association emerges as early as 30 years of age.
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Affiliation(s)
- Shannon M Fernando
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Department of Critical Care, Lakeridge Health Corporation, Oshawa, ON, Canada.
| | - Daniel Brodie
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ryan P Barbaro
- Division of Pediatric Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Cara Agerstrand
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
- Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA
| | - Jenelle Badulak
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Errol L Bush
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas Mueller
- Department of Internal Medicine II, University Hospital of Regensburg, Regensburg, Germany
| | - Laveena Munshi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Graeme MacLaren
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, Singapore
| | - Daniel I McIsaac
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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7
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Mossberg R, Ahlström B, Lipcsey M. A nationwide cohort study on the association between intensive care treatments and mental distress linked psychiatric disorders. Sci Rep 2024; 14:4519. [PMID: 38402361 PMCID: PMC10894289 DOI: 10.1038/s41598-024-55102-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 02/20/2024] [Indexed: 02/26/2024] Open
Abstract
Given the psychic strain patients experience in the intensive care unit (ICU), a potential risk of mental disorders has been suggested. However, the effects of intensive care treatment per se are unknown. We investigated whether the level of intensive care treatments is an independent risk factor for developing long-term mental disorders after intensive care. In a national cohort of adult ICU patients we combined data on diagnoses, treatment, and causes of death. We defined extensive ICU treatment as being treated with invasive ventilation for > 24 h, continuous renal replacement therapy, or both. The primary outcome was incident mental disorder 1 year after ICU admission. Extensive ICU treatment was found to be associated with a decreased risk of developing a mental disorder ≥ 1 year after ICU admission (HR 0.90, 95% CI 0.82-0.99, p = 0.04), and increasing severity of acute illness (HR 1.18, 95% CI 1.06-1.32, p < 0.001) were associated with an increased risk of mental disorders. Because death acted as a competing risk for mental illness, mortality might help explain the apparent protective effect of extensive ICU care.Trial registration Clinical Trials Registry (Identification number NCT05137977). Registered 16 November 2021. As a registry trial the patients were already included at the trial registration i.e. it was retrospectively registered.
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Affiliation(s)
- Rasmus Mossberg
- Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
- Region Värmland, Center for Clinical Research Värmland, Centralsjukhuset Karlstad, Rosenborgsgatan 9, 65230, Karlstad, Sweden.
| | - Björn Ahlström
- Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Healthcare Region Dalarna, Center for Clinical Research Dalarna, Falu Lasarett, Nissers väg 3, 79182, Falun, Sweden
| | - Miklos Lipcsey
- Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, 75185, Uppsala, Sweden
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8
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Kalra A, Kang JK, Khanduja S, Menta AK, Ahmad SA, Liu O, Rodriguez E, Spann M, Hernandez AV, Brodie D, Whitman GJR, Cho SM. Long-Term Neuropsychiatric, Neurocognitive, and Functional Outcomes of Patients Receiving ECMO: A Systematic Review and Meta-Analysis. Neurology 2024; 102:e208081. [PMID: 38181313 PMCID: PMC11023037 DOI: 10.1212/wnl.0000000000208081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/26/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Despite the common occurrence of neurologic complications during extracorporeal membrane oxygenation (ECMO) support, data on long-term neuropsychiatric, neurocognitive, and functional outcomes are sparse. We aimed to determine the prevalence of long-term neuropsychiatric symptoms, neurocognitive and functional impairment, and favorable neurologic outcomes in adult patients who receive ECMO. METHODS PubMed, Embase, Cochrane, Web of Science, and Scopus were searched for text related to ECMO and neuropsychiatric, neurocognitive, and functional outcomes from inception to May 3, 2023. Our primary outcome was the prevalence of neuropsychiatric symptoms (pain/discomfort, anxiety, depression, posttraumatic stress disorder [PTSD], and sleep disturbance) at long-term (≥6 months) follow-up. Our secondary outcomes were the prevalence of neurocognitive impairment (memory, attention, and reasoning), functional impairment (daily activities, physical activity/mobility, and personal/self-care), and favorable neurologic outcomes (Cerebral Performance Category ≤2, modified Rankin scale ≤3, or Glasgow Outcome Scale ≥4). This study was registered in PROSPERO (CRD42023420565). RESULTS We included 59 studies with 3,280 patients (median age 54 years, 69% male). The cohort consisted of 86% venoarterial (VA)-ECMO (n = 2,819) and 14% venovenous (VV)-ECMO (n = 461) patients. More than 10 tools were used to assess neuropsychiatric and neurocognitive outcomes, indicating a lack of standardization in assessment methodologies. The overall prevalence of neuropsychiatric symptoms was 41% (95% CI 33%-49%): pain/discomfort (52%, 95% CI 42%-63%), sleep disturbance (37%, 95% CI 0%-98%), anxiety (36%, 95% CI 27%-46%), depression (31%, 95% CI 22%-40%), and PTSD (18%, 95% CI 9%-29%). The prevalence of neurocognitive impairment was 38% (95% CI 13%-65%). The prevalence of functional impairment was 52% (95% CI 40%-64%): daily activities (54%, 95% CI 41%-66%), mobility (41%, 95% CI 28%-54%), and self-care (21%, 95% CI 13%-31%). The prevalence of neuropsychiatric symptoms in VV-ECMO patients was higher than that in VA-ECMO patients (55% [95% CI 34%-75%] vs 32% [95% CI 23%-41%], p = 0.01), though the prevalence of neurocognitive and functional impairment was not different between the groups. The prevalence of favorable neurologic outcomes was not different at various follow-ups: 3 months (23%, 95% CI 12%-36%), 6 months (25%, 95% CI 16%-35%), and ≥1 year (28%, 95% CI 21%-36%, p = 0.68). DISCUSSION A substantial proportion of ECMO patients seemed to experience neuropsychiatric symptoms and neurocognitive and functional impairments at long-term follow-up. Considerable heterogeneity in methodology for gauging these outcomes exists, warranting the need for standardization. Multicenter prospective observational studies are indicated to further investigate risk factors for these outcomes in ECMO-supported patients.
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Affiliation(s)
- Andrew Kalra
- From the Division of Cardiac Surgery (A.K., J.K.K., S.K., A.K.M., E.R., G.J.R.W.), Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Sidney Kimmel Medical College (A.K.), Thomas Jefferson University, Philadelphia, PA; Division of Neurosciences Critical Care (S.A.A., O.L., S.-M.C.), Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital; Informationist Services (M.S.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Pharmacy Practice (A.V.H.), University of Connecticut School of Pharmacy, Storrs; Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET) (A.V.H.), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru; and Division of Pulmonary and Critical Care Medicine (D.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jin Kook Kang
- From the Division of Cardiac Surgery (A.K., J.K.K., S.K., A.K.M., E.R., G.J.R.W.), Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Sidney Kimmel Medical College (A.K.), Thomas Jefferson University, Philadelphia, PA; Division of Neurosciences Critical Care (S.A.A., O.L., S.-M.C.), Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital; Informationist Services (M.S.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Pharmacy Practice (A.V.H.), University of Connecticut School of Pharmacy, Storrs; Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET) (A.V.H.), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru; and Division of Pulmonary and Critical Care Medicine (D.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shivalika Khanduja
- From the Division of Cardiac Surgery (A.K., J.K.K., S.K., A.K.M., E.R., G.J.R.W.), Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Sidney Kimmel Medical College (A.K.), Thomas Jefferson University, Philadelphia, PA; Division of Neurosciences Critical Care (S.A.A., O.L., S.-M.C.), Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital; Informationist Services (M.S.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Pharmacy Practice (A.V.H.), University of Connecticut School of Pharmacy, Storrs; Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET) (A.V.H.), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru; and Division of Pulmonary and Critical Care Medicine (D.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Arjun K Menta
- From the Division of Cardiac Surgery (A.K., J.K.K., S.K., A.K.M., E.R., G.J.R.W.), Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Sidney Kimmel Medical College (A.K.), Thomas Jefferson University, Philadelphia, PA; Division of Neurosciences Critical Care (S.A.A., O.L., S.-M.C.), Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital; Informationist Services (M.S.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Pharmacy Practice (A.V.H.), University of Connecticut School of Pharmacy, Storrs; Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET) (A.V.H.), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru; and Division of Pulmonary and Critical Care Medicine (D.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Syed A Ahmad
- From the Division of Cardiac Surgery (A.K., J.K.K., S.K., A.K.M., E.R., G.J.R.W.), Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Sidney Kimmel Medical College (A.K.), Thomas Jefferson University, Philadelphia, PA; Division of Neurosciences Critical Care (S.A.A., O.L., S.-M.C.), Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital; Informationist Services (M.S.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Pharmacy Practice (A.V.H.), University of Connecticut School of Pharmacy, Storrs; Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET) (A.V.H.), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru; and Division of Pulmonary and Critical Care Medicine (D.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Olivia Liu
- From the Division of Cardiac Surgery (A.K., J.K.K., S.K., A.K.M., E.R., G.J.R.W.), Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Sidney Kimmel Medical College (A.K.), Thomas Jefferson University, Philadelphia, PA; Division of Neurosciences Critical Care (S.A.A., O.L., S.-M.C.), Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital; Informationist Services (M.S.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Pharmacy Practice (A.V.H.), University of Connecticut School of Pharmacy, Storrs; Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET) (A.V.H.), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru; and Division of Pulmonary and Critical Care Medicine (D.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Emily Rodriguez
- From the Division of Cardiac Surgery (A.K., J.K.K., S.K., A.K.M., E.R., G.J.R.W.), Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Sidney Kimmel Medical College (A.K.), Thomas Jefferson University, Philadelphia, PA; Division of Neurosciences Critical Care (S.A.A., O.L., S.-M.C.), Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital; Informationist Services (M.S.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Pharmacy Practice (A.V.H.), University of Connecticut School of Pharmacy, Storrs; Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET) (A.V.H.), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru; and Division of Pulmonary and Critical Care Medicine (D.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Marcus Spann
- From the Division of Cardiac Surgery (A.K., J.K.K., S.K., A.K.M., E.R., G.J.R.W.), Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Sidney Kimmel Medical College (A.K.), Thomas Jefferson University, Philadelphia, PA; Division of Neurosciences Critical Care (S.A.A., O.L., S.-M.C.), Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital; Informationist Services (M.S.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Pharmacy Practice (A.V.H.), University of Connecticut School of Pharmacy, Storrs; Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET) (A.V.H.), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru; and Division of Pulmonary and Critical Care Medicine (D.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Adrian V Hernandez
- From the Division of Cardiac Surgery (A.K., J.K.K., S.K., A.K.M., E.R., G.J.R.W.), Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Sidney Kimmel Medical College (A.K.), Thomas Jefferson University, Philadelphia, PA; Division of Neurosciences Critical Care (S.A.A., O.L., S.-M.C.), Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital; Informationist Services (M.S.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Pharmacy Practice (A.V.H.), University of Connecticut School of Pharmacy, Storrs; Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET) (A.V.H.), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru; and Division of Pulmonary and Critical Care Medicine (D.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel Brodie
- From the Division of Cardiac Surgery (A.K., J.K.K., S.K., A.K.M., E.R., G.J.R.W.), Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Sidney Kimmel Medical College (A.K.), Thomas Jefferson University, Philadelphia, PA; Division of Neurosciences Critical Care (S.A.A., O.L., S.-M.C.), Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital; Informationist Services (M.S.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Pharmacy Practice (A.V.H.), University of Connecticut School of Pharmacy, Storrs; Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET) (A.V.H.), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru; and Division of Pulmonary and Critical Care Medicine (D.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Glenn J R Whitman
- From the Division of Cardiac Surgery (A.K., J.K.K., S.K., A.K.M., E.R., G.J.R.W.), Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Sidney Kimmel Medical College (A.K.), Thomas Jefferson University, Philadelphia, PA; Division of Neurosciences Critical Care (S.A.A., O.L., S.-M.C.), Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital; Informationist Services (M.S.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Pharmacy Practice (A.V.H.), University of Connecticut School of Pharmacy, Storrs; Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET) (A.V.H.), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru; and Division of Pulmonary and Critical Care Medicine (D.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sung-Min Cho
- From the Division of Cardiac Surgery (A.K., J.K.K., S.K., A.K.M., E.R., G.J.R.W.), Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Sidney Kimmel Medical College (A.K.), Thomas Jefferson University, Philadelphia, PA; Division of Neurosciences Critical Care (S.A.A., O.L., S.-M.C.), Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital; Informationist Services (M.S.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Pharmacy Practice (A.V.H.), University of Connecticut School of Pharmacy, Storrs; Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET) (A.V.H.), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru; and Division of Pulmonary and Critical Care Medicine (D.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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9
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Romero-Ibarguengoitia ME, Rodríguez-Torres JF, Garza-Silva A, Rivera-Cavazos A, Morales-Rodriguez DP, Hurtado-Cabrera M, Kalife-Assad R, Villarreal-Parra D, Loose-Esparza A, Gutiérrez-Arias JJ, Mata-Porras YG, Ojeda-Salazar DA, Sanz-Sánchez MA, González-Cantú A, Azzolini E, Rescigno M. Association of vaccine status, reinfections, and risk factors with Long COVID syndrome. Sci Rep 2024; 14:2817. [PMID: 38307886 PMCID: PMC10837423 DOI: 10.1038/s41598-024-52925-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/25/2024] [Indexed: 02/04/2024] Open
Abstract
The COVID-19 pandemic had a profound global impact, characterized by a high fatality rate and the emergence of enduring consequences known as Long COVID. Our study sought to determine the prevalence of Long COVID syndrome within a population of Northeastern Mexico, correlating it with patients' comorbidities, number of COVID-19 reinfection, and vaccination status. Employing an observational cross-sectional approach, we administered a comprehensive questionnaire covering medical history, demographics, vaccination status, COVID-related symptoms, and treatment. Our participant cohort included 807 patients, with an average age of 41.5 (SD 13.6) years, and women accounting 59.3% of the cohort. The follow-up was 488 (IQR 456) days. One hundred sixty-eight subjects (20.9%) met Long COVID criteria. Long COVID-19 was more prevalent when subjects had reinfections (p = 0.02) and less frequent when they had a complete vaccination scheme (p = 0.05). Through logistic regression, we found that male gender (OR 0.5, p ≤ 0.001), blood types of AB- (OR 0.48, p = 0.003) and O- (OR 0.27, p ≤ 0.001) in comparison with A+ and two doses of vaccines (OR 0.5, p = 006) to be protective factors against Long COVID; while higher BMI (OR 1.04, p = 0.005) was a risk factor. We saw that the prevalence of Long COVID was different within vaccinated patients and specific blood types, while being female and a higher BMI were associated with an increased risk of having long-COVID.
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Affiliation(s)
- Maria Elena Romero-Ibarguengoitia
- Research Department, Hospital Clínica Nova de Monterrey, San Nicolás de los Garza, Nuevo León, México.
- Escuela de Medicina, Vicerrectoría de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza García, Nuevo León, México.
| | - Juan Francisco Rodríguez-Torres
- Escuela de Medicina, Vicerrectoría de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza García, Nuevo León, México
- Internal Medicine Department, Hospital Clínica Nova de Monterrey, San Nicolás de los Garza, Nuevo León, México
| | - Arnulfo Garza-Silva
- Research Department, Hospital Clínica Nova de Monterrey, San Nicolás de los Garza, Nuevo León, México
- Escuela de Medicina, Vicerrectoría de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza García, Nuevo León, México
| | - Andrea Rivera-Cavazos
- Research Department, Hospital Clínica Nova de Monterrey, San Nicolás de los Garza, Nuevo León, México
| | - Devany Paola Morales-Rodriguez
- Research Department, Hospital Clínica Nova de Monterrey, San Nicolás de los Garza, Nuevo León, México
- Escuela de Medicina, Vicerrectoría de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza García, Nuevo León, México
| | - Mauricio Hurtado-Cabrera
- Escuela de Medicina, Vicerrectoría de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza García, Nuevo León, México
| | - Ricardo Kalife-Assad
- Escuela de Medicina, Vicerrectoría de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza García, Nuevo León, México
| | - Diana Villarreal-Parra
- Escuela de Medicina, Vicerrectoría de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza García, Nuevo León, México
| | - Alejandro Loose-Esparza
- Escuela de Medicina, Vicerrectoría de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza García, Nuevo León, México
| | - Juan José Gutiérrez-Arias
- Escuela de Medicina, Vicerrectoría de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza García, Nuevo León, México
| | - Yaressi Guadalupe Mata-Porras
- Escuela de Medicina, Vicerrectoría de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza García, Nuevo León, México
| | - Daniela Abigail Ojeda-Salazar
- Escuela de Medicina, Vicerrectoría de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza García, Nuevo León, México
| | - Miguel Angel Sanz-Sánchez
- Research Department, Hospital Clínica Nova de Monterrey, San Nicolás de los Garza, Nuevo León, México
- Escuela de Medicina, Vicerrectoría de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza García, Nuevo León, México
| | - Arnulfo González-Cantú
- Research Department, Hospital Clínica Nova de Monterrey, San Nicolás de los Garza, Nuevo León, México
- Escuela de Medicina, Vicerrectoría de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza García, Nuevo León, México
| | - Elena Azzolini
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
| | - Maria Rescigno
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
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10
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Pladet LCA, Luijken K, Donker DW, Cremer OL, Meuwese CL. Neuropsychiatric sequelae following extracorporeal membrane oxygenation in the intensive care unit. J Crit Care 2024; 79:154428. [PMID: 37758553 DOI: 10.1016/j.jcrc.2023.154428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/25/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023]
Affiliation(s)
- Lara C A Pladet
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Kim Luijken
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Dirk W Donker
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands; TechMed Centre, Cardiovascular and Respiratory Physiology, University of Twente, Enschede, the Netherlands
| | - Olaf L Cremer
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Christiaan L Meuwese
- Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.
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11
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Poveda-Henao C, Valenzuela-Faccini N, Pérez-Garzón M, Mantilla-Viviescas K, Chavarro-Alfonso O, Robayo-Amortegui H. Neurological outcomes and quality of life in post-cardiac arrest patients with return of spontaneous circulation supported by ECMO: A retrospective case series. Medicine (Baltimore) 2023; 102:e35842. [PMID: 38115364 PMCID: PMC10727675 DOI: 10.1097/md.0000000000035842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/07/2023] [Accepted: 10/06/2023] [Indexed: 12/21/2023] Open
Abstract
Post-cardiac arrest brain injury constitutes a significant contributor to morbidity and mortality, leading to cognitive impairment and subsequent disability. Individuals within this patient cohort grapple with uncertainty regarding the potential advantages of extracorporeal life support (ECMO) cannulation. This study elucidates the neurological outcomes and quality of life of post-cardiac arrest patients who attained spontaneous circulation and underwent ECMO cannulation. This is a retrospective case study within a local context, the research involved 32 patients who received ECMO support following an intrahospital cardiac arrest with return of spontaneous circulation (ROSC). An additional 32 patients experienced cardiac arrest with ROSC before undergoing cannulation. The average age was 41 years, with the primary causes of cardiac arrest identified as acute coronary syndrome (46.8%), pulmonary thromboembolism (21.88%), and hypoxemia (18.7%). The most prevalent arrest rhythm was asystole (37.5%), followed by ventricular fibrillation (34.4%). The mean SOFA score was 7 points (IQR 6.5-9), APACHE II score was 12 (IQR 9-16), RESP score was -1 (IQR -1 to -4) in cases of respiratory ECMO, and SAVE score was -3 (IQR -5 to 2) in cases of cardiac ECMO. Overall survival was 71%, and at 6 months, the Barthel score was 75 points, modified Rankin score was 2, cerebral performance categories score was 1, and the SF-12 had an average score of 30. Notably, there were no significant associations between the time, cause, or rhythm of cardiac arrest and neurological outcomes. Importantly, cardiac arrest is not a contraindication for ECMO cannulation. A meticulous assessment of candidates who have achieved spontaneous circulation after cardiac arrest, considering the absence of early signs of poor neurological prognosis, is crucial in patient selection. Larger prospective studies are warranted to validate and extend these findings.
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Affiliation(s)
| | | | - Michel Pérez-Garzón
- Critical Medicine and Intensive Care, Fundación Clínica Shaio, Bogotá, Colombia
| | | | - Omar Chavarro-Alfonso
- Critical Medicine and Intensive Care resident, Universidad de La Sabana, Chía, Colombia
| | - Henry Robayo-Amortegui
- Critical Medicine and Intensive Care resident, Universidad de La Sabana, Chía, Colombia
- Grupo de Investigacion Clinica UPTC
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12
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Liu K, Gurjar M, Nawa RK, Chung CR, Nakamura K. Light and dark sides of evidence-based and supportive ICU care for patients undergoing extracorporeal membrane oxygenation. J Intensive Care 2023; 11:61. [PMID: 38062528 PMCID: PMC10701970 DOI: 10.1186/s40560-023-00704-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/08/2023] [Indexed: 12/19/2023] Open
Affiliation(s)
- Keibun Liu
- Non-Profit Organization ICU Collaboration Network (ICON), 2-15-13 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia.
| | - Mohan Gurjar
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Rae Bareli Road, Lucknow, India
| | | | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kensuke Nakamura
- Department of Critical Care Medicine, Yokohama City University Hospital, 3-9, Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
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13
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Fernando SM, MacLaren G, Barbaro RP, Mathew R, Munshi L, Madahar P, Fried JA, Ramanathan K, Lorusso R, Brodie D, McIsaac DI. Age and associated outcomes among patients receiving venoarterial extracorporeal membrane oxygenation-analysis of the Extracorporeal Life Support Organization registry. Intensive Care Med 2023; 49:1456-1466. [PMID: 37792052 DOI: 10.1007/s00134-023-07199-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/08/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE Venoarterial extracorporeal membrane oxygenation (V-A ECMO) can be used to support severely ill patients with cardiogenic shock. While age is commonly used in patient selection, little is known regarding its association with outcomes in this population. We sought to evaluate the association between increasing age and outcomes following V-A ECMO. METHODS We used individual-level patient data from 440 centers in the international Extracorporeal Life Support Organization registry. We included all adult patients receiving V-A ECMO from 2017 to 2019. The primary outcome was hospital mortality. Secondary outcomes included a composite of complications following initiation of V-A ECMO. We conducted Bayesian analyses of the relationship between increasing age and outcomes of interest. RESULTS We included 15,172 patients receiving V-A ECMO. Of these, 8172 (53.9%) died in hospital. For the analysis conducted using weakly informed priors, and as compared to the reference category of age 18-29, the age bracket of 30-39 (odds ratio [OR] 0.94, 95% credible interval [CrI] 0.79-1.10) was not associated with hospital mortality, but age brackets 40-49 (odds ratio [OR] 1.26, 95% CrI: 1.08-1.47), 50-59 (OR 1.78, 95% CrI: 1.55-2.06), 60-69 (OR 2.24, 95% CrI: 1.94-2.59), 70-79 (OR 2.90, 95% CrI: 2.49-3.39) and ≥ 80 (OR 4.02, 95% CrI: 3.13-5.20) were independently associated with increasing hospital mortality. Similar results were found in the analysis conducted with an informative prior, as well as between increasing age and post-ECMO complications. CONCLUSIONS Among patients receiving V-A ECMO for cardiogenic shock, increasing age is strongly associated with increasing odds of death and complications, and this association emerges as early as 40 years of age.
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Affiliation(s)
- Shannon M Fernando
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Department of Critical Care, Lakeridge Health Corporation, Oshawa, ON, Canada.
| | - Graeme MacLaren
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, Singapore
| | - Ryan P Barbaro
- Division of Pediatric Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Rebecca Mathew
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Laveena Munshi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Purnema Madahar
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
- Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA
| | - Justin A Fried
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Kollengode Ramanathan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, Singapore
| | - Roberto Lorusso
- Department of Cardio Thoracic Surgery, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Daniel Brodie
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel I McIsaac
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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14
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Sterling LH, Fernando SM, Talarico R, Qureshi D, van Diepen S, Herridge MS, Price S, Brodie D, Fan E, Di Santo P, Jung RG, Parlow S, Basir MB, Scales DC, Combes A, Mathew R, Thiele H, Tanuseputro P, Hibbert B. Long-Term Outcomes of Cardiogenic Shock Complicating Myocardial Infarction. J Am Coll Cardiol 2023; 82:985-995. [PMID: 37648357 DOI: 10.1016/j.jacc.2023.06.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/24/2023] [Accepted: 06/12/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Cardiogenic shock secondary to acute myocardial infarction (AMI-CS) is associated with substantial short-term mortality; however, there are limited data on long-term outcomes and trends. OBJECTIVES This study sought to examine long-term outcomes of AMI-CS patients. METHODS This was a population-based, retrospective cohort study in Ontario, Canada of critically ill adult patients with AMI-CS who were admitted to hospitals between April 1, 2009 and March 31, 2019. Outcome data were captured using linked health administrative databases. RESULTS A total of 9,789 consecutive patients with AMI-CS from 135 centers were included. The mean age was 70.5 ± 12.3 years, and 67.7% were male. The incidence of AMI-CS was 8.2 per 100,000 person-years, and it increased over the study period. Critical care interventions were common, with 5,422 (55.4%) undergoing invasive mechanical ventilation, 1,425 (14.6%) undergoing renal replacement therapy, and 1,484 (15.2%) receiving mechanical circulatory support. A total of 2,961 patients (30.2%) died in the hospital, and 4,004 (40.9%) died by 1 year. Mortality at 5 years was 58.9%. Small improvements in short- and long-term mortality were seen over the study period. Among survivors to discharge, 2,870 (42.0%) required increased support in care from their preadmission baseline, 3,244 (47.5%) were readmitted to the hospital within 1 year, and 1,047 (15.3%) died within 1 year. The mean number of days at home in the year following discharge was 307.9 ± 109.6. CONCLUSIONS Short- and long-term mortality among patients with AMI-CS is high, with minimal improvement over time. AMI-CS survivors experience significant morbidity, with high risks of readmission and death. Future studies should evaluate interventions to minimize postdischarge morbidity and mortality among AMI-CS survivors.
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Affiliation(s)
- Lee H Sterling
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Shannon M Fernando
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Critical Care, Lakeridge Health Corporation, Oshawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Robert Talarico
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Danial Qureshi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; ICES, Toronto, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Sean van Diepen
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada; Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Margaret S Herridge
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Susanna Price
- Royal Brompton & Harefield Hospitals, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Daniel Brodie
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard G Jung
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Simon Parlow
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Mir B Basir
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Damon C Scales
- ICES, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Alain Combes
- Institute of Cardiometabolism and Nutrition, Sorbonne University, Paris, France; Service de Médecine Intensive-Réanimation, Hôpitaux Universitaires Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris, France
| | - Rebecca Mathew
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; ICES, Toronto, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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15
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Christensen E, Morabito J, Kowalsky M, Tsai JP, Rooke D, Clendenen N. Year in Review 2022: Noteworthy Literature in Cardiac Anesthesiology. Semin Cardiothorac Vasc Anesth 2023; 27:123-135. [PMID: 37126462 PMCID: PMC10445401 DOI: 10.1177/10892532231173074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Last year researchers made substantial progress in work relevant to the practice of cardiac anesthesiology. We reviewed 389 articles published in 2022 focused on topics related to clinical practice to identify 16 that will impact the current and future practice of cardiac anesthesiology. We identified 4 broad themes including risk prediction, postoperative outcomes, clinical practice, and technological advances. These articles are representative of the best work in our field in 2022.
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Affiliation(s)
- Elijah Christensen
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, CO, USA
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16
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Genzor S, Pobeha P, Šimek M, Jakubec P, Mizera J, Vykopal M, Sova M, Vaněk J, Praško J. Long-Term Follow-Up of Patients Needing Extracorporeal Membrane Oxygenation Following a Critical Course of COVID-19. Life (Basel) 2023; 13:life13041054. [PMID: 37109583 PMCID: PMC10143867 DOI: 10.3390/life13041054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION Severe respiratory failure is one of the most serious complications of coronavirus disease 2019 (COVID-19). In a small proportion of patients, mechanical ventilation fails to provide adequate oxygenation and extracorporeal membrane oxygenation (ECMO) is needed. The surviving individuals need long-term follow-up as it is not clear what their prognosis is. AIM To provide a complex clinical picture of patients during follow-up exceeding one year after the ECMO therapy due to severe COVID-19. METHODS All subjects involved in the study required ECMO in the acute stage of COVID-19. The survivors were followed-up for over one year at a specialized respiratory medical center. RESULTS Of the 41 patients indicated for ECMO, 17 patients (64.7% males) survived. The average age of survivors was 47.8 years, and the average BMI was 34.7 kg·m-2. The duration of ECMO support was 9.4 days. A mild decrease in vital capacity (VC) and transfer factor (DLCO) was observed on the initial follow-up visit (82.1% and 60%, respectively). VC improved by 6.2% and by an additional 7.5% after 6 months and 1 year, respectively. DLCO improved by 21.1% after 6 months and remained stable after 1 year. Post-intensive care consequences included psychological problems and neurological impairment in 29% of patients; 64.7% of the survivors got vaccinated against SARS-CoV-2 within 12 months of hospitalization and 17.6% experienced reinfection with a mild course. CONCLUSION The COVID-19 pandemic has significantly increased the need for ECMO. Patients' quality of life after ECMO is temporarily significantly reduced but most patients do not experience permanent disability.
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Affiliation(s)
- Samuel Genzor
- Department of Respiratory Medicine and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, 779 00 Olomouc, Czech Republic
- Center for Digital Health, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, 779 00 Olomouc, Czech Republic
| | - Pavol Pobeha
- Department of Respiratory Medicine and Tuberculosis, Faculty of Medicine, P.J. Safarik University Kosice and University Hospital Kosice, 040 01 Kosice, Slovakia
| | - Martin Šimek
- Department of Cardiac Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, 779 00 Olomouc, Czech Republic
| | - Petr Jakubec
- Department of Respiratory Medicine and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, 779 00 Olomouc, Czech Republic
| | - Jan Mizera
- Department of Respiratory Medicine and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, 779 00 Olomouc, Czech Republic
| | - Martin Vykopal
- Department of Respiratory Medicine and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, 779 00 Olomouc, Czech Republic
| | - Milan Sova
- Department of Respiratory Medicine and Tuberculosis, Faculty of Medicine and Dentistry, Masaryk University Brno and University Hospital Brno, 601 77 Brno, Czech Republic
| | - Jakub Vaněk
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, 779 00 Olomouc, Czech Republic
| | - Jan Praško
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, 779 00 Olomouc, Czech Republic
- Jessenia Inc. Rehabilitation Hospital Beroun, Akeso Holding, 155 00 Prague, Czech Republic
- Department of Psychological Sciences, Faculty of Social Sciences and Health Care, Constantine the Philosopher University in Nitra, 949 74 Nitra, Slovakia
- Department of Psychotherapy, Institute for Postgraduate Training in Health Care, 100 05 Prague, Czech Republic
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17
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Yan J, Xu Z, Fang X, You J, Niu J, Xu M, Zhang J, Hu J, He X, Li T. Cerebral Neural Changes in Venous-Arterial Extracorporeal Membrane Oxygenation Survivors. Brain Sci 2023; 13:brainsci13040630. [PMID: 37190595 DOI: 10.3390/brainsci13040630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/15/2023] [Accepted: 03/31/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is used as temporary cardiorespiratory support in patients with critical ailments, but very little is known about the functional cerebral changes in ECMO survivors. Degree centrality (DC), a graph-based assessment of network organization, was performed to explore the neural connectivity changes in ECMO survivors compared to controls and their correlation with cognitive and neurological measures. METHODS This exploratory observational study was conducted from August 2020 to May 2022. ECMO survivors and controls underwent functional magnetic resonance imaging (fMRI) of the brain. We performed DC analysis to identify voxels that showed changes in whole-brain functional connectivity with other voxels. DC was measured by the fMRI graph method and comparisons between the two groups were performed. All participants underwent neuropsychological assessment (Montreal Cognitive Assessment, MoCA). Blood serum neuron-specific enolase and the Glasgow Coma Scale (GCS) were assessed in ECMO survivors. RESULTS DC values in the right insula and right precuneus gyrus were lower in ECMO survivors and higher in the right medial superior frontal gyrus compared to controls (all p < 0.001). Decreased connectivity in the right insular and right precuneus gyrus correlated with total MoCA scores, delayed recollection, and calculation (all p < 0.05). Increased serum NSE levels, GCS score, and GCS-motor response correlated with decreased connectivity in the right insular and right precuneus gyrus and increased connectivity in the right medial superior frontal gyrus (all p < 0.05). CONCLUSIONS We showed that both functional impairment and adaptation were observed in survivors of ECMO, suggesting that neural connectivity changes may provide insights into the mechanisms that may potentially link ECMO survivors to neurological and cognitive disorders.
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Affiliation(s)
- Jueyue Yan
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, China
| | - Zhipeng Xu
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, China
| | - Xing Fang
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, China
| | - Jingyu You
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, China
| | - Jianhua Niu
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, China
| | - Mi Xu
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, China
| | - Jingchen Zhang
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, China
| | - Jia Hu
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, China
| | - Xujian He
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, China
| | - Tong Li
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, China
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18
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Li J, Li Y. Extracorporeal Membrane Oxygenation and New Mental Health Diagnoses in Adult Survivors of Critical Illness. JAMA 2023; 329:844. [PMID: 36917059 DOI: 10.1001/jama.2022.24707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Jian Li
- Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Yongnan Li
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou, China
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19
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Fernando SM, Tanuseputro P, Kyeremanteng K. Extracorporeal Membrane Oxygenation and New Mental Health Diagnoses in Adult Survivors of Critical Illness-Reply. JAMA 2023; 329:844-845. [PMID: 36917053 DOI: 10.1001/jama.2022.24704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Affiliation(s)
- Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kwadwo Kyeremanteng
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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