1
|
Huang R, Shao M, Zhang C, Fang M, Jin M, Han X, Liu N. Serum Total Bilirubin With Hospital Survival in Adults During Extracorporeal Membrane Oxygenation. Front Med (Lausanne) 2022; 9:914557. [PMID: 35814759 PMCID: PMC9263081 DOI: 10.3389/fmed.2022.914557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background Extracorporeal membrane oxygenation (ECMO) is widely used for refractory cardiopulmonary failure treatment. The disadvantage of ECMO is its higher risk profile and clinical resource consumption. This observation examines the role of serum total bilirubin (TBIL) as a predictor of adult patient outcomes on ECMO support. Methods This retrospective observation reports a single-center experience with adults on ECMO support between 2018 and 2021. Data were collected regarding demographics, ECMO details, laboratory parameters, and outcomes. We examined the elevation of TBIL to predict survival and variables associated with hyperbilirubinemia. Results The patients who died within 28 days had a twofold higher peak level of TBIL than those who survived [73.10 (38.60, 98.64) vs. 34.50 (24.03, 54.85); P = 0.003]. Univariate logistic regression analyses demonstrated that high TBIL was remarkably associated with an elevated risk of 28-day mortality (OR: 7.25; 95% CI: 2.31–25.49; P = 0.001) and total mortality (OR: 5.71; 95% CI: 1.82–20.66; P = 0.001). The TBIL value was 65 μmol/L as the best cut-off value, and the observation group was divided into a high TBIL subgroup (n = 21) or a low TBIL subgroup (n = 39). The demographic and clinical features did not show a difference, whereas Sequential Organ Failure Assessment (SOFA) and APACHE II scores and ALT, AST, and LAC before ECMO initiation correlated with high or low TBIL (P < 0.05). For coagulation function at the time of TBIL peak, the levels of prothrombin time (PT), activated partial thromboplastin time (APTT), prothrombin time activity (PTA), and fibrinogen (FIB) were different between the two subgroups (P < 0.05). The SOFA score was potentially associated with hyperbilirubinemia after ECMO initiation, and the prediction accuracy was 0.800. Conclusion Serum total bilirubin elevation appears after ECMO initiation and correlates with survival, while other markers of liver injury do not. Serum total bilirubin is an easy-to-measure biomarker to be a predictor of survival after ECMO initiation.
Collapse
Affiliation(s)
- Rui Huang
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Min Shao
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- *Correspondence: Min Shao,
| | - Cheng Zhang
- Anhui Provincial Cancer Institute, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ming Fang
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Mengmeng Jin
- Department of Respiratory and Critical Care, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xuan Han
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Nian Liu
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Nian Liu,
| |
Collapse
|
2
|
Chin CT, Keng FYJ. Out-of-hospital cardiac arrest in Singapore: Can we do better? ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:327-328. [PMID: 35786752 DOI: 10.47102/annals-acadmedsg.2022184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Chee Tang Chin
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | | |
Collapse
|
3
|
Gu M, Mei XL, Zhao YN. A review on extracorporeal membrane oxygenation and kidney injury. J Biochem Mol Toxicol 2020; 35:e22679. [PMID: 33325616 DOI: 10.1002/jbt.22679] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/04/2020] [Accepted: 11/26/2020] [Indexed: 12/17/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) is inevitable external life support in case of cardiac and respiratory failure since the 1970s. Acute kidney injury (AKI) and the requirement of renal replacement therapy (RRT) is a potential risk among these patients. This review aims to give an overview of the risk of AKI, RRT, and associated mortality among the patients who received ECMO for any of its indications. PubMed database was searched to find the relevant literature and the reference list of included studies was also searched for additional studies. The incidence of AKI ranged from 30% to 78% and RRT from 47% to 60% in ECMO patients. The pathophysiology of AKI in ECMO is multifactorial, and includes ischaemia, RBCs breakdown, comorbidity, conversion of zymogen form of pro-inflammatory mediators, structural alteration of the kidney, coadministration of nephrotoxic drugs, coagulation abnormality, and oxidative stress. ECMO was associated with the higher incidence of renal abnormalities, AKI, requirement of RRT, and associated mortality. Patients who underwent RRT had improved renal function and reduced overall mortality compared to the non-RRT group among the ECMO patients. Currently, there is no consensus evidence to support the superior use of the inline hemofilter system over continuous renal replacement therapy among patients who had AKI during ECMO.
Collapse
Affiliation(s)
- Ming Gu
- Department of Emergency and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Xiang-Lin Mei
- Department of Pathology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Ya-Nan Zhao
- Neurology Department, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| |
Collapse
|
4
|
Blegen HMJ, Plaster AL, Hobbs SD, Reed DS, Santamaria JA, Heath ZG, Nelson FD, Giles GB, Drayna PM. Posterior Segment Findings in Patients on Extracorporeal Membrane Oxygenation. JOURNAL OF VITREORETINAL DISEASES 2020; 4:490-493. [PMID: 37007663 PMCID: PMC9976074 DOI: 10.1177/2474126420937172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: Extracorporeal membrane oxygenation (ECMO) is an established treatment modality for critically ill patients with cardiopulmonary failure, yet little is known of the ocular pathology in this population. The aim of this study is to characterize the posterior segment findings of ECMO patients. Methods: This study is a retrospective analysis of 20 ECMO patients evaluated by ophthalmology from September 2012 to May 2019 at a level 1 trauma center. Comprehensive examinations assessed for intraocular pathology. Demographic data, exam findings, and mortality were analyzed. Results: The sample size consisted of 20 patients; a majority were male (75%), and mean age was 37.4 years (interquartile range, 26.75-50 years). All patients received ECMO for care of acute respiratory distress syndrome (ARDS). Average duration of ECMO therapy was 9.6 ± 6.5 days. Eleven (55%) patients had acute retinal pathology, including Purtscher-like retinopathy (20%), intraocular hemorrhage (50%), and septic chorioretinitis (bacterial or fungal, 10%). Location of hemorrhage included the retina (40%), vitreous (30%), and optic disc (15%). Sixty percent (n = 12) of patients were unable to provide a subjective history on initial assessment. Ultimately, 5 out of 20 patients (25%) died of systemic illness during their hospital stay. Conclusion: This study demonstrates high rates of retinal pathology, most commonly vitreous and/or retinal hemorrhage alongside a Purtscher-like retinopathy. This is likely secondary to complications of anticoagulation, microthrombi, septicemia, and hemodynamic instability. We found a mortality rate slightly lower than that of prior ECMO studies. Prospective studies with pre-ECMO and post-ECMO fundus photography is warranted for better understanding of these medically complex patients.
Collapse
Affiliation(s)
| | | | | | | | | | - Zachary George Heath
- Wilford Hall Ambulatory Surgical Center, Department of Ophthalmology, San Antonio, TX, USA
| | | | | | - Paul Michael Drayna
- Wilford Hall Ambulatory Surgical Center, Department of Ophthalmology, San Antonio, TX, USA
| |
Collapse
|
5
|
Zhao J, Xuan NX, Cui W, Tian BP. Neurogenic pulmonary edema following acute stroke: The progress and perspective. Biomed Pharmacother 2020; 130:110478. [PMID: 32739737 DOI: 10.1016/j.biopha.2020.110478] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 12/11/2022] Open
Abstract
Neurogenic pulmonary edema (NPE) following acute stroke is an acute respiratory distress syndrome (ARDS) with clinical characteristics that include acute onset, apparent pulmonary interstitial fluid infiltration and rapid resolution. The pathological process of NPE centers on sympathetic stimulation and fulminant release of catecholamines, which cause contraction of resistance vessels. Elevated systemic resistance forces fluid into pulmonary circulation, while pulmonary circulation overload induces pulmonary capillary pressure that elevates, and in turn damages the alveolar capillary barrier. Damage to the alveolar capillary barrier leads to pulmonary ventilation disorder, blood perfusion disorder and oxygenation disorder. Eventually, NPE will cause post-stroke patients' prognosis to further deteriorate. At present, we lack specific biological diagnostic indicators and a meticulously unified diagnostic criterion, and this results in a situation in which many patients are not recognized quickly and/or diagnosed accurately. There are no drugs that are effective against NPE. Therefore, understanding how to diagnose NPE early by identifying the risk factors and how to apply appropriate treatment to avoid a deteriorating prognosis are important scientific goals. We will elaborate the progress of NPE after acute stroke in terms of its pathophysiological mechanisms, etiology, epidemiology, clinical diagnosis and early prediction, comprehensive treatment strategies, and novel drug development. We also propose our own thinking and prospects regarding NPE.
Collapse
Affiliation(s)
- Jie Zhao
- Department of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Nan-Xia Xuan
- Department of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Wei Cui
- Department of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Bao-Ping Tian
- Department of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China.
| |
Collapse
|
6
|
Nakasato GR, Lopes JDL, Lopes CT. Predictors of complications associated with extracorporeal membrane oxygenation. Rev Bras Enferm 2020; 73:e20180666. [PMID: 32236371 DOI: 10.1590/0034-7167-2018-0666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 04/30/2019] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES to identify in the literature, the predictors of ECMO complications in adult patients. METHODS integrative review of literature, including articles in Portuguese, English and Spanish published from 2014 to 2018 in five databases. Included articles which analyzed the predictive factors of ECMO complications in adult patients using multivariate analysis. RESULTS a total of 1629 articles were identified, of which 19 were included. Nineteen predictors were identified for neurological complications (e.g., post-ECMO hypoglycemia), seven for bleeding complications (e.g., fungal pneumonia), four for infections complications (e.g., preoperative creatinine level), three for kidney complications (e.g., the length of ICU stay> 20 days) and a combination of factors for mechanical complications (e.g., median flow). CONCLUSIONS different predictors were identified to ECMO complications. The knowledge of these predictors enables the individualized targeting of preventive interventions by multidisciplinary team for modifiable factors, as well as intensification of monitoring for early recognition of non-modifiable factors.
Collapse
|
7
|
Nakasato GR, Murakami BM, Batistão Gonçalves MA, Lopes JDL, Lopes CT. Predictors of complications related to venoarterial extracorporeal membrane oxygenation in adults: A multicenter retrospective cohort study. Heart Lung 2020; 49:60-65. [DOI: 10.1016/j.hrtlng.2019.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 09/07/2019] [Accepted: 09/09/2019] [Indexed: 01/08/2023]
|
8
|
Madrahimov N, Khalikov A, Boyle EC, Natanov R, Knoefel AK, Siemeni T, Hoeffler K, Haverich A, Maus U, Kuehn C. Veno-Venous Extracorporeal Membrane Oxygenation in a Mouse. J Vis Exp 2018. [PMID: 30417887 DOI: 10.3791/58146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The use of extracorporeal membrane oxygenation (ECMO) has increased substantially in recent years. ECMO has become a reliable and effective therapy for acute as well as end-stage lung diseases. With the increase in clinical demand and prolonged use of ECMO, procedural optimization and prevention of multi-organ damage are of critical importance. The aim of this protocol is to present a detailed technique of veno-venous ECMO in a non-intubated, spontaneously breathing mouse. This protocol demonstrates the technical design of the ECMO and surgical steps. This murine ECMO model will facilitate the study of pathophysiology related to ECMO (e.g., inflammation,bleeding and thromboembolic events). Due to the abundance of genetically modified mice, the molecular mechanisms involved in ECMO-related complications can also be dissected.
Collapse
Affiliation(s)
- Nodir Madrahimov
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School;
| | - Abdurasul Khalikov
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
| | - Erin C Boyle
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
| | - Ruslan Natanov
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
| | - Ann-Kathrin Knoefel
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
| | - Thierry Siemeni
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
| | - Klaus Hoeffler
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
| | - Ulrich Maus
- Department of Pneumology, Hannover Medical School
| | - Christian Kuehn
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School
| |
Collapse
|