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Hou J, Wang C, Wei R, Zheng J, Liu Z, Wang D, Li J, Huang S. Risk factors associated with hospital mortality in non-surgical patients receiving extracorporeal membrane oxygenation and continuous renal replacement treatment: a retrospective analysis. Ren Fail 2024; 46:2398711. [PMID: 39238266 PMCID: PMC11382732 DOI: 10.1080/0886022x.2024.2398711] [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: 06/27/2024] [Revised: 08/25/2024] [Accepted: 08/26/2024] [Indexed: 09/07/2024] Open
Abstract
OBJECTIVES The prognosis-predicting factors for non-surgical patients receiving continuous renal replacement therapy (CRRT) and extracorporeal membrane oxygenation (ECMO) remains limited. In this study, we aim to analyze prognosis-predicting factors in the non-surgical patients receiving these two therapies. METHODS We retrospectively analyzed data from non-surgical patients with ECMO treatment from December 2013 until April 2023. Hospital mortality was primary endpoint of this study. The area under the curve and receiver operating characteristic curves were used to assess the sensitivity and specificity of mortality. The independent risk factors were identified by multivariate logistic regression. The prediction model was a nomogram, and decision curve analysis and the calibration plot were used to assess it. Using restricted cubic spline curves and Spearman correlation, the correlation analysis was performed. RESULTS The model that incorporated CRRT duration and age surpassed the two variables alone in predicting hospital mortality in non-surgical patients with ECMO therapy (AUC value = 0.868, 95% CI = 0.779-0.956). Older age, CRRT implantation, and duration were independent risk factors for hospital mortality (all p < 0.05). The nomogram predicting outcomes model containing on CRRT implantation and duration was developed, and the consistency between the predicted probability and observed probability and clinical utility of the models were good. CRRT duration was negatively associated with hemoglobin concentration and positively associated with urea nitrogen and serum creatinine levels. CONCLUSION Hospital mortality in non-surgical ECMO patients was found to be independently associated with older age, longer CRRT duration, and CRRT implantation.
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Affiliation(s)
- Jian Hou
- Department of Cardiology, The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou, China
| | - Cuiping Wang
- Department of Cardiothoracic ICU, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ruibin Wei
- Department of Cardiology, The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou, China
| | - Junteng Zheng
- Department of Cardiology, The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhen Liu
- Department of Cardiology, The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dayu Wang
- Department of Cardiology, The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianhao Li
- Department of Cardiology, The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou, China
| | - Suiqing Huang
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, GD, China
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Bahar AR, Bahar Y, Dandu C, Alrayyashi MS, Zghouzi M, Chalek A, Alraies MC. In-Hospital Outcomes of Patients With Acute Respiratory Distress Syndrome Treated With Extracorporeal Membrane Oxygenation. Cureus 2024; 16:e68745. [PMID: 39371810 PMCID: PMC11455599 DOI: 10.7759/cureus.68745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2024] [Indexed: 10/08/2024] Open
Abstract
BACKGROUND Treatment of acute respiratory distress syndrome (ARDS) with extracorporeal membrane oxygenation (ECMO) remains controversial. OBJECTIVE This study aims to examine outcomes in ARDS patients treated with or without ECMO. METHODS Using the National Inpatient Sample (NIS) database, all ARDS patients including those who were treated with ECMO were included in the analysis. Univariable and multivariable logistic regressions were used to estimate the odds of in-hospital outcomes between groups. RESULTS A total of 2,540,350 patients were identified (2,538,849 with ARDS; 1,501 with ARDS on ECMO). The patients who underwent ECMO included younger patients and more men. Using ECMO in ARDS patients was associated with higher in-hospital mortality, cardiopulmonary arrest, major bleeding, sepsis, acute kidney injury, and longer hospital stays (31.7 vs. 8.3 days; p < 0.001 for all). A subgroup analysis based on age and sex had similar outcomes. CONCLUSION Using ECMO in patients with ARDS was associated with worse in-hospital outcomes, including mortality and length of stay.
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Affiliation(s)
- Abdul Rasheed Bahar
- Internal Medicine, Wayne State University Detroit Medical Center, Detroit, USA
| | - Yasemin Bahar
- Internal Medicine, Wayne State University, Detroit, USA
| | - Chaitu Dandu
- Vascular Surgery, Wayne State University School of Medicine, Detroit, USA
| | | | - Mohamed Zghouzi
- Internal Medicine, Wayne State University Detroit Medical Center, Detroit, USA
| | - Adam Chalek
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - M Chadi Alraies
- Cardiology, Wayne State University Detroit Medical Center, Detroit, USA
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3
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Hart JP, Davies MG. Vascular Complications in Extracorporeal Membrane Oxygenation-A Narrative Review. J Clin Med 2024; 13:5170. [PMID: 39274383 PMCID: PMC11396245 DOI: 10.3390/jcm13175170] [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: 07/06/2024] [Revised: 08/21/2024] [Accepted: 08/24/2024] [Indexed: 09/16/2024] Open
Abstract
The establishment of a peripheral ECMO circuit can lead to significant arterial and venous complications in 10-30% of patients. Vascular complications, particularly acute limb ischemia, are associated with worsening overall outcomes. Limb ischemia occurs significantly more frequently in the early stages of VA ECMO than in VV ECMO. Mechanisms of limb ischemia include arterial obstruction, cannulation injury, loss of pulsatile flow, thromboembolism, venous stasis from compressive obstruction with large venous cannulas, and systemic vasoconstriction due to shock and pharmacologic vasoconstriction. The care team may use several mitigation strategies to prevent limb ischemia. Arterial and venous complications can be mitigated by careful access site selection, minimizing cannula size, placement of distal perfusion and/or outflow catheter(s), and continuous NIRS monitoring. Rapid intervention, when ischemia or compartment syndrome occurs, can reduce limb loss but may not affect the mortality and morbidity of the ECMO patient in the long term due to their underlying conditions and the etiology of the ECMO need.
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Affiliation(s)
- Joseph P Hart
- Center for Quality, Effectiveness, and Outcomes in Cardiovascular Diseases, Houston, TX 77054, USA
- Division of Vascular and Endovascular Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Mark G Davies
- Center for Quality, Effectiveness, and Outcomes in Cardiovascular Diseases, Houston, TX 77054, USA
- Department of Vascular and Endovascular Surgery, Ascension Health, Waco, TX 76710, USA
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Trejnowska E, Nożyński JK, Jankowski M, Brożek G, Skoczyński S, Swinarew AS, Lange D, Knapik P. Autopsy Histopathologic Lung Findings in Patients Treated With Extracorporeal Membrane Oxygenation. Arch Pathol Lab Med 2024; 148:921-927. [PMID: 37931217 DOI: 10.5858/arpa.2023-0073-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 11/08/2023]
Abstract
CONTEXT.— Extracorporeal membrane oxygenation (ECMO) is increasingly used in the treatment of respiratory and cardiac failure, but data describing lung histopathology in ECMO recipients are limited. OBJECTIVE.— To examine pulmonary histopathologic findings in patients who underwent venovenous (VV) ECMO for pulmonary reasons or venoarterial (VA) ECMO for cardiac indications shortly before death, and to determine if the pulmonary changes provided insights into therapy that may prevent complications and improve outcome. DESIGN.— We conducted a retrospective study of lung autopsies, from VV and VA ECMO recipients and patients with acute respiratory distress syndrome (ARDS) and non-ECMO treatment, between 2008 and 2020 in Silesia Center for Heart Diseases in Zabrze, Poland. RESULTS.— Among 83 ECMO patients (42-64 years; men, 57 [68.7%]), the most common histopathologic findings were bronchopneumonia (44 [53.0%]), interstitial edema (40 [48.2%]), diffuse alveolar damage (DAD; 32 [38.6%]), hemorrhagic infarct (28 [33.7%]), and pulmonary hemorrhage (25 [30.1%]). DAD was associated with longer ECMO treatment and longer hospital stay. The use of VV ECMO was a predictor of DAD in patients with ARDS and undergoing ECMO, but it also occurred in 21 of 65 patients (32.3%) in the VA ECMO group, even though VA ECMO was used for heart failure. CONCLUSIONS.— Although DAD was significantly more common in lung autopsies of VV ECMO patients, one-third of VA ECMO patients had histopathologic changes characteristic of ARDS. The presence of DAD in lung autopsies of patients treated with VA ECMO indicates that in these patients, protective lung ventilation should be considered.
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Affiliation(s)
- Ewa Trejnowska
- From the Clinical Department of Cardioanesthesia and Intensive Care Unit (Trejnowska, Knapik) and the Department of Histopathology (Nożyński, Lange), Silesian Centre for Heart Diseases, Zabrze, Poland; Faculty of Medical Sciences in Zabrze (Trejnowska, Knapik), Medical University of Silesia, Katowice, Poland
| | - Jerzy K Nożyński
- From the Clinical Department of Cardioanesthesia and Intensive Care Unit (Trejnowska, Knapik) and the Department of Histopathology (Nożyński, Lange), Silesian Centre for Heart Diseases, Zabrze, Poland; Faculty of Medical Sciences in Zabrze (Trejnowska, Knapik), Medical University of Silesia, Katowice, Poland
| | - Miłosz Jankowski
- the Department of Anaesthesiology and Intensive Therapy, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland (Jankowski)
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland (Jankowski)
| | - Grzegorz Brożek
- the Department of Epidemiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland (Brożek)
| | - Szymon Skoczyński
- the Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland (Skoczyński)
| | - Andrzej S Swinarew
- Faculty of Science and Technology, University of Silesia, Katowice, Poland (Swinarew)
- Institute of Sport Science, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland (Swinarew)
| | - Dariusz Lange
- the Department of Pathology, Faculty of Medicine, Academia of Silesia, Katowice, Poland (Lange)
| | - Piotr Knapik
- From the Clinical Department of Cardioanesthesia and Intensive Care Unit (Trejnowska, Knapik) and the Department of Histopathology (Nożyński, Lange), Silesian Centre for Heart Diseases, Zabrze, Poland; Faculty of Medical Sciences in Zabrze (Trejnowska, Knapik), Medical University of Silesia, Katowice, Poland
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Zhu M, Zha Y, Cui L, Huang R, Wei Z, Fang M, Liu N, Shao M. Assessment of Nutritional Risk Scores (the Nutritional Risk Screening 2002 and Modified Nutrition Risk in Critically Ill Scores) as Predictors of Mortality in Critically Ill Patients on Extracorporeal Membrane Oxygenation. ASAIO J 2024; 70:510-516. [PMID: 38237605 DOI: 10.1097/mat.0000000000002142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024] Open
Abstract
Nutritional risk is associated with intensive care unit (ICU) stay and mortality, the Nutritional Risk Screening 2002 (NRS 2002) and the modified Nutritional Risk in the Critically Ill (mNUTRIC) score are assessment instruments and useful in predicting the risk regarding mortality in ICU patients. Our aim was to assess the effects of mNUTRIC and NRS 2002 on mortality in patients on extracorporeal membrane oxygenation (ECMO). A retrospective cohort study was performed and 78 patients were included for final analysis. In the current study, the NRS 2002 and the mNUTRIC score within 24 hours before starting ECMO were applied to assess patients' nutritional status on ECMO and explore the relationship between nutritional status and patient outcomes. This study suggests that both mNUTRIC and NRS 2002 scores were found to be significant independent risk and prognostic factors for in-hospital and 90 day morality among ECMO patients based on multivariable logistic regression analysis ( p < 0.05), with those in the high-risk group having higher in-hospital and 90 day mortality rates than those identified as being at low risk ( p < 0.001). In comparison to the NRS 2002 score, the mNUTRIC score demonstrated a superior prognostic ability in ECMO patients.
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Affiliation(s)
- Manyi Zhu
- From the Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Department of Critical Care Medicine, The Affiliated Chuzhou Hospital of Anhui Medical University (The First People's Hospital of Chu Zhou), Chu Zhou, China
| | - Yutao Zha
- From the Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Liangwen Cui
- From the Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Rui Huang
- From the Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhengxiang Wei
- Department of Critical Care Medicine, The Affiliated Chuzhou Hospital of Anhui Medical University (The First People's Hospital of Chu Zhou), Chu Zhou, China
| | - Ming Fang
- From the Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Nian Liu
- From the Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Min Shao
- From the Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Olson C, Wothe J, Braaten J, Evans D, Damroth K, Bohman J, Seelhammer T, Saavedra-Romero R, Prekker M, Brunsvold M. Outcomes of Interfacility VV-Extracorporeal Membrane Oxygenation Transfers: A Multicenter Study. ASAIO J 2024; 70:479-484. [PMID: 38237607 DOI: 10.1097/mat.0000000000002133] [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: 06/04/2024] Open
Abstract
As the availability of extracorporeal membrane oxygenation (ECMO) expands, so has the need for interfacility transfer to ECMO centers. However, the impact of these transfers is unknown. We hypothesized that interfacility transfers would be associated with increased complications and mortality. This retrospective cohort study includes adult patients treated with venovenous (VV) ECMO at all four adult ECMO centers comprising our statewide registry. Complications, mortality, ECMO duration, length of stay, and disposition were compared based on cannulation at an ECMO center versus outside hospital and transferred by air versus ground after adjusting for baseline covariates/parameters. The study included 420 adult patients, 36% of whom were cannulated at an outside institution before transfer. Of these, 63% were transported by ground and the remainder by air. Risk adjusted logistic regression revealed similar odds of mortality between those cannulated at ECMO centers versus referring hospital and then transported (odds ratio [OR] = 0.77, confidence interval [CI] = 0.49-1.22). This study supports the practice of interfacility ECMO transfer.
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Affiliation(s)
- Conner Olson
- From the University of Minnesota Medical School Department of Surgery, Minneapolis, USA
| | - Jillian Wothe
- From the University of Minnesota Medical School Department of Surgery, Minneapolis, USA
- Abbott Northwestern Hospital Department of Critical Care, Minneapolis, USA
- Hennepin Healthcare Department of Internal Medicine, Minneapolis, USA
- Hennepin Healthcare Department of Emergency Medicine, Minneapolis, USA
| | - Jacob Braaten
- From the University of Minnesota Medical School Department of Surgery, Minneapolis, USA
| | - Danika Evans
- Hennepin Healthcare Department of Internal Medicine, Minneapolis, USA
- Hennepin Healthcare Department of Emergency Medicine, Minneapolis, USA
| | - Karl Damroth
- Mayo Clinic Department of Surgery, Rochester, USA
| | - John Bohman
- Mayo Clinic Department of Anesthesia and Perioperative Medicine, Rochester, USA
| | - Troy Seelhammer
- Mayo Clinic Department of Anesthesia and Perioperative Medicine, Rochester, USA
| | | | - Matthew Prekker
- Hennepin Healthcare Department of Internal Medicine, Minneapolis, USA
- Hennepin Healthcare Department of Emergency Medicine, Minneapolis, USA
| | - Melissa Brunsvold
- From the University of Minnesota Medical School Department of Surgery, Minneapolis, USA
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7
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Grate JC, Reynolds TS, Gordon AC, Dave SB. Infected Thrombosis Leading to Veno-Venous Extracorporeal Membrane Oxygenation Dysfunction in Chronic Thromboembolic Pulmonary Hypertension. ASAIO J 2024:00002480-990000000-00484. [PMID: 38753559 DOI: 10.1097/mat.0000000000002233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Nosocomial infections and thrombosis are frequent complications during extracorporeal membrane oxygenation (ECMO). Preventative measures and close monitoring for early recognition of these complications are imperative in patients supported with ECMO. We report the case of a 41 year old female on veno-venous ECMO awaiting surgical thrombectomy for chronic thromboembolic pulmonary hypertension that developed profound bacteremia leading to gross purulence and thrombosis of the membrane oxygenator. Recannulation in addition to targeted antibiotics, frequent cultures, imaging, and surgery were diagnostic and therapeutic interventions that led to ultimate resolution.
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Affiliation(s)
- Jeremy C Grate
- From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Tyler S Reynolds
- Department of Surgery, Mike O'Callaghan Military Medical Center, Nellis Air Force Base, Nevada
| | - Adam C Gordon
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
| | - Sagar B Dave
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
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8
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Gayen S, Dachert S, Lashari BH, Gordon M, Desai P, Criner GJ, Cardet JC, Shenoy K. Critical Care Management of Severe Asthma Exacerbations. J Clin Med 2024; 13:859. [PMID: 38337552 PMCID: PMC10856115 DOI: 10.3390/jcm13030859] [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: 01/11/2024] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Severe asthma exacerbations, including near-fatal asthma (NFA), have high morbidity and mortality. Mechanical ventilation of patients with severe asthma is difficult due to the complex pathophysiology resulting from severe bronchospasm and dynamic hyperinflation. Life-threatening complications of traditional ventilation strategies in asthma exacerbations include the development of systemic hypotension from hyperinflation, air trapping, and pneumothoraces. Optimizing pharmacologic techniques and ventilation strategies is crucial to treat the underlying bronchospasm. Despite optimal pharmacologic management and mechanical ventilation, the mortality rate of patients with severe asthma in intensive care units is 8%, suggesting a need for advanced non-pharmacologic therapies, including extracorporeal life support (ECLS). This review focuses on the pathophysiology of acute asthma exacerbations, ventilation management including non-invasive ventilation (NIV) and invasive mechanical ventilation (IMV), the pharmacologic management of acute asthma, and ECLS. This review also explores additional advanced non-pharmacologic techniques and monitoring tools for the safe and effective management of critically ill adult asthmatic patients.
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Affiliation(s)
- Shameek Gayen
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University Hospital, Philadelphia, PA 19140, USA; (S.D.); (B.H.L.); (M.G.); (P.D.); (G.J.C.); (K.S.)
| | - Stephen Dachert
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University Hospital, Philadelphia, PA 19140, USA; (S.D.); (B.H.L.); (M.G.); (P.D.); (G.J.C.); (K.S.)
| | - Bilal H. Lashari
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University Hospital, Philadelphia, PA 19140, USA; (S.D.); (B.H.L.); (M.G.); (P.D.); (G.J.C.); (K.S.)
| | - Matthew Gordon
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University Hospital, Philadelphia, PA 19140, USA; (S.D.); (B.H.L.); (M.G.); (P.D.); (G.J.C.); (K.S.)
| | - Parag Desai
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University Hospital, Philadelphia, PA 19140, USA; (S.D.); (B.H.L.); (M.G.); (P.D.); (G.J.C.); (K.S.)
| | - Gerard J. Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University Hospital, Philadelphia, PA 19140, USA; (S.D.); (B.H.L.); (M.G.); (P.D.); (G.J.C.); (K.S.)
| | - Juan Carlos Cardet
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL 33602, USA;
| | - Kartik Shenoy
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University Hospital, Philadelphia, PA 19140, USA; (S.D.); (B.H.L.); (M.G.); (P.D.); (G.J.C.); (K.S.)
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Bilodeau KS, Charette K, McMullan DM. Safety and Efficacy of Extracorporeal Membrane Oxygenation Heating Units. World J Pediatr Congenit Heart Surg 2024; 15:30-35. [PMID: 37915224 DOI: 10.1177/21501351231185114] [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: 11/03/2023]
Abstract
BACKGROUND Patient temperature during extracorporeal membrane oxygenation (ECMO) is commonly managed by dedicated heating units (HUs) that are integrated into ECMO circuitry. Currently, no HU has received approval for ECMO by the FDA in the United States. Older FDA-approved HUs have been implicated in life-threatening patient infections and are no longer manufactured or available for use in the United States. METHODS We performed laboratory tests to evaluate the safety and efficacy of the Micro-Temp and the HTP-1500 HU systems that are potentially suitable for use in ECMO and describe our initial experience with the HTP-1500 HU after being placed in clinical service. RESULTS Both units demonstrated similar heating efficacy, with the HTP-1500 achieving steady-state temperature approximately 5 h earlier than the Micro-Temp. Microorganisms were detected in the water compartment of all HUs prior to and after performing the manufacturer's recommended cleaning procedure, and after implementation of the HTP-1500 into clinical use we observed a decrease in the rate of bloodstream infection/ECMO days which did not reach statistical significance. CONCLUSION Based on the results of this analysis and our institutional experience, we believe that integration of the HTP-1500 HU, an easily replaceable HU, into ECMO systems may reduce the risk of bacterial contamination and thus nosocomial infection when the devices are cleaned and maintained according to manufacturer's guidelines.
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Affiliation(s)
- Kyle S Bilodeau
- Division of Cardiac Surgery, Seattle Children's Hospital, Seattle, WA, USA
| | - Kevin Charette
- Division of Perfusion, Seattle Children's Hospital, Seattle, WA, USA
| | - D Michael McMullan
- Division of Cardiac Surgery, Seattle Children's Hospital, Seattle, WA, USA
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10
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Wang J, Wang S, Song Y, Huang M, Cao W, Liu S, Chen S, Li X, Liu M, He Y. Analysis of 24-hour Death Risk Factors in Circulatory Failure Patients Treated with Venoarterial Extracorporeal Membrane Oxygenation. Braz J Cardiovasc Surg 2023; 38:e20220398. [PMID: 37801399 PMCID: PMC10550103 DOI: 10.21470/1678-9741-2022-0398] [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: 04/01/2022] [Accepted: 12/27/2022] [Indexed: 10/08/2023] Open
Abstract
OBJECTIVE To explore the factors affecting short-term prognosis of circulatory failure patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) treatment. METHODS A total of 136 patients undergoing VA-ECMO were enrolled in this study and subsequently divided into the death group (n=35) and the survival group (n=101) based on whether death occurred during hospitalisation. Extracorporeal membrane oxygenation (ECMO) running time, length of intensive care unit stay, length of hospital stay, costs, and ECMO complications were then compared between the two groups. RESULTS The average age of all patients undergoing ECMO was 47.64±16.78 years (53.2±16.20 years in the death group and 45.713±16.62 years in the survival group) (P=0.022). Patients in the survival group exhibited a clear downward trend in lactic acid value following ECMO treatment compared to those in the death group. Total hospitalisation stay was longer in the survival group (35 days) than in the death group (15.5 days) (P<0.001). In the analysis of ECMO complications, the incidence of neurological complications, renal failure, limb complications, and infection were higher in the death group than in the survival group (P<0.05 for all). Specifically, as a risk factor for patient survival and discharge, the occurrence of infection will lead to increased hospitalisation stays and costs (P<0.05 for both). CONCLUSION Complications such as kidney failure and infection are associated with in-hospital death, and ECMO-related complications should be actively prevented to improve the survival rate of VA-ECMO treatment.
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Affiliation(s)
- Jianwei Wang
- Institute of Geriatrics, Beijing Key Laboratory of Aging and
Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second
Medical Center, Chinese People's Liberation Army General Hospital, Beijing, People’s
Republic of China
- Chinese People’s Liberation Army Medical School, Beijing, People’s
Republic of China
- Department of Critical Care Medicine, Puyang People’s Hospital,
Henan, People’s Republic of China
| | - Shengshu Wang
- Institute of Geriatrics, Beijing Key Laboratory of Aging and
Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second
Medical Center, Chinese People's Liberation Army General Hospital, Beijing, People’s
Republic of China
| | - Yang Song
- Institute of Geriatrics, Beijing Key Laboratory of Aging and
Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second
Medical Center, Chinese People's Liberation Army General Hospital, Beijing, People’s
Republic of China
- Chinese People’s Liberation Army Medical School, Beijing, People’s
Republic of China
| | - MingJun Huang
- Department of Extracorporeal Support Center, The First Affiliated
Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Wenzhe Cao
- Institute of Geriatrics, Beijing Key Laboratory of Aging and
Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second
Medical Center, Chinese People's Liberation Army General Hospital, Beijing, People’s
Republic of China
- Chinese People’s Liberation Army Medical School, Beijing, People’s
Republic of China
| | - Shaohua Liu
- Institute of Geriatrics, Beijing Key Laboratory of Aging and
Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second
Medical Center, Chinese People's Liberation Army General Hospital, Beijing, People’s
Republic of China
- Chinese People’s Liberation Army Medical School, Beijing, People’s
Republic of China
| | - Shimin Chen
- Institute of Geriatrics, Beijing Key Laboratory of Aging and
Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second
Medical Center, Chinese People's Liberation Army General Hospital, Beijing, People’s
Republic of China
- Chinese People’s Liberation Army Medical School, Beijing, People’s
Republic of China
| | - Xuehang Li
- Institute of Geriatrics, Beijing Key Laboratory of Aging and
Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second
Medical Center, Chinese People's Liberation Army General Hospital, Beijing, People’s
Republic of China
- Chinese People’s Liberation Army Medical School, Beijing, People’s
Republic of China
| | - Miao Liu
- Department of Statistics and Epidemiology, Graduate School, Chinese
People’s Liberation Army General Hospital, Beijing, People’s Republic of China
| | - Yao He
- Institute of Geriatrics, Beijing Key Laboratory of Aging and
Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second
Medical Center, Chinese People's Liberation Army General Hospital, Beijing, People’s
Republic of China
- State Key Laboratory of Kidney Diseases, Beijing, People’s Republic
of China
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Koziol KJ, Isath A, Rao S, Gregory V, Ohira S, Van Diepen S, Lorusso R, Krittanawong C. Extracorporeal Membrane Oxygenation (VA-ECMO) in Management of Cardiogenic Shock. J Clin Med 2023; 12:5576. [PMID: 37685643 PMCID: PMC10488419 DOI: 10.3390/jcm12175576] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/13/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023] Open
Abstract
Cardiogenic shock is a critical condition of low cardiac output resulting in insufficient systemic perfusion and end-organ dysfunction. Though significant advances have been achieved in reperfusion therapy and mechanical circulatory support, cardiogenic shock continues to be a life-threatening condition associated with a high rate of complications and excessively high patient mortality, reported to be between 35% and 50%. Extracorporeal membrane oxygenation can provide full cardiopulmonary support, has been increasingly used in the last two decades, and can be used to restore systemic end-organ hypoperfusion. However, a paucity of randomized controlled trials in combination with high complication and mortality rates suggest the need for more research to better define its efficacy, safety, and optimal patient selection. In this review, we provide an updated review on VA-ECMO, with an emphasis on its application in cardiogenic shock, including indications and contraindications, expected hemodynamic and echocardiographic findings, recommendations for weaning, complications, and outcomes. Furthermore, specific emphasis will be devoted to the two published randomized controlled trials recently presented in this setting.
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Affiliation(s)
- Klaudia J. Koziol
- School of Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY 10595, USA
| | - Ameesh Isath
- Department of Cardiology, Westchester Medical Center, Valhalla, NY 10595, USA
| | - Shiavax Rao
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD 21218, USA
| | - Vasiliki Gregory
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD 21218, USA
| | - Suguru Ohira
- Division of Cardiothoracic Surgery, New York Medical College and Westchester Medical Center, Valhalla, NY 10595, USA
| | - Sean Van Diepen
- Division of Cardiology and Critical Care, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, 6202 AZ Maastricht, The Netherlands
| | - Chayakrit Krittanawong
- Cardiology Division, NYU Langone Health and NYU School of Medicine, New York, NY 10016, USA
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12
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Ferrel MN, Raza SS, Tang P, Haft J, Ala AAE. Cannulation strategies for extracorporeal membrane oxygenation. Indian J Thorac Cardiovasc Surg 2023; 39:91-100. [PMID: 37525707 PMCID: PMC10387010 DOI: 10.1007/s12055-023-01537-0] [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: 01/23/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 08/02/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is a type of extracorporeal life support (ECLS) in which the function of the heart and/or lungs is partially or completely replaced by a portable system that provides prolonged support to critically ill patients with respiratory or cardiac failure. There are two major variants of ECMO: veno-venous (VV) ECMO and veno-arterial (VA) ECMO. VV ECMO replaces the function of the lung in which it uses a cannula to remove venous blood and oxygenates it using the extracorporeal system, and returns the blood to the right atrium to be pumped to the body. VA ECMO is slightly different in that it replaces the function of the heart and lungs by returning oxygenated blood to the aorta. As a therapy for respiratory failure, ECMO minimizes hypoxia, diminishes lung stress and strain, and allows lung protective mechanical ventilation. As a support for acute and terminal heart failure, ECMO reduces preload, increases aortic flow, and allows for end-organ perfusion. Due to its physiological support and advantages, it is used for a variety of chronic and acute support purposes such as bridge therapy for heart/lung transplant, durable ventricular assist devices, and intermediate-term mechanical support postoperatively. Our review gives a broad overview of the two main types of ECMO strategies and their clinical indications, cannulation strategies, unique clinical utility, and their limitations.
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Affiliation(s)
| | - Syed Sikandar Raza
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI 48197 USA
| | - Paul Tang
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI 48197 USA
| | - Jonathan Haft
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI 48197 USA
| | - Ashraf Abou El Ala
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI 48197 USA
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13
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Condello I, Santarpino G, Nasso G, Moscarelli M, Speziale G, Lorusso R. 'Goal-directed extracorporeal circulation: transferring the knowledge and experience from daily cardiac surgery to extracorporeal membrane oxygenation'. Perfusion 2023; 38:449-454. [PMID: 34927474 DOI: 10.1177/02676591211063826] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Metabolism management plays an essential role in extracorporeal technologies. There are different metabolic management devices integrated to extracorporeal devices; the most commonly used and accepted metabolic target in adult patients is indexed oxygen delivery (280 mL/min/m2) and cardiac index (2.4 L/min/m2), which can be managed independently or according to other metabolic parameters. Extracorporeal membrane oxygenation (ECMO) is a temporary form of life support providing a prolonged biventricular circulatory and pulmonary support for patients experiencing both pulmonary and cardiac failure unresponsive to conventional therapy. The goal-directed perfusion initiative during cardiopulmonary bypass (CPB) reduced the incidence of acute kidney injury after cardiac surgery. On the basis of the available literature, the identified goals to achieve during CPB include maintenance of oxygen delivery > 300 mL O2/min/m2 and reduction in vasopressor use. ECMO and CPB are conceptually similar but differ in many aspects and finality; in particular, they differ in the scientific evidence for metabolic management nadirs. As for CPB, predictive target parameters have been found and consolidated, particularly in terms of acute renal injury and the prevention of anaerobic metabolism, while for ECMO management, a blurred path remains. In this context, we review the strategies for optimal goal-directed therapy during CPB and ECMO, trying to transfer the knowledge and experience from daily cardiac surgery to veno-arterial ECMO.
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Affiliation(s)
- Ignazio Condello
- Department of Cardiac Surgery, 46804Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Giuseppe Santarpino
- Department of Cardiac Surgery, 46804Anthea Hospital, GVM Care & Research, Bari, Italy.,Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany.,Cardiac Surgery Unit, Department of Experimental and Clinical Medicine-University "Magna Graecia" of Catanzaro, Bari, Italy
| | - Giuseppe Nasso
- Department of Cardiac Surgery, 46804Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Marco Moscarelli
- Department of Cardiac Surgery, 46804Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Giuseppe Speziale
- Department of Cardiac Surgery, 46804Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, 199236Maastricht University Medical Centre, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
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14
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Baeza-Herrera LA, Hernández-Reyes JP, Lazcano-Díaz EA, Orihuela-Sandoval C, González-Ruiz FJ, Manzur-Sandoval D, Ramos-Enríquez Á, Terrazas-Cervantes E, Rojas-Velasco G. A contrast echocardiography-based protocol to rule out thrombus in Venous-Arterial ECMO: A proof of concept. Echocardiography 2023; 40:299-302. [PMID: 36799210 DOI: 10.1111/echo.15543] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/16/2023] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
Using an ultrasound-enhancing agent (UEA) has several indications, especially in diagnosing left ventricular thrombus. Herein, we present three cases of patients who were candidates for venous-arterial extracorporeal membrane oxygenation, among whom thrombus was ruled out via contrast echocardiography. The use of a UEA in these patients was a novel approach.
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Affiliation(s)
- Luis Augusto Baeza-Herrera
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Echocardiography Laboratory, Ciudad de Mexico, Mexico.,Instituto Nacional de Cardiología Ignacio Chávez, Cardiovascular Intensive Care Unit, Ciudad de Mexico, Mexico
| | - José Pablo Hernández-Reyes
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Echocardiography Laboratory, Ciudad de Mexico, Mexico
| | | | - Consuelo Orihuela-Sandoval
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Echocardiography Laboratory, Ciudad de Mexico, Mexico
| | | | - Daniel Manzur-Sandoval
- Instituto Nacional de Cardiología Ignacio Chávez, Cardiovascular Intensive Care Unit, Ciudad de Mexico, Mexico
| | - Ángel Ramos-Enríquez
- Instituto Nacional de Cardiología Ignacio Chávez, Cardiovascular Intensive Care Unit, Ciudad de Mexico, Mexico
| | - Elías Terrazas-Cervantes
- Instituto Nacional de Cardiología Ignacio Chávez, Cardiovascular Intensive Care Unit, Ciudad de Mexico, Mexico
| | - Gustavo Rojas-Velasco
- Instituto Nacional de Cardiología Ignacio Chávez, Cardiovascular Intensive Care Unit, Ciudad de Mexico, Mexico
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15
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Buckley MS, Benanti GE, Meckel J, Tekle LA, Gilbert B, Puebla Neira D, McNierney DA, Korkames G, Yerondopoulos M, Park A, O'Hea JA, MacLaren R. Correlation between partial thromboplastin time and thromboelastography in adult critically ill patients requiring bivalirudin for extracorporeal membrane oxygenation. Pharmacotherapy 2023; 43:196-204. [PMID: 36759323 DOI: 10.1002/phar.2776] [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: 11/17/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 02/11/2023]
Abstract
STUDY OBJECTIVE Thromboelastography (TEG) offers a more dynamic assessment of hemostasis over activated partial thromboplastin time (aPTT). However, the clinical utility of TEG in monitoring bivalirudin during extracorporeal membrane oxygenation (ECMO) remains unknown. The purpose of this study was to evaluate the correlation between aPTT and TEG in adult ECMO patients anticoagulated with bivalirudin. DESIGN Multicenter, retrospective, cohort study conducted over a 2-year period. SETTING Two academic university medical centers (Banner University Medical Center) in Phoenix and Tucson, AZ. PATIENTS Adult patients requiring ECMO and bivalirudin therapy with ≥1 corresponding standard TEG and aPTT plasma samples drawn ≤4 h of each other were included. The primary endpoint was to determine the correlation coefficient between the standard TEG reaction (R) time and bivalirudin aPTT serum concentrations. MEASUREMENTS AND MAIN RESULTS A total of 104 patients consisting of 848 concurrent laboratory assessments of R time and aPTT were included. A moderate correlation between TEG R time and aPTT was demonstrated in the study population (r = 0.41; p < 0.001). Overall, 502 (59.2%) concurrent assessments of TEG R time and aPTT values showed agreement on whether they were sub-, supra-, or therapeutic according to the institution's classification for bivalirudin. The 42.2% (n = 271/642) discordant TEG R times among "therapeutic" aPTT were almost equally distributed between subtherapeutic and supratherapeutic categories. CONCLUSIONS Moderate correlation was found between TEG R time and aPTT associated with bivalirudin during ECMO in critically ill adults. Further research is warranted to address the optimal test to guide clinical decision-making for anticoagulation dosing in ECMO patients.
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Affiliation(s)
- Mitchell S Buckley
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, Arizona, USA
| | - Grace E Benanti
- Department of Pharmacy, Loyola University Medical Center, Maywood, Illinois, USA
| | - Jordan Meckel
- Department of Pharmacy, Loyola University Medical Center, Maywood, Illinois, USA
| | - Luwam A Tekle
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, Arizona, USA
| | - Brian Gilbert
- Department of Pharmacy, Wesley Medical Center, Wichita, Kansas, USA
| | - Daniel Puebla Neira
- Department of Pulmonary and Critical Care, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Dakota A McNierney
- Department of Medicine, Banner University Medical Center Phoenix, Phoenix, Arizona, USA
| | - Grace Korkames
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, Arizona, USA
| | - Melanie Yerondopoulos
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, Arizona, USA
| | - Andrew Park
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, Arizona, USA
| | - Jennifer A O'Hea
- Division of Pulmonary/Critical Care, Banner University Medical Center Phoenix, Phoenix, Arizona, USA
| | - Robert MacLaren
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA
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Contralateral Lower Extremity Ischemia on Femoral Veno-Arterial Extracorporeal Membrane Oxygenation. ASAIO J 2023; 69:e128-e130. [PMID: 36730954 DOI: 10.1097/mat.0000000000001832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Ipsilateral lower extremity ischemia is a common and morbid complication during veno-arterial extracorporeal membrane oxygenation (VA-ECMO). The cannula can impede ipsilateral distal arterial flow leading to critical limb ischemia. Cannula size, placement, and utilization of distal perfusion catheters are strategies that have been used to prevent this complication. We report the novel case of a 19-year-old female on VA-ECMO complicated by contralateral lower extremity ischemia. Diagnosis was made by computed tomography, and with repositioning of the femoral arterial cannula, she had a complete resolution of symptoms.
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17
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Nambiar PM, Sharma J, Mehta Y. Extracorporeal Membrane Oxygenation in Cardiogenic shock – A Review. JOURNAL OF CARDIAC CRITICAL CARE TSS 2023. [DOI: 10.25259/jccc_7_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Extracorporeal membrane oxygenation has been used in adult in cardiogenic shock due to myocardial infarction, myocardiopathy, myocarditis, or inability to come off cardiopulmonary bypass (CPB) after cardiac surgery.3 ECMO can provide partial or total support, but it is temporary. It is not a definitive treatment but a life support system that allows time for evaluation, diagnosis and treatment of the condition that causes heart failure. With high incidence of late stage coronary artery disease and infective myocarditis in India, the usage of ECMO for refractory cardiogenic shock is going to be a promising approach for effective management of refractory heat failure .ECMO has proven to be an effective therapeutic modality in managing cardiovascular collapse as a bridge to recovery or more definitive treatment options.
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Affiliation(s)
- Prajesh M. Nambiar
- Department of Cardiac Anesthesia, Medanta - The Medicity, Gurgaon, Haryana, India,
| | - Jeetendra Sharma
- Chief Critical Care Medicine and Chief Medical Quality, Artemis Hospital, Gurgaon, Haryana, India,
| | - Yatin Mehta
- Department of Critical Care and Anesthesiology, Medanta Institute of Critical Care and Anesthesiology, Medanta - The Medicity, Gurgaon, Haryana, India,
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18
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Incidence of Venous Thromboembolism in Adults Receiving Extracorporeal Membrane Oxygenation: A Systematic Review. ASAIO J 2022; 68:1523-1528. [PMID: 36469448 DOI: 10.1097/mat.0000000000001694] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) has become an increasingly used tool for cardiorespiratory support. Thrombosis is a well-recognized complication of ECMO, yet the burden of disease remains unclear. We undertook a systematic review to investigate the incidence of venous thromboembolism (VTE) during ECMO or soon after decannulation, in patients screened for VTE. We retrieved all studies that evaluated VTE incidence in ECMO patients in EMBASE, MEDLINE, Web of Science, and Cochrane Library from inception to April 2, 2021. Studies reporting incidence of VTE diagnosed on systematic screening tests during ECMO or within 7 days of decannulation in adult patients were included. A total of 18 studies were included in the systematic review. These studies screened a total of 1095 ECMO patients. Most studies screened for cannula-associated deep vein thrombosis (CaDVT) after decannulation. The overall incidence of DVT was 52.8% (95% CI, 49.8-55.8%). Incidence of DVT was 53.5% (95% CI, 50.0-57.0%) for venovenous ECMO vs. 34.0% (95% CI, 26.5-42.2%) for venoarterial ECMO. No studies screened for pulmonary embolism. Our systematic review found a very high incidence of DVT among patients treated with ECMO. Routine screening for DVT after decannulation for all ECMO patients may be warranted.
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19
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Joseph J, Bellezzo J. Refractory Anaphylactic Shock Requiring Emergent Venoarterial Extracorporeal Membrane Oxygenation in the Emergency Department: A Case Report. J Emerg Nurs 2022; 48:626-630. [PMID: 36109202 DOI: 10.1016/j.jen.2022.08.002] [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: 04/18/2022] [Revised: 08/04/2022] [Accepted: 08/04/2022] [Indexed: 11/17/2022]
Abstract
Venoarterial extracorporeal membrane oxygenation is a viable salvage intervention for patients who experience cardiopulmonary arrest or profound shock from any cause. Acute anaphylactic shock is a rare cause of cardiac arrest. We present a case of a 35-year-old male who experienced cardiac arrest owing to anaphylactic shock while receiving general anesthesia for a routine outpatient surgical procedure. Traditional advanced cardiac life support therapies were provided by paramedics en route to the emergency department of a suburban, community-based hospital. Maximal medical management including endotracheal intubation, intravenous steroids, intravenous crystalloid fluid administration, intravenous vasoactive medications, and high-quality cardiopulmonary resuscitation was provided. Although return of spontaneous circulation was achieved, profound cardiogenic shock persisted. Venoarterial extracorporeal membrane oxygenation was initiated by the emergency department provider and nursing team. The patient survived, was neurologically intact, had full recovery, and was discharged home several days later. We have extensive experience with venoarterial extracorporeal membrane oxygenation, and this case exemplifies the value of an established emergency department extracorporeal membrane oxygenation program in managing all causes of cardiac arrest or refractory shock.
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20
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Große-Berkenbusch K, Avci-Adali M, Arnold M, Cahalan L, Cahalan P, Velic A, Maček B, Schlensak C, Wendel HP, Stoppelkamp S. Profiling of time-dependent human plasma protein adsorption on non-coated and heparin-coated oxygenator membranes. BIOMATERIALS ADVANCES 2022; 139:213014. [PMID: 35882160 DOI: 10.1016/j.bioadv.2022.213014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/02/2022] [Accepted: 06/30/2022] [Indexed: 01/07/2023]
Abstract
Patients with severe lung diseases are highly dependent on lung support systems. Despite many improvements, long-term use is not possible, mainly because of the strong body defence reactions (e.g. coagulation, complement system, inflammation and cell activation). The systematic characterization of adsorbed proteins on the gas exchange membrane of the lung system over time can provide insights into the course of various defence reactions and identify possible targets for surface modifications. Using comprehensive mass spectrometry analyses of desorbed proteins, we were able to identify for the first time binding profiles of over 500 proteins over a period of six hours on non-coated and heparin-coated PMP hollow fiber membranes. We observed a higher degree of remodeling of the protein layer on the non-coated membrane than on the coated membrane. In general, there was a higher protein binding on the coated membrane with exception of proteins with a heparin-binding site. Focusing on the most important pathways showed that almost all coagulation factors bound in higher amounts to the non-coated membranes. Furthermore, we could show that the initiator proteins of the complement system bound stronger to the heparinized membranes, but the subsequently activated proteins bound stronger to the non-coated membranes, thus complement activation on heparinized surfaces is mainly due to the alternative complement pathway. Our results provide a comprehensive insight into plasma protein adsorption on oxygenator membranes over time and point to new ways to better understand the processes on the membranes and to develop new specific surface modifications.
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Affiliation(s)
- Katharina Große-Berkenbusch
- Clinical Research Laboratory, Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, University of Tübingen, Calwerstr. 7/1, 72076 Tübingen, Germany
| | - Meltem Avci-Adali
- Clinical Research Laboratory, Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, University of Tübingen, Calwerstr. 7/1, 72076 Tübingen, Germany
| | - Madeleine Arnold
- Clinical Research Laboratory, Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, University of Tübingen, Calwerstr. 7/1, 72076 Tübingen, Germany
| | - Linda Cahalan
- Ension Inc, 508 Pittsburg Road, Butler, PA 16002, United States of America
| | - Patrick Cahalan
- Ension Inc, 508 Pittsburg Road, Butler, PA 16002, United States of America
| | - Ana Velic
- Proteome Center Tübingen, Interfaculty Institute for Cell Biology, University of Tübingen, Auf der Morgenstelle 15, 72076 Tübingen, Germany
| | - Boris Maček
- Proteome Center Tübingen, Interfaculty Institute for Cell Biology, University of Tübingen, Auf der Morgenstelle 15, 72076 Tübingen, Germany
| | - Christian Schlensak
- Clinical Research Laboratory, Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, University of Tübingen, Calwerstr. 7/1, 72076 Tübingen, Germany
| | - Hans Peter Wendel
- Clinical Research Laboratory, Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, University of Tübingen, Calwerstr. 7/1, 72076 Tübingen, Germany
| | - Sandra Stoppelkamp
- Clinical Research Laboratory, Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, University of Tübingen, Calwerstr. 7/1, 72076 Tübingen, Germany.
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21
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Kim K, Leem AY, Kim SY, Chung KS, Park MS, Kim YS, Lee JG, Paik HC, Lee SH. Complications related to extracorporeal membrane oxygenation support as a bridge to lung transplantation and their clinical significance. Heart Lung 2022; 56:148-153. [PMID: 35908349 DOI: 10.1016/j.hrtlng.2022.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Incidence of complications related extracorporeal membrane oxygenation (ECMO) support as a bridge to lung transplantation (BTT) and its association with the patient outcome in lung transplantation (LT) has not been well documented in previous studies. OBJECTIVES We evaluated the incidence of complications related to the use of ECMO support as a BTT, and the association between the occurrence of the complications and patient outcomes in LTs. METHODS This retrospective cohort study investigated 100 consecutive patients who started ECMO support as a BTT between April 2013 and March 2020. Data for the analyses were retrieved from electronic medical records. RESULTS Fifty-six percent of the patients experienced at least one complication during the BTT with ECMO. Major bleeding was the most common complication. In multivariate logistic regression analysis, occurrence of oxygenator thromboses (OR 16.438, P = 0.008) and the use of renal replacement therapy (RRT) (OR 32.288, P < 0.001) were associated with a failed BTT. In the subgroup analysis of the LT recipients, intracranial hemorrhages, (OR 13.825, P = 0.021), RRT use, (OR 11.395, P = 0.038), and bloodstream infection occurrence (OR 6.210; P = 0.034) were identified as risk factors for in-hospital mortality. CONCLUSIONS The occurrence of complications during the use of ECMO support as a BTT was associated with unfavorable outcomes in LTs. Close monitoring and the proper management of these complications may be important to achieve better outcomes in patients using ECMO support as a BTT.
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Affiliation(s)
- Kangjoon Kim
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Severance Hospital, Yonsei University College of Medicine, Postal address: 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Ah Young Leem
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Severance Hospital, Yonsei University College of Medicine, Postal address: 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Song Yee Kim
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Severance Hospital, Yonsei University College of Medicine, Postal address: 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Kyung Soo Chung
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Severance Hospital, Yonsei University College of Medicine, Postal address: 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Moo Suk Park
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Severance Hospital, Yonsei University College of Medicine, Postal address: 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Young Sam Kim
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Severance Hospital, Yonsei University College of Medicine, Postal address: 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo Chae Paik
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su Hwan Lee
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Severance Hospital, Yonsei University College of Medicine, Postal address: 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.
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22
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Rossong H, Debreuil S, Yan W, Hiebert BM, Singal RK, Arora RC, Yamashita MH. Long-Term Survival and Quality of Life after Extracorporeal Membrane Oxygenation. J Thorac Cardiovasc Surg 2022:S0022-5223(22)00204-5. [DOI: 10.1016/j.jtcvs.2021.10.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 10/13/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
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23
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Oh TK, Cho HW, Song IA. Mortality Trends after Extracorporeal Membrane Oxygenation Support: A Korean Nationwide Cohort. Artif Organs 2022; 46:850-858. [PMID: 35083743 DOI: 10.1111/aor.14190] [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: 06/08/2021] [Revised: 12/20/2021] [Accepted: 01/12/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed to investigate the prevalence of 7-, 30-, 60-, and 365-day overall and cause-specific mortality following extracorporeal membrane oxygenation (ECMO) support. METHODS The National Health Insurance claims database in South Korea was the data source for this population-based cohort study. We enrolled all adult patients aged ≥18 years receiving intensive care unit ECMO support from January 1, 2005 to December 31, 2018. The study population was divided into three groups based on the main diagnoses during ECMO support: 1) cardiovascular, 2) respiratory, and 3) other diagnoses group (all other main diagnoses rather than cardiovascular or respiratory diseases). RESULTS A total of 18,697 patients were included in the final analysis (64.5%, 10.9%, and 24.6% in the cardiovascular, respiratory, and other groups, respectively). The corresponding 7-, 30-, 60-, and 365-day mortality rates in these groups were 33.1%, 56.1%, 62.4%, and 67.7%. Kaplan-Meier curves demonstrated that the median survival time was shortest in the cardiovascular group (12.0 days, 95% confidence interval [CI]: 11.3-12.7), with 31.0 (95% CI: 28.5-33.6) and 49.0 (95% CI: 44.4-57.6) day survival in the respiratory and other diagnoses groups (p<0.001). CONCLUSIONS Approximately one-third of patients died within 7 days, half of the patients died within 30 days, and two-thirds died within 365 days of ECMO support. Overall survival time was shortest in the cardiovascular group, followed by that of the respiratory group.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Hyoung-Won Cho
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Cho HW, Song IA, Oh TK. Limb Amputation Following Extracorporeal Membrane Oxygenation Therapy Among Survivors: A Nationwide Cohort Study from South Korea. ASAIO J 2021; 67:1322-1328. [PMID: 34261873 DOI: 10.1097/mat.0000000000001519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We aimed to investigate the incidence of limb amputation due to vascular complications related to extracorporeal membrane oxygenation (ECMO) therapy among survivors and examine its association with long-term mortality in these cases. Data from the National Health Insurance Service database in South Korea were extracted for this population-based cohort study. Adult people who underwent ECMO therapy between 2005 and 2018 were included. ECMO survivors were defined as those who survived for at least 365 days after the initiation of ECMO therapy. A total of 6,968 ECMO survivors were included in the study. Among them, 114 (1.6%) underwent limb amputation within 365 days of starting ECMO therapy. On multivariable Cox regression analysis, the risk of 3-year all-cause mortality was not significantly associated with limb amputation compared with those without limb amputation (hazard ratio: 1.53; 95% CI: 0.89-2.63; P = 0.072). In South Korea, 1.6% of ECMO survivors underwent limb amputation within 365 days after initiating ECMO therapy; however, it was not significantly associated with the 3-year all-cause mortality. Our findings warrant future studies on the impact on the quality of life and morbidity-related implications among patients who undergo limb amputation due to ECMO therapy.
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Affiliation(s)
- Hyoung-Won Cho
- From the Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Ruszel N, Kiełbowski K, Piotrowska M, Kubisa M, Grodzki T, Wójcik J, Kubisa B. Central, peripheral ECMO or CPB? Comparsion between circulatory support methods used during lung transplantation. J Cardiothorac Surg 2021; 16:341. [PMID: 34838067 PMCID: PMC8627075 DOI: 10.1186/s13019-021-01719-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 11/06/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease, cystic fibrosis and usual interstitial pneumonia are three most common indications for lung transplantation (LuTx) in Poland. As a result of irreversible destruction of pulmonary parenchyma and extended respiratory insufficiency that appear afterwards, it is crucial to estimate the reserve of gas exchange in each lung before and during surgery. Altering conditions of gas exchange require adaptation in circulatory system as well. In some of the cases the use of extracorporeal life support appears to be necessary to undergo the transplantation successfully. Cardiopulmonary bypass (CPB) or extracorporeal membrane oxygenation (ECMO) used during operation allow to replace the function of heart and lung, but they are also related to complications in the form of acute kidney failure, bleeding, heart arrhythmias or thromboembolic complications. METHODS We reviewed 77 LuTx from 2009 to 2020 performed at the Department of Thoracic Surgery and Transplantation. 40/77 (51%) patients required intraoperative extracorporeal assistance: 8 required CBP and 32 required ECMO. In the ECMO group 14/32 (44%) patients had peripheral cannulation and 18/32 (56%) had central one. We have calculated the survival rates and reviewed postoperative complications after lung transplantations. Cumulative Kaplan-Meier survival curves were calculated. Differences between the groups were evaluated by the Chi- square analysis for discontinuous variables and t-test for continuous variables. RESULTS The use of intraoperative central extracorporeal membrane oxygenator was associated with increased survival rates comparing to patients without external support (30-days, 1-year, 3-years, 5-years rates: 78%, 66%, 66%, 66% vs 83%, 65%, 59%, 44% respectively). Furthermore, survival was enhanced comparing to peripheral ECMO or cardiopulmonary bypass as well (50%, 41%, 41%, 33%; 75%, 50%, 50%, 38% respectively). Acute kidney injury and thromboembolic complications occurred statistically more often in case of patients that underwent lung transplantation with support devices (p = 0.005, p = 0.02 respectively). Frequency of other complications was comparable among groups. CONCLUSIONS The use of central extracorporeal membrane oxygenation should be favorized over peripheral cannulation or cardiopulmonary bypass. CPB should be no longer used during LuTx. Trial registration Not applicable.
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Affiliation(s)
- Nikola Ruszel
- Department of Thoracic Surgery and Transplantation, Independent Public Regional Hospital, Pomeranian Medical University, Sokołowskiego 11 Street, Szczecin-Zdunowo, Poland.
| | - Kajetan Kiełbowski
- Department of Thoracic Surgery and Transplantation, Independent Public Regional Hospital, Pomeranian Medical University, Sokołowskiego 11 Street, Szczecin-Zdunowo, Poland
| | - Maria Piotrowska
- Department of Thoracic Surgery and Transplantation, Independent Public Regional Hospital, Pomeranian Medical University, Sokołowskiego 11 Street, Szczecin-Zdunowo, Poland
| | - Michał Kubisa
- Department of Thoracic Surgery and Transplantation, Independent Public Regional Hospital, Pomeranian Medical University, Sokołowskiego 11 Street, Szczecin-Zdunowo, Poland
| | - Tomasz Grodzki
- Department of Thoracic Surgery and Transplantation, Independent Public Regional Hospital, Pomeranian Medical University, Sokołowskiego 11 Street, Szczecin-Zdunowo, Poland
| | - Janusz Wójcik
- Department of Thoracic Surgery and Transplantation, Independent Public Regional Hospital, Pomeranian Medical University, Sokołowskiego 11 Street, Szczecin-Zdunowo, Poland
| | - Bartosz Kubisa
- Department of Thoracic Surgery and Transplantation, Independent Public Regional Hospital, Pomeranian Medical University, Sokołowskiego 11 Street, Szczecin-Zdunowo, Poland
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Predictors of mortality following extracorporeal membrane oxygenation support in an unselected, critically ill patient population. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:290-297. [PMID: 34819965 PMCID: PMC8596723 DOI: 10.5114/aic.2021.109149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/18/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Mechanical circulatory support (MCS) has been established as a means of augmenting circulation in patients with critically decreased systolic function due to a variety of underlying clinical reasons. Different methods of MCS may be used, with the venous-arterial extracorporeal membrane oxygenation system (VA-ECMO) being one of the most utilized devices in everyday care. Aim To determine independent predictors influencing mortality outcomes following VA-ECMO therapy in a large, unselected, adult, critically ill patient population in cardiogenic shock (CS). Material and methods Data on 235 consecutive, real-world VA-ECMO treatments were assessed. Analysis was conducted for all subjects requiring MCS with the VA-ECMO as the first instalment, regardless of underlying cause or eventual upgrade. All potential clinical factors influencing mortality were examined and evaluated. Results Overall mortality was ~66% at median 28 days follow-up and significantly depended upon pH < 7.3 (HR = 3.56; p < 0.001), and age ≥ 65 years (HR = 1.96; p = 0.001). Acute coronary syndrome (ACS) as an indication for VA-ECMO displayed a nearly significant value (HR = 1.44; p = 0.07). Heart transplant (hTX) primary graft failure as an indication for the VA-ECMO displayed a clearly favorable outcome (HR = 0.51, p = 0.025); all data based on multivariate Cox regression analysis. Conclusions Mortality in patients requiring VA-ECMO remains high. We conclude that only decreased pH values and advanced age clearly influence mortality in this MCS scenario. ACS also bodes unfavorably, whereas hTX as an indication clearly shows better survival.
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Tani M. Veno-venous extracorporeal membrane oxygenation in the management of refractory bilateral bronchial dehiscence after lung transplant: a case report. JA Clin Rep 2021; 7:77. [PMID: 34654984 PMCID: PMC8519744 DOI: 10.1186/s40981-021-00480-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/10/2021] [Accepted: 10/08/2021] [Indexed: 11/26/2022] Open
Abstract
Background Bronchial dehiscence is a life-threatening complication after lung transplant. If it is not treated by placement of stent or reanastomosis, the chance of survival will depend on the availability of a new graft. However, retransplant is not a practical management option in Japan, where waiting time for lung transplant is extensive. We described a case of refractory bilateral bronchial dehiscence managed by veno-venous extracorporeal oxygenation membrane (VV ECMO) while allowing the dehiscence to heal. Case presentation A 25-year-old man with idiopathic pulmonary arterial hypertension underwent a bilateral lung transplant. The patient developed bilateral bronchial dehiscence. Open reanastomosis was not successful, and air leakage recurred under low positive pressure ventilation. VV ECMO was established to maintain oxygenation with spontaneous breathing until both dehiscence were closed by adhesions. Conclusion In a patient with refractory bilateral bronchial dehiscence, VV ECMO may provide bronchial rest and serve as a bridge therapy to recovery.
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Affiliation(s)
- Makiko Tani
- Department of Anesthesiology and Resuscitology, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
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Oh TK, Park HY, Song IA. Delirium and Long-Term Outcomes among Survivors of Extracorporeal Membrane Oxygenation Therapy: A Nationwide Cohort Study in South Korea. J Intensive Care Med 2021; 37:870-876. [PMID: 34565204 DOI: 10.1177/08850666211032610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The prevalence of delirium and its association with long-term outcomes of extracorporeal membrane oxygenation (ECMO) therapy have not yet been identified. We aimed to investigate the prevalence of delirium and its associated factors during hospitalization among ECMO survivors. We also examined whether the occurrence of delirium was associated with 1-year all-cause mortality among ECMO survivors. Methods: As a population-based cohort study, data were obtained from the National Health Insurance Service database in South Korea. Adults older than 18 years who received ECMO therapy between 2005 and 2018 were included in this study. ECMO survivors were defined as patients who were discharged from the hospital. Results: The analysis included a total of 8153 ECMO survivors, of whom 551 (6.8%) experienced delirium during hospitalization. Older age (odds ratio [OR]: 1.01, 95% confidence interval [CI]: 1.00-1.02; P = 0.004), male sex (OR: 1.38, 95% CI: 1.13-1.68; P = 0.002), underlying depression (OR: 1.90, 95% CI: 1.49-2.41; P < 0.001), and longer length of hospital stay (OR: 1.02, 95% CI: 1.02-1.03; P < 0.001) were associated with a higher incidence of delirium. In multivariable Cox regression modeling, the occurrence of delirium was not significantly associated with the risk of 1-year all-cause mortality (hazard ratio: 0.90, 95% CI: 0.76-1.07; P = 0.229). Conclusion: The prevalence of delirium among ECMO survivors during hospitalization was 6.8% in South Korea, and old age, male sex, longer duration of hospital stay, and underlying depression were associated with it. However, there was no significant association between delirium and 1-year all-cause mortality among ECMO survivors.
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Affiliation(s)
- Tak Kyu Oh
- 65462Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Yoon Park
- 58927Seoul National University Hospital, Seoul, South Korea
| | - In-Ae Song
- 65462Seoul National University Bundang Hospital, Seongnam, Korea
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Abstract
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2021. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2021 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from https://link.springer.com/bookseries/8901 .
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Affiliation(s)
- Marlies Ostermann
- Department of Critical Care, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Nuttha Lumlertgul
- Department of Critical Care, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Division of Nephrology and Excellence Centre for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Critical Care Nephrology Research Unit, Chulalongkorn University, Bangkok, Thailand
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Oh TK, Song IA, Lee SY, Choi HR. Prior Antiplatelet Therapy and Stroke Risk in Critically Ill Patients Undergoing Extracorporeal Membrane Oxygenation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168679. [PMID: 34444428 PMCID: PMC8394632 DOI: 10.3390/ijerph18168679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 11/16/2022]
Abstract
We aimed to investigate whether prior exposure to antiplatelet therapy (anti-PLT) was associated with stroke incidence after the initiation of extracorporeal membrane oxygenation (ECMO) therapy. We conducted a population-based cohort study based on health records obtained from the National Health Insurance Service database in South Korea. Adult patients (aged ≥ 18 years) who underwent ECMO therapy in the intensive care unit during 2009-2018 were enrolled. In total, 17,237 patients who underwent ECMO therapy were included; stroke occurred in 779 (4.5%) of 17,237 patients within 7 days of initiating the ECMO therapy. The number of patients in the anti-PLT and control groups was 3909 (22.7%) and 13,328 (77.3%), respectively. In the multivariable logistic regression analysis, the anti-PLT group showed 33% lower incidence of stroke than the control group (odds ratio (OR): 0.67, 95% confidence interval (CI): 0.55-0.82; p < 0.001). The cardiovascular group showed 35% lower incidence of stroke than the control group (OR: 0.65, 95% CI: 0.52-0.78; p < 0.001), whereas the respiratory group (p = 0.821) and the other group (p = 0.705) did not show any significant association. Prior anti-PLT therapy was associated with a lower incidence of stroke within 7 days of initiating ECMO therapy, which was more evident in the cardiovascular group.
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Affiliation(s)
- Tak-Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea;
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea;
- Correspondence: (I.-A.S.); (H.-R.C.)
| | - Sol-Yi Lee
- Department of Anesthesiology and Pain Medicine, Inje University Seoul Paik Hospital, Seoul 04551, Korea;
| | - Hey-Ran Choi
- Department of Anesthesiology and Pain Medicine, Inje University Seoul Paik Hospital, Seoul 04551, Korea;
- Correspondence: (I.-A.S.); (H.-R.C.)
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Park HY, Song IA, Cho HW, Oh TK. Insomnia disorder and long-term mortality in adult patients treated with extracorporeal membrane oxygenation in South Korea. J Sleep Res 2021; 31:e13454. [PMID: 34350639 DOI: 10.1111/jsr.13454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/05/2021] [Accepted: 07/17/2021] [Indexed: 11/27/2022]
Abstract
We investigated the prevalence of insomnia in extracorporeal membrane oxygenation (ECMO)-treated patients and examined the association between post-ECMO insomnia disorder and long-term mortality. In the present population-based cohort study, we used data from the National Health Insurance Claims database in South Korea. All adult patients who underwent ECMO between 2006 and 2014 were included, and ECMO-treated patients were defined as those who survived >365 days after ECMO. Insomnia disorder was identified using the International Classification of Diseases 10th Revision codes G47.0 and F51.0. Overall, 3,055 ECMO-treated patients were included in the final analysis: 431 (14.1%) had pre-ECMO insomnia disorder, while 148 (4.8%) were newly diagnosed with insomnia disorder up to 1 year after ECMO. In multivariable Cox regression model, patients with post-ECMO insomnia disorder had higher 5-year all-cause mortality (ACM) than controls (hazard ratio [HR] 1.71, 95% confidence interval [CI] 1.21-2.42; p = 0.003); however, those with pre-ECMO insomnia disorder did not (p = 0.655). In sensitivity analysis, post-ECMO insomnia disorder with underlying psychiatric illness was associated with a 2.39-fold higher 5-year ACM in ECMO-treated patients (HR 2.39, 95% CI 1.52-3.75; p < 0.001). In conclusion, at 1-year after ECMO, 4.8% of ECMO-treated patients were newly diagnosed with insomnia disorder, and post-ECMO insomnia disorder was associated with higher 5-year ACM, especially in those with underlying psychiatric illness. Our present results suggest that the development of insomnia disorder might be related to poorer long-term survival in ECMO-treated patients, especially in case of underlying psychiatric illness.
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Affiliation(s)
- Hye Yoon Park
- Department of Psychiatry, Seoul National University Hospital, Seoul, South Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyoung-Won Cho
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Extracorporeal membrane oxygenation for the anesthetic management of a patient with severe airway stenosis caused by thyroid carcinoma invasion. Surg Today 2021; 51:2000-2005. [PMID: 34232373 DOI: 10.1007/s00595-021-02331-4] [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: 12/22/2020] [Accepted: 03/08/2021] [Indexed: 10/20/2022]
Abstract
The treatment of a thyroid carcinoma extending into the thoracic cavity with severe airway stenosis is difficult, since there is a risk of acute respiratory decompensation at every stage of anesthesia. Extracorporeal membrane oxygenation (ECMO) is a life support technique for maintaining both the cardiac and respiratory functions. It is used for the management of acute, severe, reversible respiratory or cardiac failure refractory to conventional management. We herein describe the use of ECMO for the anesthetic management of an elderly patient with severe airway stenosis caused by thyroid carcinoma invasion, which underwent total thyroidectomy with the resection of four tracheal rings and end-to-end anastomosis under a median sternotomy. Although the risks and benefits should be carefully weighed before a decision to use ECMO is made, the use of ECMO in the management of general anesthesia may be a rational and effective strategy for maintaining oxygenation.
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Oh TK, Cho HW, Lee HT, Song IA. Chronic respiratory disease and survival outcomes after extracorporeal membrane oxygenation. Respir Res 2021; 22:195. [PMID: 34225713 PMCID: PMC8256197 DOI: 10.1186/s12931-021-01796-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/01/2021] [Indexed: 01/19/2023] Open
Abstract
Background Quality of life following extracorporeal membrane oxygenation (ECMO) therapy is an important health issue. We aimed to describe the characteristics of patients who developed chronic respiratory disease (CRD) following ECMO therapy, and investigate the association between newly diagnosed post-ECMO CRDs and 5-year all-cause mortality among ECMO survivors. Methods We analyzed data from the National Health Insurance Service in South Korea. All adult patients who underwent ECMO therapy in the intensive care unit between 2006 and 2014 were included. ECMO survivors were defined as those who survived for 365 days after ECMO therapy. Chronic obstructive pulmonary disease (COPD), asthma, interstitial lung disease, lung cancer, lung disease due to external agents, obstructive sleep apnea, and lung tuberculosis were considered as CRDs. Results A total of 3055 ECMO survivors were included, and 345 (11.3%) were newly diagnosed with CRDs 365 days after ECMO therapy. The prevalence of asthma was the highest at 6.1% (185). In the multivariate logistic regression, ECMO survivors who underwent ECMO therapy for acute respiratory distress syndrome (ARDS) or respiratory failure had a 2.00-fold increase in post-ECMO CRD (95% confidence interval [CI]: 1.39 to 2.89; P < 0.001). In the multivariate Cox regression, newly diagnosed post-ECMO CRD was associated with a 1.47-fold (95% CI: 1.17 to 1.86; P = 0.001) higher 5-year all-cause mortality. Conclusions At 12 months after ECMO therapy, 11.3% of ECMO survivors were newly diagnosed with CRDs. Patients who underwent ECMO therapy for ARDS or respiratory failure were associated with a higher incidence of newly diagnosed post-ECMO CRD compared to those who underwent ECMO for other causes. Additionally, post-ECMO CRDs were associated with a higher 5-year all-cause mortality. Our results suggest that ECMO survivors with newly diagnosed post-ECMO CRD might be a high-risk group requiring dedicated interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-021-01796-8.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-ro, 173, Beon-gil, Bundang-gu, Seongnam, 13620, South Korea
| | - Hyoung-Won Cho
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Gumi-ro, 173, Beon-gil, Bundang-gu, Seongnam, 13620, South Korea
| | - Hun-Taek Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-ro, 173, Beon-gil, Bundang-gu, Seongnam, 13620, South Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-ro, 173, Beon-gil, Bundang-gu, Seongnam, 13620, South Korea.
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Park HY, Cho HW, Song IA, Lee S, Oh TK. Long-term mortality associated with depression among South Korean survivors of extracorporeal membrane oxygenation. Brain Behav 2021; 11:e02218. [PMID: 34056866 PMCID: PMC8323046 DOI: 10.1002/brb3.2218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Depression is an important sequela in critically ill patients. However, its prevalence after extracorporeal membrane oxygenation (ECMO) therapy and its association with long-term mortality remain controversial. METHODS Data were extracted from the South Korean National Health Insurance Service database in this population-based cohort study. Adults who received ECMO therapy from 2006 to 2014 were included. Survivors of ECMO were defined as patients who underwent ECMO and survived over 365 days after the initiation of ECMO therapy. RESULTS A total of 3,055 survivors of ECMO were included in the final analysis. They were classified into the pre-ECMO depression group (n = 275 [9.0%]), post-ECMO depression group (n = 331 [10.8%]), and other ECMO survivor group. In the multivariable Cox regression model, a 1.52-fold higher mortality was observed in the post-ECMO depression group than in the other groups (hazard ratio, 1.52; 95% confidence interval, 1.17-1.96; p = .002). However, there was no statistically significant difference between the pre-ECMO depression group and the other groups (p = .075). CONCLUSIONS The prevalence of pre- and post-ECMO depression was 9.0% and 10.8%, respectively. Additionally, post-ECMO depression was associated with an increased 5 year all-cause mortality; however, pre-ECMO depression was not.
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Affiliation(s)
- Hye Youn Park
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyoung-Won Cho
- Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sukyoon Lee
- Department of Neurology, Inje University College of Medicine, Busan, Republic of Korea
| | - Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Cho HW, Song IA, Oh TK. Trends in extracorporeal membrane oxygenation treatment from 2005 to 2018 in South Korea. Perfusion 2021; 37:545-552. [PMID: 34013822 DOI: 10.1177/02676591211018130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This study aimed to investigate trends in extracorporeal membrane oxygenation (ECMO) treatment during 2005-2018 and examine factors associated with in-hospital mortality. METHODS We conducted a population-based cohort study based on health records obtained from the National Health Insurance Service database in South Korea. All adult patients (⩾18 years old) who received ECMO treatment in the intensive care unit after hospitalization from 2005 to 2018 were enrolled. RESULTS We analyzed data for 21,129 adult ECMO patients from 128 hospitals. The prevalence of ECMO treatment gradually and continuously increased from 4 per 100,000 individuals (95% confidence interval [CI]: 3-4) in 2005 to 67.4 per 100,000 individuals (95% CI: 65-68) in 2018. There was a significant increase in ECMO treatment for acute respiratory distress syndrome (ARDS) or respiratory failure (from 2.5% during 2005-2008 to 14.5% during 2016-2018). The overall in-hospital and 30-day mortality rates of the patients were 48.4% and 53.5%, respectively. The in-hospital mortality rate was highest among patients with shock (62.1%) and lowest among ECMO patients with liver failure (21.6%). On multivariable logistic regression, a higher hospital case volume was associated with improvement in in-hospital mortality (p < 0.001). CONCLUSIONS In South Korea, the prevalence of ECMO treatment has increased gradually and continuously between 2005 and 2018. There was a significant increase in the prevalence of ECMO treatment for ARDS or respiratory failure. Our results support that ECMO treatment indications have been expanding, and ECMO will become vital for treating critically ill patients in the future.
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Affiliation(s)
- Hyoung-Won Cho
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Cho HW, Song IA, Oh TK. Weekend effect in extracorporeal membrane oxygenation therapy initiation: a nationwide cohort study in South Korea. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:742. [PMID: 34268355 PMCID: PMC8246153 DOI: 10.21037/atm-21-180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/17/2021] [Indexed: 11/06/2022]
Abstract
Background Extracorporeal membrane oxygenation (ECMO) therapy requires close monitoring and optimal management after initiation. However, it remains unclear whether the day of the week of ECMO initiation affects patient outcomes. We aimed to investigate whether the initiation of ECMO therapy during a weekend was associated with increased mortality risk. Methods We performed a population-level cohort study, based on health records obtained from the National Health Insurance Service database in South Korea. All critically ill adult patients who received ECMO therapy in the intensive care unit during 2005-2018 were enrolled. The primary endpoint was the 60-day mortality rate following ECMO therapy. Multivariable Cox regression was used for the analysis. Results Data from a total of 21,129 ECMO patients were included in the analysis, of whom 12,825 (60.7%) died within 60 days. There were 4,647 (22.0%) patients who received ECMO therapy during a weekend (weekend group). Multivariable Cox regression revealed that the weekend group was at increased risk of 60-day mortality compared to the weekday group (hazard ratio: 1.05, 95% confidence interval: 1.01 to 1.09; P=0.025). In the sensitivity analysis, ECMO patients whose therapy started on a Saturday were at higher risk of 60-day mortality (hazard ratio relative to those whose therapy started on a Wednesday: 1.11, 95% confidence interval: 1.04-1.19; P=0.003). However, starting ECMO therapy on other weekdays (Thursday, Friday, Sunday, Monday, or Tuesday) did not affect mortality outcomes (P>0.05). Conclusions ECMO therapy initiated during a weekend was associated with a slightly increased risk of 60-day mortality compared to that associated with ECMO therapy initiated on a weekday. This association was more evident in patients who received ECMO therapy that started on a Saturday. Further studies are needed to confirm these findings.
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Affiliation(s)
- Hyoung-Won Cho
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Hiramatsu T, Shimizu S, Koga H. Prognostic factors in patients treated with extracorporeal membrane oxygenation and continuous renal replacement therapy. Perfusion 2021; 37:570-574. [PMID: 33870783 DOI: 10.1177/02676591211011039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Extracorporeal membrane oxygenation (ECMO) and Continuous renal replacement therapy (CRRT) are treatments for critically ill patients with respiratory failure and acute kidney injury. However, no reliable factors have been identified to predict survival in patients treated with both ECMO and CRRT. The aim of this study was to identify prognostic factors for discharging intensive care unit (ICU) patients who required CRRT during ECMO. METHODS We retrospectively analyzed data from patients who required CRRT in addition to the ECMO, between April 2015 and March 2018. The patients were divided into two groups: patients who survived and patients who died during ICU hospitalization. We determined their demographic and clinical characteristics, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, Simplified Acute Physiology Score II (SAPS II) scores, and sequential organ failure assessment (SOFA) scores. Further, we assessed whether these characteristics differed between individuals who did or did not survive the ICU hospitalization. RESULTS We found that the APACHE II and SAPS II scores differed significantly between both ECMO and CRRT treated patients who did or did not survive hospitalization. Further, intracranial hemorrhage during ECMO and CRRT therapy was associated with lower survival rate. CONCLUSIONS Using APACHE II and SAPS II scores might be helpful in making treatment decisions for patients treated with ECMO and CRRT. Intracranial hemorrhage could be a poor prognostic factor. Our findings indicate the potential utility of APACHE II and SAPS II scores to predict mortality in patients treated with both ECMO and CRRT.
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Affiliation(s)
- Toshiki Hiramatsu
- Department of Critical Care Medicine, ASO Iizuka Hospital, Iizuka city, Fukuoka, Japan
| | - Shigemitsu Shimizu
- Department of Clinical Engineering, ASO Iizuka Hospital, Iizuka city, Fukuoka, Japan
| | - Hidenobu Koga
- Clinical Research Support Office, ASO Iizuka Hospital, Iizuka city, Fukuoka, Japan
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Quality of Life and Long-Term Mortality Among Survivors of Extracorporeal Membrane Oxygenation: A Nationwide Cohort Study in South Korea. Crit Care Med 2021; 49:e771-e780. [PMID: 34261933 DOI: 10.1097/ccm.0000000000005015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The quality of life after extracorporeal membrane oxygenation therapy has emerged as an important issue for extracorporeal membrane oxygenation survival; however, its association with long-term prognosis has not been identified. We investigated the changes in the quality of life after extracorporeal membrane oxygenation among the survivors and examine the association between a worse quality of life and 3-year all-cause mortality. DESIGN This was a population-based cohort study. SETTING Data were obtained from the National Health Insurance Service database in South Korea. PATIENTS Adult individuals (≥ 18 yr old) who received extracorporeal membrane oxygenation therapy from 2006 to 2017 were included. Extracorporeal membrane oxygenation survivors were defined as patients who had survived for 1-year after the initiation of extracorporeal membrane oxygenation therapy. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The income level, employment status, and registered disability were examined before and 1-year after extracorporeal membrane oxygenation therapy. The decreased income level, job loss, and newly acquired disability were considered as change in the quality of life among extracorporeal membrane oxygenation survivors. A total of 5,821 adult extracorporeal membrane oxygenation survivors were included in the final analysis, and 2,959 patients (50.8%) experienced quality of life change. Specifically, 1,782 patients (30.6%) experienced a decrease in income, 682 (11.7%) lost their jobs, and 1,540 (26.5%) had a new disability within 1-year after extracorporeal membrane oxygenation therapy. In the multivariable Cox regression model, newly acquired disability was associated with 2.31-fold higher 3-year all-cause mortality among extracorporeal membrane oxygenation survivors (hazard ratio, 2.31; 95% CI, 1.79-2.97; p < 0.001), while job loss (p = 0.180) and decreased income (p = 0.993) were not associated with the 3-year all-cause mortality. CONCLUSIONS At 12 months after extracorporeal membrane oxygenation therapy, nearly half survivors experienced quality of life worsening such as unemployment, decreased income, and new disability. Additionally, among the three factors, acquiring a new disability might significantly increase the 3-year mortality. This is the first study to report the association between changes in the quality of life and long-term prognosis in extracorporeal membrane oxygenation survivors.
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Cho HW, Song IA, Oh TK. Prior Statin Therapy and Mortality After Extracorporeal Membrane Oxygenation Therapy: A Retrospective, Population-Based, Cohort Study. J Cardiothorac Vasc Anesth 2021; 35:3612-3619. [PMID: 33715948 DOI: 10.1053/j.jvca.2021.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate whether prior statin therapy is associated with an improvement in mortality among patients who undergo extracorporeal membrane oxygenation (ECMO) therapy. DESIGN Retrospective, population-based, cohort study. SETTING Health records were obtained from the National Health Insurance Service database in South Korea. PATIENTS All adult patients (≥18 y) who underwent ECMO therapy in the intensive care unit between 2005 and 2018 were enrolled. EXPOSURES Statin users were defined as patients who were prescribed continuous oral statins ≥90 days before ECMO. MEASUREMENTS AND MAIN RESULTS The primary endpoint of this study was 90-day mortality. A total of 21,129 adult patients from 128 hospitals were included (4,737 [22.4%] statin users and 16,392 [77.6%] nonusers). After propensity score matching, 9,474 ECMO patients (4,737 in each group) were included in the final analysis. In the propensity-score-matched cohort, statin users exhibited lower 90-day mortality than did nonusers (58.6% [2,774/4,737] in statin users v 65.6% [3,106/4,737] in nonusers). In addition, on Cox regression, 90-day mortality in statin users was 14% less than that in nonusers (hazard ratio 0.86, 95% confidence interval 0.81-0.90; p < 0.001). CONCLUSION Among patients who underwent ECMO in South Korea, prior statin therapy was found to be associated with lower 90-day mortality rates after ECMO therapy. However, because this study had a retrospective design, future prospective trials are needed to confirm the findings.
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Affiliation(s)
- Hyoung-Won Cho
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
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Benedetto M, Nardozi L, Baca GL, Loforte A, Baiocchi M. Heart failure: role and point of view of cardiac intensivist. Cardiovasc Diagn Ther 2021; 11:301-308. [PMID: 33708501 DOI: 10.21037/cdt-20-339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Heart failure is an acute or chronic syndrome where the heart is unable to provide adequate amount of oxygen to body tissues. The treatment of heart failure aims to give an immediate answer in terms of regression of volume overload and restoration of hemodynamic stability and then to ensure management of clinical exacerbation, reduction in hospital stay, and increasing of survival. The pharmacological treatment of heart failure includes drugs with different strength of evidence. When the patient is no more responsive to medical therapy a non-pharmacological approach may be required. The first step is cardiac resynchronization therapy and implantable cardiac defibrillator. Then hospitalization and inotropic support may be needed. When cardiac disease reaches the end stage, the severe decrease in multi organ perfusion requires a quick therapeutic response. This is a time dependent scenario, when mechanical circulatory support (MCS) plays a crucial role. MCS may be used as temporary hemodynamic support on situations where myocardial recovery is likely, such as after revascularization and in cases of fulminant acute myocarditis. Conversion to ventricular assist devices or transplantation should be considered if longer duration of MCS is required. Advances in the treatment of cardiogenic shock patients in terms of pharmacological therapies, short term and long term MCS could provide opportunities to improve survival, but they also increase the complexity of clinical care. For this reason a multidisciplinary shock team approach is paramount for early symptom detection, to guide initial haemodynamic therapy and for the right choice of MCS device at the right time.
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Affiliation(s)
- Maria Benedetto
- Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, Sant' Orsola Malpighi University Hospital, Bologna, Italy
| | - Ludovica Nardozi
- Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, Sant' Orsola Malpighi University Hospital, Bologna, Italy
| | | | - Antonio Loforte
- Cardiothoracic Department, Sant' Orsola Malpighi University Hospital, Bologna, Italy
| | - Massimo Baiocchi
- Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, Sant' Orsola Malpighi University Hospital, Bologna, Italy
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Microbial Colonization of Oxygenator and Clinical Outcomes in Extracorporeal Membrane Oxygenation. ASAIO J 2021; 67:930-934. [PMID: 33528159 DOI: 10.1097/mat.0000000000001337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The importance of microbial colonization during extracorporeal membrane oxygenation (ECMO) is unclear. We prospectively cultured ECMO oxygenators and retrospectively reviewed the culture results, clinical outcomes, and associated factors in 112 ECMO patients (122 oxygenators, 1,196 ECMO days). Of the oxygenators, 11.6% (n = 13) had positive cultures. The most common pathogen was Klebsiella pneumoniae, followed by Acinetobacter baumannii and Staphylococcus epidermidis. Nine (69%) cases showed catheter colonization, and five (38%) bloodstream infection (BSI) with the same microorganism. Most of the microorganisms were multidrug resistant. BSI tended to be associated with oxygenator colonization (r = 0.172, p = 0.070). The patients were divided into oxygenator colonization (n = 13) and no colonization groups (n = 99). Successful weaning from ECMO and survival to discharge were significantly lower in the oxygenator colonization group (weaning 30.8% vs. 90.9%, p < 0.001, survival 23.1% vs. 76.8%; p < 0.001). In multivariate analyses, age (per decade) (odds ratio [OR] = 1.95, 95% CI = 1.28-2.95; p = 0.002), oxygenator colonization (OR = 15.49, 95% CI = 3.31-72.46; p < 0.001), and renal replacement therapy (OR = 4.61, 95% CI = 1.69-12.58; p = 0.003) were significantly associated with mortality. Oxygenator colonization was associated with poor outcomes in ECMO patients. These results support the early exchange and culture of oxygenators in patients with persisting bacteremia.
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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.
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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
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Ajmi I, Mahnkopf C, Brachmann J, Sinani M, Oudeh M, Schnupp S. Rotablation of Heavily Calcified Left Main Stenosis and Aortic Valve Valvuloplasty Under ECMO Cardiopulmonary Support. JACC Case Rep 2020; 2:2448-2454. [PMID: 34317192 PMCID: PMC8304597 DOI: 10.1016/j.jaccas.2020.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 10/25/2022]
Abstract
High-risk coronary intervention involving the left main coronary artery represents an indication for mechanical circulatory support in hemodynamically unstable patients. Extracorporeal membrane oxygenation permits adequate hemodynamic stabilization and myocardial recovery from life-threatening pulmonary and cardiac failure. Our case report demonstrates the importance of choosing the correct method of hemodynamic support in different case scenarios. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Issameddine Ajmi
- Address for correspondence: Dr. Issameddine Ajmi, Department of Cardiology, Klinikum Coburg, Ketschendorfer Strasse 33, 96450 Coburg, Germany.
| | | | - Johannes Brachmann
- Department of Cardiology and Intensive Care Medicine, Medical Clinic II, Coburg Clinic, Coburg, Germany
| | - Muhamet Sinani
- Department of Cardiology and Intensive Care Medicine, Medical Clinic II, Coburg Clinic, Coburg, Germany
| | - Mahmoud Oudeh
- Department of Cardiology and Intensive Care Medicine, Medical Clinic II, Coburg Clinic, Coburg, Germany
| | - Steffen Schnupp
- Department of Cardiology and Intensive Care Medicine, Medical Clinic II, Coburg Clinic, Coburg, Germany
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Michael C, Venkateswaran R. The challenges of venoarterial extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock. Indian J Thorac Cardiovasc Surg 2020; 37:289-293. [PMID: 33191993 PMCID: PMC7647888 DOI: 10.1007/s12055-020-01068-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 11/29/2022] Open
Abstract
Postcardiotomy cardiogenic shock describes the syndrome of refractory cardiac performance following cardiac surgery. The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) for the management of postcardiotomy cardiogenic shock is controversial, and there are at least three scenarios where it may be necessary: first, pre-emptive postoperative VA-ECMO, where the decision for postoperative mechanical support is made prior to surgery, for example, in the context of poor pre-operative cardiac function; second, early yet unplanned post-cardiopulmonary bypass VA-ECMO following a long duration of cardiopulmonary bypass due to, for example, unexpected surgical complications; third, late rescue VA-ECMO following several attempts at weaning, either immediately following cardiopulmonary bypass or following transfer to the intensive care unit. The use of mechanical circulatory support for postcardiotomy cardiogenic shock is further complicated by the wide range of available devices, the availability of VA-ECMO in different centres, variations in experience and expertise as a function of local VA-ECMO workload, and regional variations in the diagnosis and management of postcardiotomy cardiogenic shock. Furthermore, survival appears to be low for such patients and it is not yet possible to predict who will survive. Many questions remain, however, such as those in relation to practices around patient selection, how best to study long-term outcomes, the ethics and efficacy of ECMO in such patients, and on all aspects of clinical decision-making. This review sets these clinical challenges in the context of the available evidence, including that from our centre.
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Affiliation(s)
- Charlesworth Michael
- Department of Cardiothoracic Critical Care, Anaesthesia and ECMO, Wythenshawe Hospital, Manchester, UK
| | - Rajamiyer Venkateswaran
- Department of Cardiothoracic Surgery and Transplantation, Wythenshawe Hospital, Manchester, UK
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Amin F, Lombardi J, Alhussein M, Posada JD, Suszko A, Koo M, Fan E, Ross H, Rao V, Alba AC, Billia F. Predicting Survival After VA-ECMO for Refractory Cardiogenic Shock: Validating the SAVE Score. CJC Open 2020; 3:71-81. [PMID: 33458635 PMCID: PMC7801193 DOI: 10.1016/j.cjco.2020.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/04/2020] [Indexed: 01/08/2023] Open
Abstract
Background Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is used increasingly to support patients who are in cardiogenic shock. Due to the risk of complications, prediction models may aid in identifying patients who would benefit most from VA-ECMO. One such model is the Survival After Veno-Arterial Extracorporeal Membrane Oxygenation (SAVE) score. Therefore, we wanted to validate the utility of the SAVE score in a contemporary cohort of adult patients. Methods Retrospective data were extracted from electronic health records of 120 patients with cardiogenic shock supported with VA-ECMO between 2011 and 2018. The SAVE score was calculated for each patient to predict survival to hospital discharge. We assessed the SAVE score calibration by comparing predicted vs observed survival at discharge. We assessed discrimination with the area under the receiver operating curve using logistic regression. Results A total of 45% of patients survived to hospital discharge. Survivors had a significantly higher mean SAVE score (–9.3 ± 4.1 in survivors vs –13.1 ± 4.4, respectively; P = 0.001). SAVE score discrimination was adequate (c = 0.77; 95% confidence interval 0.69-0.86; P < 0.001). SAVE score calibration was limited, as observed survival rates for risk classes II-V were higher in our cohort (II: 67% vs 58%; III: 78% vs 42%; IV: 61% vs 30%; and V: 29% vs 18%). Conclusions The SAVE score underestimates survival in a contemporary North American cohort of adult patients with cardiogenic shock. Its inaccurate performance could lead to denying ECMO support to patients deemed to be too high risk. Further studies are needed to validate additional predictive models for patients requiring VA-ECMO.
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Affiliation(s)
- Faizan Amin
- Peter Munk Cardiac Centre, Toronto, Ontario, Canada.,Ted Roger's Center for Heart Research, Toronto, Ontario, Canada
| | | | - Mosaad Alhussein
- Peter Munk Cardiac Centre, Toronto, Ontario, Canada.,Ted Roger's Center for Heart Research, Toronto, Ontario, Canada
| | - Juan Duero Posada
- Peter Munk Cardiac Centre, Toronto, Ontario, Canada.,Ted Roger's Center for Heart Research, Toronto, Ontario, Canada
| | | | | | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine and Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada
| | - Heather Ross
- Peter Munk Cardiac Centre, Toronto, Ontario, Canada.,Ted Roger's Center for Heart Research, Toronto, Ontario, Canada
| | - Vivek Rao
- Peter Munk Cardiac Centre, Toronto, Ontario, Canada
| | - Ana Carolina Alba
- Peter Munk Cardiac Centre, Toronto, Ontario, Canada.,Ted Roger's Center for Heart Research, Toronto, Ontario, Canada
| | - Filio Billia
- Peter Munk Cardiac Centre, Toronto, Ontario, Canada.,Ted Roger's Center for Heart Research, Toronto, Ontario, Canada
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Cheng W, Ma XD, Su LX, He HW, Wang L, Tang B, Du W, Zhou YK, Wang H, Cui N, Long Y, Liu DW, Guo YH, Wang Y, Shan GL, Zhou X, Zhang SY, Zhao YP. Cross-sectional study for the clinical application of extracorporeal membrane oxygenation in Mainland China, 2018. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:554. [PMID: 32917257 PMCID: PMC7484920 DOI: 10.1186/s13054-020-03270-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 09/02/2020] [Indexed: 01/19/2023]
Abstract
Background To investigate the epidemiology and in-hospital mortality of veno-venous (VV) and veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) in Mainland China throughout 2018. Methods Patients supported by ECMO from 1700 tertiary hospitals in 31 provinces from January 1 to December 31, 2018, were selected from the National Clinical Improvement System database. Results The 1700 included hospitals had 2073 cases of ECMO in 2018, including 714 VV and 1359 VA ECMOs. The average patient age was 50 years (IQR 31–63), and 1346 were male. The average hospital stay was 17 days (IQR 7–30), and the average costs per case was $36,334 (IQR 22,547–56,714). The three provinces with the highest number of ECMO cases were Guangdong, Beijing, and Zhejiang; the southeast coastal areas and regions with higher GDP levels had more cases. Overall in-hospital mortality was 29.6%. Mortality was higher among patients who were male, over 70 years old, living in underdeveloped areas, and who were treated during the summer. Mortality in provinces with more ECMO cases was relatively low. The co-existence of congenital malformations, blood system abnormalities, or nervous system abnormalities increased in-hospital mortality. Conclusions Mortality and medical expenses of ECMO among patients in China were relatively low, but large regional and seasonal differences were present. Risk factors for higher in-hospital mortality were older age, male sex, in underdeveloped areas, and treatment during the summer. Additionally, congenital malformations and blood system and nervous system abnormalities were associated with in-hospital mortality.
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Affiliation(s)
- Wei Cheng
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Xu-Dong Ma
- Department of Medical Administration, National Health Commission of the People's Republic of China, Beijing, 100044, China
| | - Long-Xiang Su
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Huai-Wu He
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Lu Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Bo Tang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Wei Du
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Yuan-Kai Zhou
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Hao Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Na Cui
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Yun Long
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Da-Wei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Yan-Hong Guo
- Department of Medical Administration, National Health Commission of the People's Republic of China, Beijing, 100044, China
| | - Ye Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences (CAMS) & School of Basic Medicine, Peking Union Medical College, Beijing, 100730, China
| | - Guang-Liang Shan
- Department of Epidemiology and Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences (CAMS) & School of Basic Medicine, Peking Union Medical College, Beijing, 100730, China
| | - Xiang Zhou
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China.
| | - Shu-Yang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Yu-Pei Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
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Extracorporeal Cardiopulmonary Resuscitation (ECPR) for Out-of-Hospital Cardiac Arrest due to Pulseless Ventricular Tachycardia/Fibrillation. J Interv Cardiol 2020; 2020:6939315. [PMID: 32733171 PMCID: PMC7382749 DOI: 10.1155/2020/6939315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 06/30/2020] [Indexed: 11/17/2022] Open
Abstract
Background Survival rates for out-of-hospital cardiac arrest are very low and neurologic recovery is poor. Innovative strategies have been developed to improve outcomes. A collaborative extracorporeal cardiopulmonary resuscitation (ECPR) program for out-of-hospital refractory pulseless ventricular tachycardia (VT) and/or ventricular fibrillation (VF) has been developed between The Ohio State University Wexner Medical Center and Columbus Division of Fire. Methods From August 15, 2017, to June 1, 2019, there were 86 patients that were evaluated in the field for cardiac arrest in which 42 (49%) had refractory pulseless VT and/or VF resulting from different underlying pathologies and were placed on an automated cardiopulmonary resuscitation device; from these 42 patients, 16 (38%) met final inclusion criteria for ECPR and were placed on extracorporeal membrane oxygenation (ECMO) in the cardiac catheterization laboratory (CCL). Results From the 16 patients who underwent ECPR, 4 (25%) survived to hospital discharge with cerebral perfusion category 1 or 2. Survivors tended to be younger (48.0 ± 16.7 vs. 59.3 ± 12.7 years); however, this difference was not statistically significant (p=0.28) likely due to a small number of patients. Overall, 38% of patients underwent percutaneous coronary intervention (PCI). No significant difference was found between survivors and nonsurvivors in emergency medical services dispatch to CCL arrival time, lactate in CCL, coronary artery disease severity, undergoing PCI, and pre-ECMO PaO2, pH, and hemoglobin. Recovery was seen in different underlying pathologies. Conclusion ECPR for out-of-hospital refractory VT/VF cardiac arrest demonstrated encouraging outcomes. Younger patients may have a greater chance of survival, perhaps the need to be more aggressive in this subgroup of patients.
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Neurological Monitoring and Complications of Pediatric Extracorporeal Membrane Oxygenation Support. Pediatr Neurol 2020; 108:31-39. [PMID: 32299748 PMCID: PMC7698354 DOI: 10.1016/j.pediatrneurol.2020.03.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 12/17/2022]
Abstract
Extracorporeal membrane oxygenation is extracorporeal life support for life-threatening cardiopulmonary failure. Since its introduction, the use of extracorporeal membrane oxygenation has expanded to patients with more complex comorbidities without change in patient mortality rates. Although many patients survive, significant neurological complications like seizures, ischemic strokes, and intracranial hemorrhage can occur during extracorporeal membrane oxygenation care. The risks of these complications often add to the complexity of decision-making surrounding extracorporeal membrane oxygenation support. In this review, we discuss the pathophysiology and incidence of neurological complications in children supported on extracorporeal membrane oxygenation, factors influencing the incidence of these complications, commonly used neurological monitoring modalities, and outcomes for this complex patient population. We discuss the current literature on the use of electroencephalography for both seizure detection and monitoring of background electroencephalographic changes, in addition to the use of less commonly used imaging modalities like transcranial Doppler. We summarize the knowledge gaps and the lack of clinical consensus guidelines for managing these potentially life-changing neurological complications. Finally, we discuss future work to further understand the pathophysiology of extracorporeal membrane oxygenation-related neurological complications.
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Roumy A, Liaudet L, Rusca M, Marcucci C, Kirsch M. Pulmonary complications associated with veno-arterial extra-corporeal membrane oxygenation: a comprehensive review. Crit Care 2020; 24:212. [PMID: 32393326 PMCID: PMC7216520 DOI: 10.1186/s13054-020-02937-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 04/30/2020] [Indexed: 01/07/2023] Open
Abstract
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a life-saving technology that provides transient respiratory and circulatory support for patients with profound cardiogenic shock or refractory cardiac arrest. Among its potential complications, VA-ECMO may adversely affect lung function through various pathophysiological mechanisms. The interaction of blood components with the biomaterials of the extracorporeal membrane elicits a systemic inflammatory response which may increase pulmonary vascular permeability and promote the sequestration of polymorphonuclear neutrophils within the lung parenchyma. Also, VA-ECMO increases the afterload of the left ventricle (LV) through reverse flow within the thoracic aorta, resulting in increased LV filling pressure and pulmonary congestion. Furthermore, VA-ECMO may result in long-standing pulmonary hypoxia, due to partial shunting of the pulmonary circulation and to reduced pulsatile blood flow within the bronchial circulation. Ultimately, these different abnormalities may result in a state of persisting lung inflammation and fibrotic changes with concomitant functional impairment, which may compromise weaning from VA-ECMO and could possibly result in long-term lung dysfunction. This review presents the mechanisms of lung damage and dysfunction under VA-ECMO and discusses potential strategies to prevent and treat such alterations.
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Affiliation(s)
- Aurélien Roumy
- Department of Cardiovascular Surgery, University Hospital, Lausanne, Switzerland.
| | - Lucas Liaudet
- Department of Intensive Care Medicine, University Hospital, Lausanne, Switzerland
| | - Marco Rusca
- Department of Intensive Care Medicine, University Hospital, Lausanne, Switzerland
| | - Carlo Marcucci
- Department of Anesthesiology, University Hospital, Lausanne, Switzerland
| | - Matthias Kirsch
- Department of Cardiovascular Surgery, University Hospital, Lausanne, Switzerland
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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.
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