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Rizvi SSA, Nagle M, Roberts B, McDermott L, Miller K, Pasquarello C, Braddock A, Choi C, Yang Q, Hirose H. Cardiac Extracorporeal Membrane Oxygenation in Community Cardiac Surgery Program: Are the Results Comparable? Cureus 2024; 16:e58947. [PMID: 38800214 PMCID: PMC11126332 DOI: 10.7759/cureus.58947] [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: 04/18/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) outcomes in small centers are commonly considered less favorable than in large-volume centers. New ECMO protocols and procedures were established in our regional community hospital system as part of a cardiogenic shock initiative. This retrospective study aims to evaluate the outcomes of veno-arterial extracorporeal membrane oxygenation (VA ECMO) and extracorporeal cardiopulmonary resuscitation (ECPR) in a community hospital system with cardiac surgery capability and assess whether protocol optimization and cannulation standards result in comparable outcomes to larger centers whether the outcomes of this new ECMO program at the community hospital setting were comparable to the United States averages. METHODS Our regional system comprises five hospitals with 1500 beds covering southwestern New Jersey, with only one of these hospitals having cardiac surgery and ECMO capability. In May 2021, the new ECMO program was initiated. Patients were screened by a multidisciplinary call, cannulated by our ECMO team, and subsequently treated by the designated team. We reviewed our cardiac ECMO outcomes over two years, from May 2021 to April 2023, in patients who required ECMO due to cardiogenic shock or as a part of extracorporeal cardiopulmonary resuscitation (ECPR). RESULTS A total of 60 patients underwent cardiac ECMO, and all were VA ECMO, including 18 (30%) patients who required ECPR for cardiac arrest. The overall survival rate for our cardiac ECMO program turned out to be 48% (29/60), with 50% (22/42) in VA ECMO excluding ECPR and 39% (7/18) in the ECPR group. The hospital survival rate for the VA ECMO and ECPR groups was 36% (15/42) and 28% (5/18), respectively. The ELSO-reported national average for hospital survival is 48% for VA ECMO and 30% for ECPR. Considering these benchmarks, the hospital survival rate of our program did not significantly lag behind the national average. CONCLUSIONS With protocol, cannulation standards, and ECMO management optimized, the VA ECMO results of a community hospital system with cardiac surgery capability were not inferior to those of larger centers.
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Affiliation(s)
| | - Matthew Nagle
- Surgery, Virtua Our Lady of Lourdes Hospital, Camden, USA
| | - Brian Roberts
- Surgery, Virtua Our Lady of Lourdes Hospital, Camden, USA
| | | | | | | | | | - Chun Choi
- Surgery, Virtua Our Lady of Lourdes Hospital, Camden, USA
| | - Qiong Yang
- Surgery, Virtua Our Lady of Lourdes Hospital, Camden, USA
- Cardiovascular and Thoracic Surgery, Cleveland Clinic, Cleveland, USA
| | - Hitoshi Hirose
- Surgery, Virtua Our Lady of Lourdes Hospital, Camden, USA
- Cardiovascular and Thoracic Surgery, Cleveland Clinic, Cleveland, USA
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2
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Patel B, Said AS, Justus A, Abrams D, Pham T, Antonini MV, Moore E, Shekar K, Zakhary B. An International Survey of Extracorporeal Membrane Oxygenation Education and Credentialing Practices. ATS Sch 2024; 5:71-83. [PMID: 38633517 PMCID: PMC11022670 DOI: 10.34197/ats-scholar.2022-0132oc] [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: 11/30/2022] [Accepted: 09/05/2023] [Indexed: 04/19/2024] Open
Abstract
Background The use of extracorporeal membrane oxygenation (ECMO) has grown rapidly over the past decades because of evolving indications, advances in circuit technology, and encouraging results from modern trials. Because ECMO is a complex and highly invasive therapy that requires a multidisciplinary team, optimal education, training, and credentialing remain a challenge. Objective The primary objectives of this study were to investigate the prevalence and application of ECMO education and ECMO practitioner credentialing at ECMO centers globally. In addition, we explored differences among education and credentialing practices in relation to various ECMO center characteristics. Methods We conducted an observational study of ECMO centers worldwide using a survey querying participants in two major domains: ECMO education and ECMO practitioner credentialing. Of note, the questionnaire included ECMO program characteristics, such as type and size of hospital and ECMO experience and volume, to explore the association with the two domains. Results A total of 241 (32%) of the 732 identified ECMO centers responded to the survey, representing 41 countries across the globe. ECMO education was offered at 221 (92%) of the 241 centers. ECMO education was offered at 105 (98.0%) high-ECMO volume centers compared with 136 (87.5%) low-ECMO volume centers (P = 0.005). Credentialing was established at 101 (42%) of the 241 centers. Credentialing processes existed at 52 (49.5%) high-ECMO volume centers compared with 51 (37.5%) low-ECMO volume centers (P = 0.08) and 101 (49.3%) Extracorporeal Life Support Organization centers compared with 1 (2.7%) non-Extracorporeal Life Support Organization center (P < 0.001). Conclusion We found significant variability in whether ECMO educational curricula are offered at ECMO centers. We also found fewer than half of the ECMO centers surveyed had established credentialing programs for ECMO practitioners. Future studies that assess variability in outcomes among centers with and without standardized educational and credentialing practices are needed.
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Affiliation(s)
- Bhoumesh Patel
- Division of Cardiac Anesthesiology,
Department of Anesthesiology, Yale School of Medicine, New Haven,
Connecticut
| | - Ahmed S. Said
- Division of Pediatric Critical Care,
Department of Pediatrics, Washington University, St. Louis, Missouri
| | - Angelo Justus
- Adult Intensive Care, Sunshine Coast
University Hospital, Sunshine Coast, Queensland, Australia
| | - Darryl Abrams
- Division of Pulmonary, Allergy, and
Critical Care, Columbia University Medical Center, New York, New York
| | - Tái Pham
- Service de Médecine
Intensive-Réanimation, Hôpitaux Universitaires Paris-Saclay, Le
Kremlin-Bicêtre, France
- Université Paris-Saclay, Villejuif,
France
| | - Marta Velia Antonini
- Intensive Care Unit, Bufalini Hospital,
Cesena, Italy
- Department of Biomedical, Metabolic, and
Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elizabeth Moore
- University of Iowa Heart and Vascular
Center, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Kiran Shekar
- Adult Intensive Care Services, the
Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane,
Queensland, Australia
- University of Queensland, Brisbane,
Queensland, Australia
- Institute of Health and Biomedical
Innovation, Queensland University of Technology, Brisbane and Faculty of
Medicine, Bond University, Gold Coast, Queensland, Australia; and
| | - Bishoy Zakhary
- Pulmonary and Critical Care Medicine,
Oregon Health and Science University, Portland, Oregon
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Mazzeffi MA, Krajewski M, Shelton K, Dalia A, Najam F, Gutsche J, Nurok M. Measuring and Reporting Quality for Adult Extracorporeal Membrane Oxygenation Centers: Is It Possible and Is It Time? Anesth Analg 2022; 135:719-724. [DOI: 10.1213/ane.0000000000006080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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4
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Shudo Y, Alassar A, Wang H, Lingala B, He H, Zhu Y, Hiesinger W, MacArthur JW, Boyd JH, Lee AM, Currie M, Woo YJ. Post-Transplant Extracorporeal Membrane Oxygenation for Severe Primary Graft Dysfunction to Support the Use of Marginal Donor Hearts. Transpl Int 2022; 35:10176. [PMID: 35340846 PMCID: PMC8943911 DOI: 10.3389/ti.2022.10176] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/18/2022] [Indexed: 12/27/2022]
Abstract
Severe primary graft dysfunction (PGD) is the leading cause of early postoperative mortality following orthotopic heart transplantation (OHT). Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been used as salvage therapy. This study aimed to evaluate the outcomes in adult OHT recipients who underwent VA-ECMO for severe PGD. We retrospectively reviewed 899 adult (≥18 years) patients who underwent primary OHT at our institution between 1997 and 2017. Recipients treated with VA-ECMO (19, 2.1%) exhibited a higher incidence of previous cardiac surgery (p = .0220), chronic obstructive pulmonary disease (p = .0352), and treatment with a calcium channel blocker (p = .0018) and amiodarone (p = .0148). Cardiopulmonary bypass (p = .0410) and aortic cross-clamp times (p = .0477) were longer in the VA-ECMO cohort and they were more likely to have received postoperative transfusion (p = .0013); intra-aortic balloon pump (IABP, p < .0001), and reoperation for bleeding or tamponade (p < .0001). The 30-day, 1-year, and overall survival after transplantation of non-ECMO patients were 95.9, 88.8, and 67.4%, respectively, compared to 73.7, 57.9, and 47.4%, respectively in the ECMO cohort. Fourteen (73.7%) of the ECMO patients were weaned after a median of 7 days following OHT (range: 1-12 days). Following OHT, VA-ECMO may be a useful salvage therapy for severe PGD and can potentially support the usage of marginal donor hearts.
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Affiliation(s)
- Yasuhiro Shudo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Aiman Alassar
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Hanjay Wang
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Bharathi Lingala
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Hao He
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Yuanjia Zhu
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - William Hiesinger
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - John W MacArthur
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Jack H Boyd
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Anson M Lee
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Maria Currie
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, United States
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Zhu Y, Lingala B, Baiocchi M, Toro Arana V, Williams KM, Shudo Y, Oyer PE, Woo YJ. The Stanford experience of heart transplantation over five decades. Eur Heart J 2021; 42:4934-4943. [PMID: 34333595 DOI: 10.1093/eurheartj/ehab416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/03/2021] [Accepted: 06/18/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS Since 1968, heart transplantation has become the definitive treatment for patients with end-stage heart failure. We aimed to summarize our experience in heart transplantation at Stanford University since the first transplantation performed over 50 years ago. METHODS AND RESULTS From 6 January 1968 to 30 November 2020, 2671 patients presented to Stanford University for heart transplantation, of which 1958 were adult heart transplantations. Descriptive analyses were performed for patients in 1968-95 (n = 639). Stabilized inverse probability weighting was applied to compare patients in 1996-2006 (n = 356) vs. 2007-19 (n = 515). Follow-up data were updated through 2020. The primary endpoint was all-cause mortality. Prior to weighting, recipients in 2007-19 vs. those in 1996-2006 were older and had heavier burden of chronic diseases. After the application of stabilized inverse probability weighting, the distance organ travelled increased from 84.2 ± 111.1 miles to 159.3 ± 169.9 miles from 1996-2006 to 2007-19. Total allograft ischaemia time also increased over time (199.6 ± 52.7 vs. 225.3 ± 50.0 min). Patients in 2007-19 showed superior survival than those in 1996-2006 with a median survival of 12.1 vs. 11.1 years. CONCLUSION In this half-century retrospective descriptive study from one of the largest heart transplant programmes in the USA, long-term survival after heart transplantation has improved over time despite increased recipient and donor age, worsening comorbidities, increased technical complexity, and prolonged total allograft ischaemia time. Further investigation is warranted to delineate factors associated with the excellent outcomes observed in this study.
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Affiliation(s)
- Yuanjia Zhu
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Bharathi Lingala
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Michael Baiocchi
- Department of Epidemiology and Population Health, Stanford University, 291 Campus Drive, Stanford, CA 94305, USA and
| | - Veronica Toro Arana
- School of Medicine, Stanford University, 291 Campus Drive, Stanford, CA 94305, USA
| | - Kiah M Williams
- School of Medicine, Stanford University, 291 Campus Drive, Stanford, CA 94305, USA
| | - Yasuhiro Shudo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Philip E Oyer
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
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Shih E, Squiers JJ, DiMaio JM, George T, Banwait J, Monday K, Blough B, Meyer D, Schwartz GS. Outcomes of Extracorporeal Membrane Oxygenation in Patients With Severe Acute Respiratory Distress Syndrome Caused by COVID-19 Versus Influenza. Ann Thorac Surg 2021; 113:1445-1451. [PMID: 34139189 PMCID: PMC8204847 DOI: 10.1016/j.athoracsur.2021.05.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/29/2021] [Accepted: 05/19/2021] [Indexed: 01/08/2023]
Abstract
Background Extracorporeal membrane oxygenation (ECMO) can be effective for refractory acute respiratory distress syndrome (ARDS) in patients with influenza, but its utility in patients with coronavirus disease 2019 (COVID-19) is uncertain. We compared outcomes of patients with refractory ARDS from COVID-19 and influenza placed on ECMO. Methods We conducted a retrospective analysis of 120 patients with refractory ARDS due to COVID-19 or influenza placed on ECMO at 2 referral centers from January 2013 to October 2020. Patient characteristics and clinical outcomes were compared. The primary endpoint was survival to discharge. Results Baseline characteristics and comorbidities were similar. During the study period, 53 patients with COVID-19 and 67 patients with influenza were supported. Venovenous ECMO was the predominant initial cannulation strategy in both groups (COVID 92.5% vs influenza 95.5%; P = .5). Survival to hospital discharge was 62.3% (33 of 53 patients) in the COVID-19 group and 64.2% (43 of 67 patients) in the influenza group (P = .8). In patients successfully decannulated, median length of time on ECMO was longer in COVID-19 patients (14 [interquartile range (IQR), 9-30] days vs influenza 10.5 [IQR, 6.8-14.3] days; P = .004). Among patients discharged alive, COVID-19 patients had longer overall length of stay (COVID-19 37 [IQR, 27-62] days vs influenza 13.5 [IQR, 9.3-24] days; P = .007). Conclusions In patients with refractory ARDS from COVID-19 or influenza placed on ECMO, there was no significant difference in survival to hospital discharge. In patients surviving to decannulation, the duration of ECMO support and total length of stay were longer in COVID-19 patients.
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Affiliation(s)
- Emily Shih
- Department of Surgery, Baylor University Medical Center, Dallas, Texas.
| | - John J Squiers
- Department of Surgery, Baylor University Medical Center, Dallas, Texas; Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - J Michael DiMaio
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Timothy George
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Jasjit Banwait
- Baylor Scott and White Research Institute, Dallas, Texas
| | - Kara Monday
- Department of Surgery, Baylor University Medical Center, Dallas, Texas
| | - Britton Blough
- Department of Surgery, Baylor University Medical Center, Dallas, Texas
| | - Dan Meyer
- Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, Texas
| | - Gary S Schwartz
- Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, Texas
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Ohman EM, Zwischenberger BA, Thiele H. Left Ventricular Support for the Management of Cardiogenic Shock: Sooner May Be Better. JACC Cardiovasc Interv 2021; 14:1120-1122. [PMID: 34016409 DOI: 10.1016/j.jcin.2021.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/25/2022]
Affiliation(s)
- E Magnus Ohman
- Division of Cardiology, Duke Heart Center, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina, USA.
| | - Brittany A Zwischenberger
- Division of Cardiovascular and Thoracic Surgery, Duke Heart Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
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8
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Shah AS. Commentary: The prodigal son returns. J Thorac Cardiovasc Surg 2020; 163:1376-1377. [PMID: 33323197 DOI: 10.1016/j.jtcvs.2020.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Ashish S Shah
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Vanderbilt Medical Center East, Nashville, Tenn.
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9
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Yan W, Arora RC. Commentary: Stronger together: Interinstitutional collaboration is a key step to improving patient outcomes after contemporary extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg 2020; 163:1375-1376. [PMID: 33293071 DOI: 10.1016/j.jtcvs.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Weiang Yan
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rakesh C Arora
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
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