1
|
Johannes F, Frohofer-Vollenweider R, Teuschl Y. Neurological Complications of the Lower Extremities After Femoral Cannulated Extracorporeal Membrane Oxygenation: A Systematic Review. J Intensive Care Med 2024; 39:534-541. [PMID: 38018080 PMCID: PMC11092294 DOI: 10.1177/08850666231217679] [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: 08/13/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Femoral cannulated extracorporeal membrane oxygenation (ECMO) has been associated with neurologic complications in the lower extremity ipsilateral to the cannulation. There is uncertainty about the prevalence of these complications and their mechanisms of development. OBJECTIVE Aim of this systematic review was to investigate the prevalence of neurological complications after ECMO and to describe possible underlying mechanisms. METHOD A systematic literature search was performed in Medline-Ovid, Embase, Cochrane Library, CINAHL, and PEDro until April 2021 for clinical trials in English or German language which quantified neurologic complications in the lower extremity ipsilateral to the ECMO cannulation of adults. The complications had to be delimitable to intensive care unit-acquired weakness. Methodological quality was assessed by 2 independent investigators using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the National Heart, Lung, and Blood Institute. RESULTS Eight observational studies were included in the synthesis. Study quality was good to fair in 88% of the papers. Overall, 47 of 202 patients (23.3%; ranging from 3% to 48% across studies) with femoral ECMO cannulation showed neurologic complications of the lower extremity ipsilateral to the cannulation. Peripheral ischemia and compression of nerves by the ECMO cannula are discussed as mechanisms of injury. CONCLUSION The occurrence of neurological complications after ECMO was common and can lead to long-term impairment. The mechanisms are largely unknown but currently there is no sufficient evidence for the involvement of ECMO. Standardized assessments are needed to systematically screen for neurological complications early after ECMO, to enable countermeasures and prevent further complications.
Collapse
Affiliation(s)
- Frauke Johannes
- Department of Clinical Neurosciences and Preventive Medicine, University of Continuing Education Krems, Krems, Austria
| | - Rahel Frohofer-Vollenweider
- Nursing and Allied Health Profession Office, Physiotherapy Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Yvonne Teuschl
- Department of Clinical Neurosciences and Preventive Medicine, University of Continuing Education Krems, Krems, Austria
| |
Collapse
|
2
|
Zhao Y, Wang H, Cheng Y, Zhang J, Zhao L. Factors Influencing Successful Weaning From Venoarterial Extracorporeal Membrane Oxygenation: A Systematic Review. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00328-8. [PMID: 38969612 DOI: 10.1053/j.jvca.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 05/01/2024] [Accepted: 05/11/2024] [Indexed: 07/07/2024]
Abstract
With advancements in extracorporeal life support (ECLS) technologies, venoarterial extracorporeal membrane oxygenation (VA-ECMO) has emerged as a crucial cardiopulmonary support mechanism. This review explores the significance of VA-ECMO system configuration, cannulation strategies, and timing of initiation. Through an analysis of medication management strategies, complication management, and comprehensive preweaning assessments, it aims to establish a multidimensional evaluation framework to assist clinicians in making informed decisions regarding weaning from VA-ECMO, thereby ensuring the safe and effective transition of patients.
Collapse
Affiliation(s)
- Yanlong Zhao
- Department of Cardiology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Heru Wang
- Department of Cardiology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Yihao Cheng
- Department of Cardiology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Jifeng Zhang
- School of Pharmaceutical Sciences, Jilin University, Changchun, Jilin, China
| | - Lei Zhao
- Department of Cardiology, The Second Hospital of Jilin University, Changchun, Jilin, China.
| |
Collapse
|
3
|
Li YY, Peng J, Ping YY, Jia Jun W, Lu Y, Liu JJ, Xu SK, Guan LH, Huang D, Wang QB, Qian JY, Zhao ZX, Wei YB, Ge JB, Huang X. Virtual reality-based cognitive-behavioural therapy for the treatment of anxiety in patients with acute myocardial infarction: a randomised clinical trial. Gen Psychiatr 2024; 37:e101434. [PMID: 38645380 PMCID: PMC11029180 DOI: 10.1136/gpsych-2023-101434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 03/08/2024] [Indexed: 04/23/2024] Open
Abstract
Background The presence of mental health conditions is pervasive in patients who experienced acute myocardial infarction (AMI), significantly disrupting their recovery. Providing timely and easily accessible psychological interventions using virtual reality-based cognitive-behavioural therapy (VR-CBT) could potentially improve both acute and long-term symptoms affecting their mental health. Aims We aim to examine the effectiveness of VR-CBT on anxiety symptoms in patients with AMI who were admitted to the intensive care unit (ICU) during the acute stage of their illness. Methods In this single-blind randomised clinical trial, participants with anxiety symptoms who were admitted to the ICU due to AMI were continuously recruited from December 2022 to February 2023. Patients who were Han Chinese aged 18-75 years were randomly assigned (1:1) via block randomisation to either the VR-CBT group to receive VR-CBT in addition to standard mental health support, or the control group to receive standard mental health support only. VR-CBT consisted of four modules and was delivered at the bedside over a 1-week period. Assessments were done at baseline, immediately after treatment and at 3-month follow-up. The intention-to-treat analysis began in June 2023. The primary outcome measure was the changes in anxiety symptoms as assessed by the Hamilton Anxiety Rating Scale (HAM-A). Results Among 148 randomised participants, 70 were assigned to the VR-CBT group and 78 to the control group. The 1-week VR-CBT intervention plus standard mental health support significantly reduced the anxiety symptoms compared with standard mental health support alone in terms of HAM-A scores at both post intervention (Cohen's d=-1.27 (95% confidence interval (CI): -1.64 to -0.90, p<0.001) and 3-month follow-up (Cohen's d=-0.37 (95% CI: -0.72 to -0.01, p=0.024). Of the 70 participants who received VR-CBT, 62 (88.6%) completed the entire intervention. Cybersickness was the main reported adverse event (n=5). Conclusions Our results indicate that VR-CBT can significantly reduce post-AMI anxiety at the acute stage of the illness; the improvement was maintained at the 3-month follow-up. Trial registration number The trial was registered at www.chictr.org.cn with the identifier: ChiCTR2200066435.
Collapse
Affiliation(s)
- Yuan Yuan Li
- Department of Psychological Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| | - Juan Peng
- Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yuan Yang Ping
- Department of Psychological Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| | - Weng Jia Jun
- Department of Psychological Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yan'e Lu
- School of Nursing, Peking University, Beijing, China
| | - Jia Jia Liu
- School of Nursing, Peking University, Beijing, China
| | - Shi Kun Xu
- Zhongshan Hospital Fudan University, Shanghai, China
| | - Li Hua Guan
- Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Dong Huang
- Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Qi Bing Wang
- Department of Psychological Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| | - Ju Ying Qian
- Department of Psychological Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| | - Ze Xin Zhao
- Department of Psychological Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| | - Ya Bin Wei
- Beijing Key Laboratory of Drug Dependence Research, National Institute on Drug Dependence, Peking University, Beijing, China
| | - Jun Bo Ge
- Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Xiao Huang
- Department of Psychological Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| |
Collapse
|
4
|
Fresiello L, Hermens JAJ, Pladet L, Meuwese CL, Donker DW. The physiology of venoarterial extracorporeal membrane oxygenation - A comprehensive clinical perspective. Perfusion 2024; 39:5S-12S. [PMID: 38651580 DOI: 10.1177/02676591241237639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Venoarterial extracorporeal membrane oxygenation (VA ECMO) has become a standard of care for severe cardiogenic shock, refractory cardiac arrest and related impending multiorgan failure. The widespread clinical use of this complex temporary circulatory support modality is still contrasted by a lack of formal scientific evidence in the current literature. This might at least in part be attributable to VA ECMO related complications, which may significantly impact on clinical outcome. In order to limit adverse effects of VA ECMO as much as possible an indepth understanding of the complex physiology during extracorporeally supported cardiogenic shock states is critically important. This review covers all relevant physiological aspects of VA ECMO interacting with the human body in detail. This, to provide a solid basis for health care professionals involved in the daily management of patients supported with VA ECMO and suffering from cardiogenic shock or cardiac arrest and impending multiorgan failure for the best possible care.
Collapse
Affiliation(s)
- Libera Fresiello
- Cardiovascular and Respiratory Physiology, TechMed Center, University of Twente, Enschede, The Netherlands
| | - Jeannine A J Hermens
- Intensive Care Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lara Pladet
- Intensive Care Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Christiaan L Meuwese
- Department of Cardiology, Thorax Center, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Intensive Care Adults, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Dirk W Donker
- Cardiovascular and Respiratory Physiology, TechMed Center, University of Twente, Enschede, The Netherlands
- Intensive Care Center, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
5
|
Ono R, Iwahana T, Aoki K, Kato H, Okada S, Kobayashi Y. Fulminant Myocarditis with SARS-CoV-2 Infection: A Narrative Review from the Case Studies. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2024; 2024:9000598. [PMID: 38469104 PMCID: PMC10927348 DOI: 10.1155/2024/9000598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 03/13/2024]
Abstract
One of the severe complications of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is myocarditis. However, the characteristics of fulminant myocarditis with SARS-CoV-2 infection are still unclear. We systematically reviewed the previously reported cases of fulminant myocarditis associated with SARS-CoV-2 infection from January 2020 to December 2022, identifying 108 cases. Of those, 67 were male and 41 female. The average age was 34.8 years; 30 patients (27.8%) were ≤20 years old, whereas 10 (9.3%) were ≥60. Major comorbidities included hypertension, obesity, diabetes mellitus, asthma, heart disease, gynecologic disease, hyperlipidemia, and connective tissue disorders. Regarding left ventricular ejection fraction (LVEF) at admission, 93% of the patients with fulminant myocarditis were classified as having heart failure with reduced ejection fraction (LVEF ≤ 40%). Most of the cases were administered catecholamines (97.8%), and mechanical circulatory support (MCS) was required in 67 cases (62.0%). The type of MCS was extracorporeal membrane oxygenation (n = 56, 83.6%), percutaneous ventricular assist device (Impella®) (n = 19, 28.4%), intra-aortic balloon pumping (n = 12, 12.9%), or right ventricular assist device (n = 2, 3.0%); combination of these devices occurred in 20 cases (29.9%). The average duration of MCS was 7.7 ± 3.8 days. Of the 76 surviving patients whose cardiac function was available for follow-up, 65 (85.5%) recovered normally. The overall mortality rate was 22.4%, and the recovery rate was 77.6% (alive: 83 patients, dead: 24 patients; outcome not described: 1 patient).
Collapse
Affiliation(s)
- Ryohei Ono
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Togo Iwahana
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Kaoruko Aoki
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Hirotoshi Kato
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Sho Okada
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| |
Collapse
|
6
|
Lenz M, Krychtiuk KA, Zilberszac R, Heinz G, Riebandt J, Speidl WS. Mechanical Circulatory Support Systems in Fulminant Myocarditis: Recent Advances and Outlook. J Clin Med 2024; 13:1197. [PMID: 38592041 PMCID: PMC10932153 DOI: 10.3390/jcm13051197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Fulminant myocarditis (FM) constitutes a severe and life-threatening form of acute cardiac injury associated with cardiogenic shock. The condition is characterised by rapidly progressing myocardial inflammation, leading to significant impairment of cardiac function. Due to the acute and severe nature of the disease, affected patients require urgent medical attention to mitigate adverse outcomes. Besides symptom-oriented treatment in specialised intensive care units (ICUs), the necessity for temporary mechanical cardiac support (MCS) may arise. Numerous patients depend on these treatment methods as a bridge to recovery or heart transplantation, while, in certain situations, permanent MCS systems can also be utilised as a long-term treatment option. Methods: This review consolidates the existing evidence concerning the currently available MCS options. Notably, data on venoarterial extracorporeal membrane oxygenation (VA-ECMO), microaxial flow pump, and ventricular assist device (VAD) implantation are highlighted within the landscape of FM. Results: Indications for the use of MCS, strategies for ventricular unloading, and suggested weaning approaches are assessed and systematically reviewed. Conclusions: Besides general recommendations, emphasis is put on the differences in underlying pathomechanisms in FM. Focusing on specific aetiologies, such as lymphocytic-, giant cell-, eosinophilic-, and COVID-19-associated myocarditis, this review delineates the indications and efficacy of MCS strategies in this context.
Collapse
Affiliation(s)
- Max Lenz
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria (W.S.S.)
- Ludwig Boltzmann Institute for Cardiovascular Research, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Konstantin A. Krychtiuk
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria (W.S.S.)
| | - Robert Zilberszac
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria (W.S.S.)
| | - Gottfried Heinz
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria (W.S.S.)
| | - Julia Riebandt
- Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Walter S. Speidl
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria (W.S.S.)
- Ludwig Boltzmann Institute for Cardiovascular Research, Waehringer Guertel 18-20, 1090 Vienna, Austria
| |
Collapse
|
7
|
Kalra A, Kang JK, Khanduja S, Menta AK, Ahmad SA, Liu O, Rodriguez E, Spann M, Hernandez AV, Brodie D, Whitman GJR, Cho SM. Long-Term Neuropsychiatric, Neurocognitive, and Functional Outcomes of Patients Receiving ECMO: A Systematic Review and Meta-Analysis. Neurology 2024; 102:e208081. [PMID: 38181313 PMCID: PMC11023037 DOI: 10.1212/wnl.0000000000208081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/26/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Despite the common occurrence of neurologic complications during extracorporeal membrane oxygenation (ECMO) support, data on long-term neuropsychiatric, neurocognitive, and functional outcomes are sparse. We aimed to determine the prevalence of long-term neuropsychiatric symptoms, neurocognitive and functional impairment, and favorable neurologic outcomes in adult patients who receive ECMO. METHODS PubMed, Embase, Cochrane, Web of Science, and Scopus were searched for text related to ECMO and neuropsychiatric, neurocognitive, and functional outcomes from inception to May 3, 2023. Our primary outcome was the prevalence of neuropsychiatric symptoms (pain/discomfort, anxiety, depression, posttraumatic stress disorder [PTSD], and sleep disturbance) at long-term (≥6 months) follow-up. Our secondary outcomes were the prevalence of neurocognitive impairment (memory, attention, and reasoning), functional impairment (daily activities, physical activity/mobility, and personal/self-care), and favorable neurologic outcomes (Cerebral Performance Category ≤2, modified Rankin scale ≤3, or Glasgow Outcome Scale ≥4). This study was registered in PROSPERO (CRD42023420565). RESULTS We included 59 studies with 3,280 patients (median age 54 years, 69% male). The cohort consisted of 86% venoarterial (VA)-ECMO (n = 2,819) and 14% venovenous (VV)-ECMO (n = 461) patients. More than 10 tools were used to assess neuropsychiatric and neurocognitive outcomes, indicating a lack of standardization in assessment methodologies. The overall prevalence of neuropsychiatric symptoms was 41% (95% CI 33%-49%): pain/discomfort (52%, 95% CI 42%-63%), sleep disturbance (37%, 95% CI 0%-98%), anxiety (36%, 95% CI 27%-46%), depression (31%, 95% CI 22%-40%), and PTSD (18%, 95% CI 9%-29%). The prevalence of neurocognitive impairment was 38% (95% CI 13%-65%). The prevalence of functional impairment was 52% (95% CI 40%-64%): daily activities (54%, 95% CI 41%-66%), mobility (41%, 95% CI 28%-54%), and self-care (21%, 95% CI 13%-31%). The prevalence of neuropsychiatric symptoms in VV-ECMO patients was higher than that in VA-ECMO patients (55% [95% CI 34%-75%] vs 32% [95% CI 23%-41%], p = 0.01), though the prevalence of neurocognitive and functional impairment was not different between the groups. The prevalence of favorable neurologic outcomes was not different at various follow-ups: 3 months (23%, 95% CI 12%-36%), 6 months (25%, 95% CI 16%-35%), and ≥1 year (28%, 95% CI 21%-36%, p = 0.68). DISCUSSION A substantial proportion of ECMO patients seemed to experience neuropsychiatric symptoms and neurocognitive and functional impairments at long-term follow-up. Considerable heterogeneity in methodology for gauging these outcomes exists, warranting the need for standardization. Multicenter prospective observational studies are indicated to further investigate risk factors for these outcomes in ECMO-supported patients.
Collapse
Affiliation(s)
- Andrew Kalra
- From the Division of Cardiac Surgery (A.K., J.K.K., S.K., A.K.M., E.R., G.J.R.W.), Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Sidney Kimmel Medical College (A.K.), Thomas Jefferson University, Philadelphia, PA; Division of Neurosciences Critical Care (S.A.A., O.L., S.-M.C.), Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital; Informationist Services (M.S.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Pharmacy Practice (A.V.H.), University of Connecticut School of Pharmacy, Storrs; Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET) (A.V.H.), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru; and Division of Pulmonary and Critical Care Medicine (D.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jin Kook Kang
- From the Division of Cardiac Surgery (A.K., J.K.K., S.K., A.K.M., E.R., G.J.R.W.), Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Sidney Kimmel Medical College (A.K.), Thomas Jefferson University, Philadelphia, PA; Division of Neurosciences Critical Care (S.A.A., O.L., S.-M.C.), Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital; Informationist Services (M.S.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Pharmacy Practice (A.V.H.), University of Connecticut School of Pharmacy, Storrs; Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET) (A.V.H.), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru; and Division of Pulmonary and Critical Care Medicine (D.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shivalika Khanduja
- From the Division of Cardiac Surgery (A.K., J.K.K., S.K., A.K.M., E.R., G.J.R.W.), Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Sidney Kimmel Medical College (A.K.), Thomas Jefferson University, Philadelphia, PA; Division of Neurosciences Critical Care (S.A.A., O.L., S.-M.C.), Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital; Informationist Services (M.S.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Pharmacy Practice (A.V.H.), University of Connecticut School of Pharmacy, Storrs; Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET) (A.V.H.), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru; and Division of Pulmonary and Critical Care Medicine (D.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Arjun K Menta
- From the Division of Cardiac Surgery (A.K., J.K.K., S.K., A.K.M., E.R., G.J.R.W.), Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Sidney Kimmel Medical College (A.K.), Thomas Jefferson University, Philadelphia, PA; Division of Neurosciences Critical Care (S.A.A., O.L., S.-M.C.), Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital; Informationist Services (M.S.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Pharmacy Practice (A.V.H.), University of Connecticut School of Pharmacy, Storrs; Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET) (A.V.H.), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru; and Division of Pulmonary and Critical Care Medicine (D.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Syed A Ahmad
- From the Division of Cardiac Surgery (A.K., J.K.K., S.K., A.K.M., E.R., G.J.R.W.), Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Sidney Kimmel Medical College (A.K.), Thomas Jefferson University, Philadelphia, PA; Division of Neurosciences Critical Care (S.A.A., O.L., S.-M.C.), Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital; Informationist Services (M.S.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Pharmacy Practice (A.V.H.), University of Connecticut School of Pharmacy, Storrs; Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET) (A.V.H.), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru; and Division of Pulmonary and Critical Care Medicine (D.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Olivia Liu
- From the Division of Cardiac Surgery (A.K., J.K.K., S.K., A.K.M., E.R., G.J.R.W.), Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Sidney Kimmel Medical College (A.K.), Thomas Jefferson University, Philadelphia, PA; Division of Neurosciences Critical Care (S.A.A., O.L., S.-M.C.), Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital; Informationist Services (M.S.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Pharmacy Practice (A.V.H.), University of Connecticut School of Pharmacy, Storrs; Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET) (A.V.H.), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru; and Division of Pulmonary and Critical Care Medicine (D.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Emily Rodriguez
- From the Division of Cardiac Surgery (A.K., J.K.K., S.K., A.K.M., E.R., G.J.R.W.), Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Sidney Kimmel Medical College (A.K.), Thomas Jefferson University, Philadelphia, PA; Division of Neurosciences Critical Care (S.A.A., O.L., S.-M.C.), Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital; Informationist Services (M.S.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Pharmacy Practice (A.V.H.), University of Connecticut School of Pharmacy, Storrs; Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET) (A.V.H.), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru; and Division of Pulmonary and Critical Care Medicine (D.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Marcus Spann
- From the Division of Cardiac Surgery (A.K., J.K.K., S.K., A.K.M., E.R., G.J.R.W.), Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Sidney Kimmel Medical College (A.K.), Thomas Jefferson University, Philadelphia, PA; Division of Neurosciences Critical Care (S.A.A., O.L., S.-M.C.), Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital; Informationist Services (M.S.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Pharmacy Practice (A.V.H.), University of Connecticut School of Pharmacy, Storrs; Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET) (A.V.H.), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru; and Division of Pulmonary and Critical Care Medicine (D.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Adrian V Hernandez
- From the Division of Cardiac Surgery (A.K., J.K.K., S.K., A.K.M., E.R., G.J.R.W.), Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Sidney Kimmel Medical College (A.K.), Thomas Jefferson University, Philadelphia, PA; Division of Neurosciences Critical Care (S.A.A., O.L., S.-M.C.), Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital; Informationist Services (M.S.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Pharmacy Practice (A.V.H.), University of Connecticut School of Pharmacy, Storrs; Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET) (A.V.H.), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru; and Division of Pulmonary and Critical Care Medicine (D.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel Brodie
- From the Division of Cardiac Surgery (A.K., J.K.K., S.K., A.K.M., E.R., G.J.R.W.), Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Sidney Kimmel Medical College (A.K.), Thomas Jefferson University, Philadelphia, PA; Division of Neurosciences Critical Care (S.A.A., O.L., S.-M.C.), Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital; Informationist Services (M.S.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Pharmacy Practice (A.V.H.), University of Connecticut School of Pharmacy, Storrs; Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET) (A.V.H.), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru; and Division of Pulmonary and Critical Care Medicine (D.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Glenn J R Whitman
- From the Division of Cardiac Surgery (A.K., J.K.K., S.K., A.K.M., E.R., G.J.R.W.), Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Sidney Kimmel Medical College (A.K.), Thomas Jefferson University, Philadelphia, PA; Division of Neurosciences Critical Care (S.A.A., O.L., S.-M.C.), Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital; Informationist Services (M.S.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Pharmacy Practice (A.V.H.), University of Connecticut School of Pharmacy, Storrs; Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET) (A.V.H.), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru; and Division of Pulmonary and Critical Care Medicine (D.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sung-Min Cho
- From the Division of Cardiac Surgery (A.K., J.K.K., S.K., A.K.M., E.R., G.J.R.W.), Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Sidney Kimmel Medical College (A.K.), Thomas Jefferson University, Philadelphia, PA; Division of Neurosciences Critical Care (S.A.A., O.L., S.-M.C.), Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital; Informationist Services (M.S.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Pharmacy Practice (A.V.H.), University of Connecticut School of Pharmacy, Storrs; Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET) (A.V.H.), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru; and Division of Pulmonary and Critical Care Medicine (D.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
8
|
Briglio SE, Khanduja V, Lothan JD, Gorantla VR. Fulminant Myocarditis and Venoarterial Extracorporeal Membrane Oxygenation: A Systematic Review. Cureus 2024; 16:e54711. [PMID: 38524063 PMCID: PMC10960644 DOI: 10.7759/cureus.54711] [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: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
This systematic review aimed to look at the effectiveness of venoarterial extracorporeal membrane oxygenation (VA-ECMO) therapy in treating fulminant myocarditis and evaluating the optimal length of time a patient should be placed on VA-ECMO. Fulminant myocarditis is a potentially life-threatening medical condition most commonly brought on by cardiogenic shock, which often progresses to severe circulatory compromise, requiring the patient to be placed on some form of mechanical circulatory assistance to maintain adequate tissue perfusion. Medical centers have multiple mechanical assistive devices available for treatment at their disposal, but our area of focus was placed on one system in particular: VA-ECMO therapy. Although the technology has been around for more than 30 years, there is limited information on how effective VA-ECMO is regarding the treatment of fulminant myocarditis. Due to the lack of data regarding the treatment administration of VA-ECMO for fulminant myocarditis, standard treatment duration guidelines do not exist, resulting in a wide variation of treatment administrations among medical centers. In regard to short-term outcomes, VA-ECMO has shown to be effective in treating fulminant myocarditis, with a one-year post-hospital survival rate ranging from 57.1% to 78% at discharge. For long-term health and survival, the studies that recorded long-term survival ranged from 65% to 94.1%. However, given the small number of studies that pursue this, more research is needed to prove the efficacy of VA-ECMO for the treatment of fulminant myocarditis.
Collapse
Affiliation(s)
- Spencer E Briglio
- Anatomical Sciences, St. George's University School of Medicine, True Blue, GRD
| | - Viraj Khanduja
- Anatomical Sciences, St. George's University School of Medicine, True Blue, GRD
| | | | | |
Collapse
|
9
|
Shibata N, Kondo T, Okumura T, Imaizumi T, Dohi K, Izawa H, Ohte N, Amano T, Murohara T. Clinical Value of Troponin Levels to Cardiac Function and Prognosis in Patients with Fulminant Myocarditis. Int Heart J 2024; 65:218-229. [PMID: 38556333 DOI: 10.1536/ihj.23-589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Troponin (Tn) is a biomarker related to myocardial necrosis and is elevated in patients with myocarditis. This study aimed to investigate the association between cardiac Tn levels and the course of cardiac function, and prognosis in patients with fulminant myocarditis (FM) receiving percutaneous mechanical circulatory support (MCS).We used data from a multicenter retrospective registry, CHANGE PUMP 2, which included 216 patients with FM who required MCS. Among them, 141 patients whose Tn levels were available were analyzed. The patients were divided into low and high Tn groups according to the median values of TnT and TnI.The median age was 54 years, and 59.6% were male. The TnT and TnI on day 1 (at MCS initiation) were 3.8 (1.4-10.0) and 21.4 (8.4-68.8) ng/mL. While the left ventricular ejection fraction (LVEF) was similar on day 1 (25.0% versus 24.5%), the low Tn group showed better LVEF improvement on day 7 than the high Tn group (45.0% versus 25.3%, P < 0.001). LVEF at 1 year after admission was higher in the low Tn group (65.0% versus 59.7%, P = 0.039). The low Tn group had a better 90-day composite endpoint in death, durable left ventricular assist device implantation, and heart transplantation compared to the high Tn group (hazard ratio 0.47, 95% CI 0.23-0.95).Tn levels were associated with short- and long-term cardiac recovery and adverse outcomes in patients with FM receiving MCS due to cardiogenic shock.
Collapse
Affiliation(s)
- Naoki Shibata
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Toru Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Takahiro Imaizumi
- Department of Nephrology, Nagoya University Graduate School of Medicine
- Department of Advanced Medicine, Nagoya University Hospital
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University
| | - Nobuyuki Ohte
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University Hospital
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
| |
Collapse
|
10
|
Huang F, Ammirati E, Ponnaiah M, Montero S, Raimbault V, Abrams D, Lebreton G, Pellegrino V, Ihle J, Bottiroli M, Persichini R, Barrionuevo-Sánchez MI, Ariza-Solé A, Ng PY, Sin SWC, Ayer R, Buscher H, Belaid S, Delmas C, Ferreira R, Roncon-Albuquerque R, Lόpez-Sobrino T, Bunge JJH, Fisser C, Franchineau G, McCanny J, Ohshimo S, Sionis A, Hernández-Pérez FJ, Barge-Caballero E, Balik M, Muglia H, Park S, Donker DW, Porral B, Aïssaoui N, Mekontso Dessap A, Burgos V, Lesouhaitier M, Fried J, Jung JS, Rosillo S, Scherrer V, Nseir S, Winszewski H, Jorge-Pérez P, Kimmoun A, Diaz R, Combes A, Schmidt M. Fulminant myocarditis proven by early biopsy and outcomes. Eur Heart J 2023; 44:5110-5124. [PMID: 37941449 DOI: 10.1093/eurheartj/ehad707] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/17/2023] [Accepted: 10/06/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND AND AIMS While endomyocardial biopsy (EMB) is recommended in adult patients with fulminant myocarditis, the clinical impact of its timing is still unclear. METHODS Data were collected from 419 adult patients with clinically suspected fulminant myocarditis admitted to intensive care units across 36 tertiary centres in 15 countries worldwide. The diagnosis of myocarditis was histologically proven in 210 (50%) patients, either by EMB (n = 183, 44%) or by autopsy/explanted heart examination (n = 27, 6%), and clinically suspected cardiac magnetic resonance imaging confirmed in 96 (23%) patients. The primary outcome of survival free of heart transplantation (HTx) or left ventricular assist device (LVAD) at 1 year was specifically compared between patients with early EMB (within 2 days after intensive care unit admission, n = 103) and delayed EMB (n = 80). A propensity score-weighted analysis was done to control for confounders. RESULTS Median age on admission was 40 (29-52) years, and 322 (77%) patients received temporary mechanical circulatory support. A total of 273 (65%) patients survived without HTx/LVAD. The primary outcome was significantly different between patients with early and delayed EMB (70% vs. 49%, P = .004). After propensity score weighting, the early EMB group still significantly differed from the delayed EMB group in terms of survival free of HTx/LVAD (63% vs. 40%, P = .021). Moreover, early EMB was independently associated with a lower rate of death or HTx/LVAD at 1 year (odds ratio of 0.44; 95% confidence interval: 0.22-0.86; P = .016). CONCLUSIONS Endomyocardial biopsy should be broadly and promptly used in patients admitted to the intensive care unit for clinically suspected fulminant myocarditis.
Collapse
Affiliation(s)
- Florent Huang
- Department of Cardiology, Foch Hospital, Suresnes, France
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris Cedex 13, France
| | - Enrico Ammirati
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milan, Italy
| | - Maharajah Ponnaiah
- ICAN Intelligence and Omics, Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital, Paris, France
| | - Santiago Montero
- Acute Cardiovascular Care Unit, Cardiology, Departament de Medicina, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain
| | - Victor Raimbault
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris Cedex 13, France
| | - Darryl Abrams
- Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital and Center for Acute Respiratory Failure, Columbia University Medical Center, New York, NY, USA
| | - Guillaume Lebreton
- Service de Chirurgie Cardiaque, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris Cedex 13, France
| | | | - Joshua Ihle
- Intensive Care Unit, Alfred Hospital, Melbourne, Australia
| | - Maurizio Bottiroli
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milan, Italy
| | - Romain Persichini
- Medical-Surgical Intensive Care Unit, Félix Guyon Hospital, CHU de La Réunion, France
| | - Marisa Isabel Barrionuevo-Sánchez
- Intensive Cardiac Care Unit, Cardiology Department, Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Ariza-Solé
- Intensive Cardiac Care Unit, Cardiology Department, Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pauline Yeung Ng
- Adult Intensive Care Unit, Queen Mary Hospital, Hong-Kong, China
| | - Simon Wai Ching Sin
- Department of Anaesthesiology, The University of Hong Kong, Hong-Kong, China
| | - Raj Ayer
- Intensive Care Unit, St Vincent Hospital, Sydney, Australia
| | - Hergen Buscher
- Intensive Care Unit, St Vincent Hospital, Sydney, Australia
| | - Slimane Belaid
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Clément Delmas
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Rita Ferreira
- Intensive Care Unit, Saint João Hospital, Porto, Portugal
| | | | | | - Jeroen J H Bunge
- Department of Intensive Care Adults, and Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Christoph Fisser
- Intensive Care Unit, University Medical Centre Regensburg, Regensburg, Germany
| | - Guillaume Franchineau
- Department of Intensive Care Medicine and Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Sorbonne Université, Paris Cedex 18, France
| | - Jamie McCanny
- Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust Hospital, London, UK
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francisco José Hernández-Pérez
- Advanced Heart Failure and Transplant Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Eduardo Barge-Caballero
- Cardiology Department, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), CIBERCV, A Coruña, Spain
| | - Martin Balik
- Department of Anaesthesiology and Intensive Care, General University Hospital, Prague, Czech Republic
| | | | - Sunghoon Park
- Intensive Care Unit, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Dirk W Donker
- Intensive Care Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Cardiovascular and Respiratory Physiology, TechMed Center, University of Twente, Enschede, The Netherlands
| | - Beatriz Porral
- Intensive Care Department, Hospital Alvaro Cunqueiro, Vigo, Spain
| | - Nadia Aïssaoui
- Intensive Care Unit, Cochin Hospital, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris Cedex 5, France
| | - Armand Mekontso Dessap
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Mondor Hospital, Créteil, France
| | - Virginia Burgos
- Acute Cardiac Care Unit, Department of Cardiology, Hospital Marqués de Valdecilla, Santander, Spain
| | - Mathieu Lesouhaitier
- Departement of Infectious Diseases and Intensive Care Unit, Pontchaillou Hospital, Rennes 35200, France
| | - Justin Fried
- Department of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jae-Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Sandra Rosillo
- Department of Cardiology, Hospital Universitario La Paz, IDIPAZ, Madrid, Spain
| | - Vincent Scherrer
- Department of Anesthesiology and Critical Care, CHU Rouen, Rouen F-76000, France
| | - Saad Nseir
- Médecine Intensive-Réanimation, Inserm U1285, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, CHU de Lille, University Lille, Lille, France
| | | | - Pablo Jorge-Pérez
- Department of Cardiology, Hospital Universitario de Canarias Nuestra Señora de Candelaria, Canary Islands, Tenerife, Spain
| | - Antoine Kimmoun
- CHRU de NANCY, Service de Médecine Intensive et Réanimation, Inserm U1116, Université de Lorraine, Nancy, France
| | - Rodrigo Diaz
- Department of Cardiology, Clínica Las Condes, Las Condes, Chile
| | - Alain Combes
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris Cedex 13, France
- Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Matthieu Schmidt
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris Cedex 13, France
- Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
| |
Collapse
|
11
|
Wu X, Wang X, Luo J, Tian F, Bian J. Nursing Management of a Patient With Fulminant Myocarditis and Electrical Storm Receiving ECMO: A Case Report. Crit Care Nurse 2023; 43:22-33. [PMID: 38035616 DOI: 10.4037/ccn2023112] [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: 12/02/2023]
Abstract
INTRODUCTION Fulminant myocarditis is a devastating disease with significant mortality and complications. The care of patients with fulminant myocarditis is rarely reported. CLINICAL FINDINGS A 17-year-old female patient was admitted to the emergency department with dizziness, amaurosis fugax, and chest tightness. Initial assessment revealed elevated levels of troponin T (4.753 ng/mL), troponin I (49.540 ng/mL), creatine kinase (1306 U/L), creatine kinase-MB isoenzymes (75.71 ng/mL), lactate dehydrogenase (509 U/L), and N-terminal pro-B-type natriuretic peptide (6345 pg/mL). The patient had recurrent ventricular tachycardia and failed to maintain a sinus rhythm after multiple electrical cardioversions. DIAGNOSIS Echocardiography revealed a left ventricular ejection fraction of 34%. Magnetic resonance imaging results confirmed the diagnosis of myocarditis. INTERVENTIONS The patient received extracorporeal membrane oxygenation for 6 days, intra-aortic balloon pump support for 7 days, and mechanical ventilation for 5 days. Norepinephrine and dopamine were used to keep circulation stable, lidocaine and amiodarone were used to control heart rate, and glucocorticoids and immunoglobulins were used to modulate immunity. OUTCOMES The patient was discharged after 23 days. A month after discharge, echocardiography showed that the ejection fraction was 60%. The patient reported complete resolution of signs and symptoms of fulminant myocarditis at follow-up assessment. CONCLUSION This case report presents the activities of bedside nurses in caring for a patient with fulminant myocarditis and broadens the literature describing nursing interventions for patients with fulminant myocarditis.
Collapse
Affiliation(s)
- Xiaoxiao Wu
- Xiaoxiao Wu is a clinical nurse in the nursing department, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoyan Wang
- Xiaoyan Wang is a clinical nurse in the coronary care unit, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China
| | - Jinmei Luo
- Jinmei Luo is a clinical nurse in the coronary care unit, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen
| | - Fang Tian
- Fang Tian is a clinical head nurse in the coronary care unit, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen
| | - Jin Bian
- Jin Bian is a clinical head nurse in the hypertension ward, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing
| |
Collapse
|
12
|
Hermens JA, Meuwese CL, Szymanski MK, Gianoli M, van Dijk D, Donker DW. Patient-centered weaning from venoarterial extracorporeal membrane oxygenation: "A practice-oriented narrative review of literature". Perfusion 2023; 38:1349-1359. [PMID: 35939761 DOI: 10.1177/02676591221115938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Venoarterial extracorporeal membrane oxygenation (V-A ECMO) is increasingly used in cardiogenic shock for rapid stabilization and bridging towards recovery, long-term mechanical circulatory support or transplant. Although technological advances have instigated its widespread use, the complex, long-lasting ECMO care creates a significant strain on hospital staff and resources. Therefore, optimal clinical management including timely decisions on ECMO removal and further therapy are pivotal, yet require a well-structured weaning approach. Although dedicated guidelines are lacking, a variety of weaning protocols have distillated echocardiographic and hemodynamic predictors for successful weaning. Nevertheless, a strikingly high mortality up to 70% after initial successful weaning raises concerns about the validity of current weaning strategies. Here, we plead for a patient-tailored approach including a bailout strategy when weaning fails. This should account not only for left- but also right ventricular function and interdependence, as well as the temporal course of cardiac recovery in function of extracorporeal support. Patients with a high risk of weaning failure should be identified early, enabling timely transportation to an advanced heart failure center. This review summarizes predictors of successful weaning and discusses all relevant elements for a structured weaning approach with a central role for patient-specific clinical considerations and echocardiography.
Collapse
Affiliation(s)
- Jeannine Aj Hermens
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Christiaan L Meuwese
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Mariusz K Szymanski
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Monica Gianoli
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Diederik van Dijk
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Dirk W Donker
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands
| |
Collapse
|
13
|
Urata S, Michihata N, Inuzuka R, Matsui H, Fushimi K, Ishimaru M, Kato M, Yasunaga H. Factors affecting in-hospital mortality among pediatric patients with myocarditis treated with mechanical circulatory support. J Cardiol 2023; 82:108-112. [PMID: 36997000 DOI: 10.1016/j.jjcc.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/21/2023] [Accepted: 03/11/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Mechanical circulatory support (MCS) is a common treatment modality for circulatory failure caused by pediatric myocarditis. Despite improvements in treatment strategy, the mortality rate of pediatric patients with myocarditis treated with MCS is still high. Identifying the factors associated with mortality among pediatric patients with myocarditis treated with MCS may help reduce the mortality rate. METHODS This retrospective cohort study examined the data of patients aged <16 years who were admitted to a hospital between July 2010 and March 2018 for myocarditis; the data were collected from the Diagnosis Procedure Combination database, which is a national inpatient database in Japan. RESULTS During the study period, 105 of the 598 patients with myocarditis were treated with MCS. We excluded seven patients who died within 24 h of admission, resulting in 98 eligible patients. The overall in-hospital mortality was 22 %. In-hospital mortality was higher among patients aged <2 years and those who received cardiopulmonary resuscitation (CPR). Multivariable logistic regression analysis showed significantly higher in-hospital mortality among patients aged <2 years old [odds ratio (OR), 6.57; 95 % confidence interval (CI), 1.89-22.87] and those who received CPR (OR, 4.70; 95 % CI, 1.51-14.63; p < 0.01). CONCLUSION The in-hospital mortality of pediatric patients with myocarditis treated with MCS was high, particularly of children younger than 2 years and those who received CPR.
Collapse
Affiliation(s)
- Susumu Urata
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan; Division of Cardiology, National Center for Child and Development, Tokyo, Japan.
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryo Inuzuka
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Miho Ishimaru
- Department of Health Service Research, Faculty of Medicine, University of Tsukuba, Japan
| | - Motohiro Kato
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
14
|
Giordani AS, Baritussio A, Vicenzetto C, Peloso-Cattini MG, Pontara E, Bison E, Fraccaro C, Basso C, Iliceto S, Marcolongo R, Caforio ALP. Fulminant Myocarditis: When One Size Does Not Fit All - A Critical Review of the Literature. Eur Cardiol 2023; 18:e15. [PMID: 37405349 PMCID: PMC10316338 DOI: 10.15420/ecr.2022.54] [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: 10/19/2022] [Accepted: 12/12/2022] [Indexed: 07/06/2023] Open
Abstract
Fulminant myocarditis, rather than being a distinct form of myocarditis, is instead a peculiar clinical presentation of the disease. The definition of fulminant myocarditis has varied greatly in the last 20 years, leading to conflicting reports on prognosis and treatment strategies, mainly because of varied inclusion criteria in different studies. The main conclusion of this review is that fulminant myocarditis may be due to different histotypes and aetiologies that can be diagnosed only by endomyocardial biopsy and managed by aetiology-directed treatment. This life-threatening presentation requires rapid, targeted management both in the short term (mechanical circulatory support, inotropic and antiarrhythmic treatment and endomyocardial biopsy) and in the long term (including prolonged follow-up). Fulminant presentation has also recently been identified as a risk factor for worsened prognosis, even long after the resolution of the acute phase of myocarditis.
Collapse
Affiliation(s)
- Andrea Silvio Giordani
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Anna Baritussio
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Cristina Vicenzetto
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Maria Grazia Peloso-Cattini
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Elena Pontara
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Elisa Bison
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Chiara Fraccaro
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Cristina Basso
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Sabino Iliceto
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Renzo Marcolongo
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Alida Linda Patrizia Caforio
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| |
Collapse
|
15
|
Coppens A, Zahr N, Chommeloux J, Bleibtreu A, Hekimian G, Pineton de Chambrun M, LeFevre L, Schmidt M, Robert J, Junot H, Combes A, Luyt CE. Pharmacokinetics/pharmacodynamics of ceftobiprole in patients on extracorporeal membrane oxygenation. Int J Antimicrob Agents 2023; 61:106765. [PMID: 36804372 DOI: 10.1016/j.ijantimicag.2023.106765] [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] [Received: 12/05/2022] [Revised: 02/06/2023] [Accepted: 02/12/2023] [Indexed: 02/19/2023]
Abstract
INTRODUCTION Due to its bacteriological spectrum and efficacy in skin and soft tissue infections, ceftobiprole may be of interest for extracorporeal membrane oxygenation (ECMO) cannula-related infection. It is unknown whether ceftobiprole pharmacokinetics (PK) are changed by ECMO. METHODS A retrospective monocentric cohort study was performed of 35 patients with suspected ECMO-related cannula infections (28 on ECMO, seven after ECMO removal), who received ceftobiprole as empiric treatment and had ceftobiprole blood levels measured at trough, peak and CT50 (50% of the dosing interval). Ceftobiprole blood levels of the 28 patients on ECMO were compared with those of the seven patients without ECMO. Factors associated with low ceftobiprole trough levels were also explored. RESULTS Among the 35 patients included, 29 had a confirmed cannula-related infection and 48 pathogens were isolated. Ceftobiprole MIC was determined in 29 of these 48, and 23 (79%) were susceptible to ceftobiprole. Ceftobiprole blood levels (at trough, peak and CT50) were similar in ECMO and non-ECMO patients. Moreover, in patients whose pathogens responsible for infection were susceptible to ceftobiprole, 94% had a ceftobiprole trough level above the MIC. Ceftobiprole blood levels were decreased in patients with acute renal failure requiring renal replacement therapy (RRT) and in those with increased renal clearance (defined as creatinine clearance > 130 mL/min), independent of ECMO. No other factor was associated with modification of ceftobiprole PK/pharmacodynamics (PK/PD). CONCLUSIONS The ceftobiprole PK/PD was no different in patients during ECMO or after its withdrawal. Factors associated with decreased ceftobiprole blood levels were patients requiring RRT and those with increased renal clearance.
Collapse
Affiliation(s)
- Alexandre Coppens
- Médecine Intensive Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne-Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Noël Zahr
- AP-HP Sorbonne Université, Pitié-Salpêtrière Hospital, Department of Pharmacology, CIC-1901, Pharmacokinetics and Therapeutic Drug Monitoring Unit, UMR-S 1166, F-75013 Paris, France
| | - Juliette Chommeloux
- Médecine Intensive Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne-Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Alexandre Bleibtreu
- Service des Maladies Infectieuses et Tropicales, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne-Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Guillaume Hekimian
- Médecine Intensive Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne-Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Marc Pineton de Chambrun
- Médecine Intensive Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne-Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Lucie LeFevre
- Médecine Intensive Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne-Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Matthieu Schmidt
- Médecine Intensive Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne-Université, Hôpital Pitié-Salpêtrière, Paris, France; Sorbonne Université, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France
| | - Jérôme Robert
- Bactériologie-Hygiène, DMU GioGem, Hôpital Pitié-Salpêtrière, APHP Sorbonne Université and CIMI-Paris, Inserm U1135, Sorbonne-Université, F-75013 Paris, France
| | - Helga Junot
- Service de pharmacie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne-Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Alain Combes
- Médecine Intensive Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne-Université, Hôpital Pitié-Salpêtrière, Paris, France; Sorbonne Université, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France
| | - Charles-Edouard Luyt
- Médecine Intensive Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne-Université, Hôpital Pitié-Salpêtrière, Paris, France; Sorbonne Université, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France.
| |
Collapse
|
16
|
Yang W, He X, Wang Z, Lu L, Zhou G, Cheng J, Hao X. Research focus and theme trend on fulminant myocarditis: A bibliometric analysis. Front Cardiovasc Med 2022; 9:935073. [PMID: 36187003 PMCID: PMC9515361 DOI: 10.3389/fcvm.2022.935073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
AimsThis study intends to explore the research focus and trends of fulminant myocarditis (FM) to have a better understanding of the topic.Materials and methodsThe data were downloaded from the Web of Science (WoS) database using the topic (TS) advanced search strategy. Many instruments were used to extract, analyze, and visualize the data, such as Microsoft Excel, HistCite Pro, GunnMap, BibExcel, and VOSviewer.ResultsFrom 1985 to 2022, 726 documents were indexed in the WoS. The United States and Columbia University were the most productive country and institutions. Keywords co-occurrence was carried out and four research themes were identified. In addition, the top three prolific authors, the first three highly cited authors, and the core authors of the author co-citation network were identified. The topics that they kept an eye on were analyzed, and the research areas of key authors were similar to the results of keyword co-occurrence. The hot topics of FM were related to the mechanical circulatory support, etiology, diagnosis, and the disease or therapy associated with FM.ConclusionThis study carried out a systematic analysis of the documents related to FM from 1985 to 2022, which can provide a guideline for researchers to understand the theme trend to promote future research to be carried out.
Collapse
Affiliation(s)
- Weimei Yang
- Department of Cardiovascular Diseases, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xifei He
- Department of Cardiovascular Diseases, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Xifei He,
| | - Zhaozhao Wang
- Department of Cardiovascular Diseases, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Zhaozhao Wang,
| | - Lijuan Lu
- Department of Cardiovascular Diseases, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ge Zhou
- Department of Cardiovascular Diseases, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Cheng
- Department of Cardiovascular Diseases, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinying Hao
- School of Humanities and Social Sciences, University of Science and Technology of China, Hefei, China
| |
Collapse
|
17
|
How to Optimize ECLS Results beyond Ventricular Unloading: From ECMO to CentriMag ® eVAD. J Clin Med 2022; 11:jcm11154605. [PMID: 35956219 PMCID: PMC9369484 DOI: 10.3390/jcm11154605] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/31/2022] [Accepted: 08/05/2022] [Indexed: 11/24/2022] Open
Abstract
CentriMag® extracorporeal VAD support could represent a more physiological choice than conventional ECMO in primary cardiogenic shock. We therefore evaluated the outcome of patients with primary cardiogenic shock who were supported with CentriMag® extracorporeal VAD implantation versus conventional ECMO. We retrospectively reviewed all extracorporeal life supports implanted for primary cardiogenic shock between January 2009 and December 2018 at our institution. Among 212 patients, 143 cases (67%) were treated exclusively with ECMO (Group 1) and 69 cases (33%) with extracorporeal VAD implantation (Group 2, 48 of whom as conversion of ECMO). ECLS mean duration was 8.37 ± 8.43 days in Group 1 and 14.25 ± 10.84 days in Group 2 (p = 0.001), while the mean rates of the highest predicted flow were 61.21 ± 16.01% and 79.49 ± 18.42% (p = 0.001), respectively. Increasing mechanical support flow was related to in-hospital mortality and overall mortality in Group 1 (HR 11.36, CI 95%: 2.19–44.20), but not in Group 2 (HR 1.48, CI 95%: 0.32–6.80). High-flow ECMO patients had lower survival with respect to high-flow extracorporeal VAD patients (p = 0.027). In the setting of high-flow mechanical circulatory support, CentriMag® extracorporeal VAD optimized patient survival, granting long-term assistance and physiological circulation patterns.
Collapse
|
18
|
Barhoum P, Pineton de Chambrun M, Dorgham K, Kerneis M, Burrel S, Quentric P, Parizot C, Chommeloux J, Bréchot N, Moyon Q, Lebreton G, Boussouar S, Schmidt M, Yssel H, Lefevre L, Miyara M, Charuel JL, Marot S, Marcelin AG, Luyt CE, Leprince P, Amoura Z, Montalescot G, Redheuil A, Combes A, Gorochov G, Hékimian G. Phenotypic Heterogeneity of Fulminant COVID-19--Related Myocarditis in Adults. J Am Coll Cardiol 2022; 80:299-312. [PMID: 35863846 PMCID: PMC9291241 DOI: 10.1016/j.jacc.2022.04.056] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/06/2022] [Accepted: 04/18/2022] [Indexed: 12/14/2022]
Abstract
Background Adults who have been infected with SARS-CoV-2 can develop a multisystem inflammatory syndrome (MIS-A), including fulminant myocarditis. Yet, several patients fail to meet MIS-A criteria, suggesting the existence of distinct phenotypes in fulminant COVID-19–related myocarditis. Objectives This study sought to compare the characteristics and clinical outcome between patients with fulminant COVID-19–related myocarditis fulfilling MIS-A criteria (MIS-A+) or not (MIS-A−). Methods A monocentric retrospective analysis of consecutive fulminant COVID-19–related myocarditis in a 26-bed intensive care unit (ICU). Results Between March 2020 and June 2021, 38 patients required ICU admission (male 66%; mean age 32 ± 15 years) for suspected fulminant COVID-19–related myocarditis. In-ICU treatment for organ failure included dobutamine 79%, norepinephrine 60%, mechanical ventilation 50%, venoarterial extracorporeal membrane oxygenation 42%, and renal replacement therapy 29%. In-hospital mortality was 13%. Twenty-five patients (66%) met the MIS-A criteria. MIS-A− patients compared with MIS-A+ patients were characterized by a shorter delay between COVID-19 symptoms onset and myocarditis, a lower left ventricular ejection fraction, and a higher rate of in-ICU organ failure, and were more likely to require mechanical circulatory support with venoarterial extracorporeal membrane oxygenation (92% vs 16%; P < 0.0001). In-hospital mortality was higher in MIS-A− patients (31% vs 4%). MIS-A+ had higher circulating levels of interleukin (IL)-22, IL-17, and tumor necrosis factor-α (TNF-α), whereas MIS-A− had higher interferon-α2 (IFN-α2) and IL-8 levels. RNA polymerase III autoantibodies were present in 7 of 13 MIS-A− patients (54%) but in none of the MIS-A+ patients. Conclusion MIS-A+ and MIS-A− fulminant COVID-19–related myocarditis patients have 2 distinct phenotypes with different clinical presentations, prognosis, and immunological profiles. Differentiating these 2 phenotypes is relevant for patients’ management and further understanding of their pathophysiology.
Collapse
Affiliation(s)
- Petra Barhoum
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France
| | - Marc Pineton de Chambrun
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France; Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France; Sorbonne Université, AP-HP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2, Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France; Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France; Sorbonne Université, AP-HP, Hôpital La Pitié-Salpêtrière, Département d'Immunologie, Paris, France
| | - Karim Dorgham
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France; Sorbonne Université, AP-HP, Hôpital La Pitié-Salpêtrière, Département d'Immunologie, Paris, France
| | - Mathieu Kerneis
- Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France; Sorbonne Université, AP-HP, Hôpital La Pitié-Salpêtrière, ACTION Study Group, Département de Cardiologie, Paris, France
| | - Sonia Burrel
- Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), INSERM U1136, Paris, France; Sorbonne Université, AP-HP, Hôpital La Pitié-Salpêtrière, Service de Virologie, Paris, France
| | - Paul Quentric
- Sorbonne Université, AP-HP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2, Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France; Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France; Sorbonne Université, AP-HP, Hôpital La Pitié-Salpêtrière, Département d'Immunologie, Paris, France
| | - Christophe Parizot
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France; Sorbonne Université, AP-HP, Hôpital La Pitié-Salpêtrière, Département d'Immunologie, Paris, France
| | - Juliette Chommeloux
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France
| | - Nicolas Bréchot
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France
| | - Quentin Moyon
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France; Sorbonne Université, AP-HP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2, Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
| | - Guillaume Lebreton
- Sorbonne Université, AP-HP, Hôpital La Pitié-Salpêtrière, Service de Chirurgie Cardio-Thoracique, Paris, France
| | - Samia Boussouar
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Unité d'Imagerie Cardiovasculaire et Thoracique (ICT), Paris, France
| | - Matthieu Schmidt
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France; Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Hans Yssel
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Lucie Lefevre
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France
| | - Makoto Miyara
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France; Sorbonne Université, AP-HP, Hôpital La Pitié-Salpêtrière, Département d'Immunologie, Paris, France
| | - Jean-Luc Charuel
- Sorbonne Université, AP-HP, Hôpital La Pitié-Salpêtrière, Département d'Immunologie, Paris, France
| | - Stéphane Marot
- Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), INSERM U1136, Paris, France; Sorbonne Université, AP-HP, Hôpital La Pitié-Salpêtrière, Service de Virologie, Paris, France
| | - Anne-Geneviève Marcelin
- Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), INSERM U1136, Paris, France; Sorbonne Université, AP-HP, Hôpital La Pitié-Salpêtrière, Service de Virologie, Paris, France
| | - Charles-Edouard Luyt
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France; Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Pascal Leprince
- Sorbonne Université, AP-HP, Hôpital La Pitié-Salpêtrière, Service de Chirurgie Cardio-Thoracique, Paris, France
| | - Zahir Amoura
- Sorbonne Université, AP-HP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2, Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
| | - Gilles Montalescot
- Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France; Sorbonne Université, AP-HP, Hôpital La Pitié-Salpêtrière, ACTION Study Group, Département de Cardiologie, Paris, France
| | - Alban Redheuil
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Unité d'Imagerie Cardiovasculaire et Thoracique (ICT), Paris, France
| | - Alain Combes
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France; Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Guy Gorochov
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France; Sorbonne Université, AP-HP, Hôpital La Pitié-Salpêtrière, Département d'Immunologie, Paris, France.
| | - Guillaume Hékimian
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France.
| |
Collapse
|
19
|
Delaye J, Cacciatore P, Kole A. Valuing the "Burden" and Impact of Rare Diseases: A Scoping Review. Front Pharmacol 2022; 13:914338. [PMID: 35754469 PMCID: PMC9213803 DOI: 10.3389/fphar.2022.914338] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/09/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction: Rare diseases (RDs) are a severe, chronic, degenerative and often life-threatening group of conditions affecting more than 30 million people in Europe. Their impact is often underreported and ranges from psychological and physical symptoms seriously compromising quality of life. There is then a need to consolidate knowledge on the economic, social, and quality of life impacts of rare diseases. Methods: This scoping review is the result of 9 qualitative interviews with experts and a literature search on Cost-of-Illness (COI) studies and quality of life (QoL) studies following the PRISMA methodology. Grey literature was also included to complement findings. Results. 63 COI studies were retrieved, covering 42 diseases and a vast majority of them using a prevalence-based approach (94%). All studies included medical costs, while 60% included non-medical costs, 68% productivity losses and 43% informal care costs. 56 studies on QoL were retrieved, mostly from Europe, with 30 different measurement tools. Grey literature included surveys from the pharmaceutical industry and patient organisations. Discussion: The majority of studies evaluating the impact of RDs on the individual and society use the COI approach, mostly from a societal perspective. Studies often vary in scope, making them difficult to consolidate or compare results. While medical costs and productivity losses are consistently included, QoL aspects are rarely considered in COI and are usually measured through generic tools. Conclusion: A comprehensive study on impact of rare disease across countries in Europe is lacking. Existing studies are heterogeneous in their scope and methodology and often lack a holistic picture of the impact of rare. Consensus on standards and methodology across countries and diseases is then needed. Studies that consider a holistic approach are often conducted by pharmaceutical companies and patient organisations exploring a specific disease area but are not necessarily visible in the literature and could benefit from the sharing of standards and best practices.
Collapse
Affiliation(s)
- Julien Delaye
- European Organisation for Rare Diseases (EURORDIS), Paris, France
| | | | - Anna Kole
- European Organisation for Rare Diseases (EURORDIS), Paris, France
| |
Collapse
|
20
|
Oh JH, Kim GB, Seok H. Implication of microRNA as a potential biomarker of myocarditis. Clin Exp Pediatr 2022; 65:230-238. [PMID: 35240034 PMCID: PMC9082251 DOI: 10.3345/cep.2021.01802] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/29/2022] [Indexed: 12/15/2022] Open
Abstract
Myocarditis was previously attributed to an epidemic viral infection. Additional harmful reagents, in addition to viruses, play a role in its etiology. Coronavirus disease 2019 (COVID-19) vaccine-induced myocarditis has recently been described, drawing attention to vaccine-induced myocarditis in children and adolescents. Its pathology is based on a series of complex immune responses, including initial innate immune responses in response to viral entry, adaptive immune responses leading to the development of antigen-specific antibodies, and autoimmune responses to cellular injury caused by cardiomyocyte rupture that releases antigens. Chronic inflammation and fibrosis in the myocardium eventually result in cardiac failure. Recent advancements in molecular biology have remarkably increased our understanding of myocarditis. In particular, microRNAs (miRNAs) are a hot topic in terms of the role of new biomarkers and the pathophysiology of myocarditis. Myocarditis has been linked with microRNA-221/222 (miR-221/222), miR-155, miR-10a*, and miR-590. Despite the lack of clinical trials of miRNA intervention in myocarditis yet, multiple clinical trials of miRNAs in other cardiac diseases have been aggressively conducted to help pave the way for future research, which is bolstered by the success of recently U.S. Food and Drug Administration-approved small-RNA medications. This review presents basic information and recent research that focuses on myocarditis and related miRNAs as a potential novel biomarker and the therapeutics.
Collapse
Affiliation(s)
- Jin-Hee Oh
- Department of Pediatrics, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Heeyoung Seok
- Department of Transdisciplinary Research and Collaboration, Genomics Core Facility, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
21
|
Aissi James S, Klein T, Lebreton G, Nizard J, Chommeloux J, Bréchot N, Pineton de Chambrun M, Hékimian G, Luyt CE, Levy B, Kimmoun A, Combes A, Schmidt M. Amniotic fluid embolism rescued by venoarterial extracorporeal membrane oxygenation. Crit Care 2022; 26:96. [PMID: 35392980 PMCID: PMC8988404 DOI: 10.1186/s13054-022-03969-3] [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: 12/14/2021] [Accepted: 03/23/2022] [Indexed: 11/21/2022] Open
Abstract
Background Amniotic fluid embolism (AFE) is a rare but often catastrophic complication of pregnancy that leads to cardiopulmonary dysfunction and severe disseminated intravascular coagulopathy (DIC). Although few case reports have reported successful use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) with AFE, concerns can be raised about the increased bleeding risks with that device.
Methods This study included patients with AFE rescued by VA-ECMO hospitalized in two high ECMO volume centers between August 2008 and February 2021. Clinical characteristics, critical care management, in-intensive care unit (ICU) complications, and hospital outcomes were collected. ICU survivors were assessed for health-related quality of life (HRQL) in May 2021. Results During that 13-year study period, VA-ECMO was initiated in 54 parturient women in two high ECMO volume centers. Among that population, 10 patients with AFE [median (range) age 33 (24–40), SAPS II at 69 (56–81)] who fulfilled our diagnosis criteria were treated with VA-ECMO. Pregnancy evolved for 36 (30–41) weeks. Seven patients had a cardiac arrest before ECMO and two were cannulated under cardiopulmonary resuscitation. Pre-ECMO hemodynamic was severely impaired with an inotrope score at 370 (55–1530) μg/kg/min, a severe left ventricular ejection fraction measured at 14 (0–40)%, and lactate at 12 (2–30) mmol/L. 70% of these patients were alive at hospital discharge despite an extreme pre-ECMO severity and massive blood product transfusion. However, HRQL was lower than age-matched controls and still profoundly impaired in the role-physical, bodily pain, and general health components after a median of 44 months follow-up. Conclusion In this rare per-delivery complication, our results support the use of VA-ECMO despite intense DIC and ongoing bleeding. Future studies should focus on customized, patient-centered, rehabilitation programs that could lead to improved HRQL in this population.
Collapse
Affiliation(s)
- Sarah Aissi James
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Thomas Klein
- Université de Lorraine, CHRU de Nancy, Institut Lorrain du Cœur Et Des Vaisseaux, Service de Médecine Intensive-Réanimation, U1116, FCRIN-INICRCT, Nancy, France
| | - Guillaume Lebreton
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France.,Service de Chirurgie Cardiaque, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Jacky Nizard
- Department of Gynaecology and Obstetrics, Groupe Hospitalier Pitié-Salpêtrière, CNRS UMR 7222, INSERM U1150, Sorbonne Universités, Paris, France
| | - Juliette Chommeloux
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013, Paris, France.,Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France
| | - Nicolas Bréchot
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013, Paris, France.,Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France
| | - Marc Pineton de Chambrun
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013, Paris, France.,Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France
| | - Guillaume Hékimian
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013, Paris, France.,Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France
| | - Charles-Edouard Luyt
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013, Paris, France.,Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France
| | - Bruno Levy
- Université de Lorraine, CHRU de Nancy, Institut Lorrain du Cœur Et Des Vaisseaux, Service de Médecine Intensive-Réanimation, U1116, FCRIN-INICRCT, Nancy, France
| | - Antoine Kimmoun
- Université de Lorraine, CHRU de Nancy, Institut Lorrain du Cœur Et Des Vaisseaux, Service de Médecine Intensive-Réanimation, U1116, FCRIN-INICRCT, Nancy, France
| | - Alain Combes
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013, Paris, France.,Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France.,Sorbonne Université, GRC 30, RESPIRE, Assistance Publique-Hôpitaux de Paris (APHP) Hôpital Pitié-Salpêtrière, Paris, France
| | - Matthieu Schmidt
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013, Paris, France. .,Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France. .,Sorbonne Université, GRC 30, RESPIRE, Assistance Publique-Hôpitaux de Paris (APHP) Hôpital Pitié-Salpêtrière, Paris, France. .,Service de Medecine Intensive Reanimation, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.
| |
Collapse
|
22
|
Castillo AV, Ivsic T. Overview of pediatric myocarditis and pericarditis. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
23
|
Lin WJ, Chang YL, Weng LC, Tsai FC, Huang HC, Yeh SL, Chen KH. Post-Discharge Depression Status for Survivors of Extracorporeal Membrane Oxygenation (ECMO): Comparison of Veno-Venous ECMO and Veno-Arterial ECMO. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063333. [PMID: 35329031 PMCID: PMC8954682 DOI: 10.3390/ijerph19063333] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 12/16/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) is one of the common invasive treatments for the care of critically ill patients with heart failure, respiratory failure, or both. There are two modes of ECMO, namely, veno-venous (VV) and veno-arterial (VA), which have different indications, survival rates, and incidences of complications. This study’s aim was to examine whether depression status differed between patients who had received VV-ECMO or VA-ECMO and had been discharged from the hospital. This was a descriptive, cross-sectional, and correlational study of patients who had been discharged from the hospital at least one month after receiving ECMO at a medical center in northern Taiwan from June 2006 to June 2020 (N = 142). Participants were recruited via convenience and quota sampling. Data were collected in the cardiovascular outpatient department between October 2015–October 2016 (n = 52) and September 2019–August 2020 (n = 90). Participants completed the Hospital Anxiety and Depression Scale–Depression (HADS-D) as a measure of depression status. Post-discharge depression scores for patients who received VV-ECMO (n = 67) was significantly higher (p = 0.018) compared with participants who received VA-ECMO (n = 75). In addition, the mode of ECMO was a predictor of post-discharge depression (p = 0.008) for participants who received VV-ECMO. This study concluded that patients who received VV-ECMO may require greater mental health support. Healthcare professionals should establish a psychological clinical care pathway evaluated by multiple healthcare professionals.
Collapse
Affiliation(s)
- Wan-Jung Lin
- Department of Nursing, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 100, Taiwan;
| | - Yu-Ling Chang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan; (Y.-L.C.); (L.-C.W.)
- Department of Nursing, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City 333, Taiwan
| | - Li-Chueh Weng
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan; (Y.-L.C.); (L.-C.W.)
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City 333, Taiwan
| | - Feng-Chun Tsai
- Department of Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City 333, Taiwan; (F.-C.T.); (H.-C.H.)
- College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Huei-Chiun Huang
- Department of Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City 333, Taiwan; (F.-C.T.); (H.-C.H.)
| | - Shu-Ling Yeh
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan Branch, Taoyuan City 333, Taiwan;
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City 333, Taiwan
| | - Kang-Hua Chen
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan; (Y.-L.C.); (L.-C.W.)
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan Branch, Taoyuan City 333, Taiwan;
- Correspondence: ; Tel.: +886-3-211-8800 (ext. 5211)
| |
Collapse
|
24
|
Abstract
Fulminant myocarditis (FM) is an uncommon syndrome characterized by sudden and severe hemodynamic compromise secondary to acute myocardial inflammation, often presenting as profound cardiogenic shock, life-threatening ventricular arrhythmias and/or electrical storm. FM may be refractory to conventional therapies and require mechanical circulatory support (MCS). The immune system has been recognized as playing a pivotal role in the pathophysiology of myocarditis, leading to an increased focus on immunosuppressive treatment strategies. Recent data have highlighted not only the fact that FM has significantly worse outcomes than non-FM, but that prognosis and management strategies of FM are heavily dependent on histological subtype, placing greater emphasis on the role of endomyocardial biopsy in diagnosis. The impact of subtype on severity and prognosis will likewise influence how aggressively the myocarditis is managed, including whether MCS is warranted. Many patients with refractory cardiogenic shock secondary to FM end up requiring MCS, with venoarterial extracorporeal membrane oxygenation demonstrating favorable survival rates, particularly when initiated prior to the development of multiorgan failure. Among the challenges facing the field are the need to more precisely identify immunopathophysiological pathways in order to develop targeted therapies, and the need to better optimize the timing and management of MCS to minimize complications and maximize outcomes.
Collapse
|
25
|
Bourcier S, Desnos C, Clément M, Hékimian G, Bréchot N, Taccone FS, Belliato M, Pappalardo F, Broman LM, Malfertheiner MV, Lunz D, Schmidt M, Leprince P, Combes A, Lebreton G, Luyt CE. Extracorporeal cardiopulmonary resuscitation for refractory in-hospital cardiac arrest: A retrospective cohort study. Int J Cardiol 2022; 350:48-54. [PMID: 34995699 DOI: 10.1016/j.ijcard.2021.12.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Extracorporeal cardiopulmonary resuscitation (ECPR) is a rescue therapy for refractory cardiac arrest, but its high mortality has raised questions about patient selection. No selection criteria have been proposed for patients experiencing in-hospital cardiac arrest. We aimed to identify selection criteria available at the time ECPR was considered for patients with in-hospital cardiac arrest. We analyzed data of in-hospital cardiac arrest patients undergoing ECPR in our extracorporeal membrane oxygenation (ECMO) center (March 2007 to March 2019). Intensive care unit (ICU) and 1-year survival post-hospital discharge were assessed. Factors associated with ICU survival before ECPR were investigated. An external validation cohort from a previous multicenter study was used to validate our results. RESULTS Among the 137 patients (67.9% men; median [IQR] age, 54 [43-62] years; low-flow duration, 45 [30-70] min) requiring ECPR, 32.1% were weaned-off ECMO. Their respective ICU- and 1-year survival rates were 21.9% and 19%. Most 1-year survivors had favorable neurological outcomes (cerebral performance category score 1 or 2). ICU survivors compared to nonsurvivors, respectively, were more likely to have a shockable initial rhythm (53.3% versus 24.3%; P < 0.01), a shorter median (IQR) low-flow time (30 (25-53) versus 50 (35-80) min, P < 0.01) and they more frequently underwent a subsequent intervention (63.3% versus 26.2%, P < 0.01). The algorithm obtained by combining age, initial rhythm and low-flow duration discriminated between patient groups with very different survival probabilities in the derivation and validation cohorts. CONCLUSION Survival of ECPR-managed in-hospital cardiac arrest patients in this cohort was poor but hospital survivors' 1-year neurological outcomes were favorable. When deciding whether or not to use ECPR, the combination of age, initial rhythm and low-flow duration can improve patient selection.
Collapse
Affiliation(s)
- Simon Bourcier
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Médecine Intensive Réanimation, Paris, France
| | - Cyrielle Desnos
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Médecine Intensive Réanimation, Paris, France
| | - Marina Clément
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Cardiovascular and Thoracic Surgery, Paris, France
| | - Guillaume Hékimian
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Médecine Intensive Réanimation, Paris, France
| | - Nicolas Bréchot
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Médecine Intensive Réanimation, Paris, France; Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Cliniques Universitaires de Bruxelles (CUB) Erasme, Brussels, Belgium
| | - Mirko Belliato
- UOS Advanced Respiratory Intensive Care Unit, UOC Anestesia e Rianimazione 2 Cardiopolmonare, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federico Pappalardo
- Department of Anesthesia and Intensive Care, IRCCS ISMETT, UPMC Italy, Palermo, Italy
| | - Lars Mikael Broman
- ECMO Centre Karolinska, Karolinska University Hospital, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Maximilian Valentin Malfertheiner
- Department of Internal Medicine II, Cardiology and Pneumology, Intensive Care, University Medical Center Regensburg, Regensburg, Germany
| | - Dirk Lunz
- Department of Anesthesiology and Intensive Care, University Hospital Regensburg, Regensburg, Germany
| | - Matthieu Schmidt
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Médecine Intensive Réanimation, Paris, France; Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Pascal Leprince
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Cardiovascular and Thoracic Surgery, Paris, France; Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Alain Combes
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Médecine Intensive Réanimation, Paris, France; Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Guillaume Lebreton
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Cardiovascular and Thoracic Surgery, Paris, France; Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Charles-Edouard Luyt
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Médecine Intensive Réanimation, Paris, France; Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France.
| |
Collapse
|
26
|
[Extracorporeal membrane oxygenation and hemodynamics : Therapy is not only a friend of the heart]. DIE ANAESTHESIOLOGIE 2022; 71:967-982. [PMID: 36449054 PMCID: PMC9709734 DOI: 10.1007/s00101-022-01230-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 12/03/2022]
Abstract
Extracorporeal support systems for the heart and lungs are employed for cardiac, pulmonary and also cardiopulmonary failure; however, neither the pure lung support by venovenous extracorporeal membrane oxygenation (vvECMO) nor the venoarterial (va) ECMO behave in a hemodynamically inert manner with respect to the patient's own cardiovascular system. The success of ECMO treatment is decisively dependent on monitoring before and during the execution and the pathophysiological understanding of the hemodynamic changes that occur during treatment. This article explicitly elucidates these "concomitant phenomena" and discusses fundamental aspects of cardiovascular physiology and the specific interplay with ECMO treatment.
Collapse
|
27
|
Chen KH, Lee PS, Tsai FC, Weng LC, Yeh SL, Huang HC, Lin SS. Health-related outcomes of extracorporeal membrane oxygenation in adults: A cross-sectional study. Heart Lung 2021; 52:76-85. [PMID: 34911020 DOI: 10.1016/j.hrtlng.2021.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/12/2021] [Accepted: 11/22/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Patients with critical illness may face challenges after hospital discharge; therapeutic outcomes of extracorporeal membrane oxygenation (ECMO) are typically measured by survival rate. However, ECMO is an integral part of treatment in critical care medicine, which requires an outcome measure beyond survival. Post-discharge health-related quality of life (HRQoL) is such an indicator. OBJECTIVES To measure HRQoL in adult patients who had previously undergone ECMO and explore influential factors related to HRQoL. METHODS This cross-sectional descriptive study used a convenience sample of patients discharged between April 2006-April 2016 after at least one month following ECMO. The study was conducted from October 2015 to October 2016, which included data collected from structured questionnaires: the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised and Short-Form Survey-36-v2. Stepwise linear regression determined predictor variables of physical and mental HRQoL. RESULTS Age of participants (N = 144) ranged from 24 to 81 years; long-term survival rate was 28.6% after a median follow-up of 1060 days (range = 44-3150 days). Mean scores for physical and mental components of HRQoL were 46.32 and 50.39, respectively. Level of HRQoL was low to moderate. Employment affected all physical components of HRQoL; depression was the main predictor for physical and mental components. Self-perceived health status and anxiety were also factors that influenced HRQoL. CONCLUSIONS Variables of employment, self-perceived health status and mental health influenced HRQoL. Early assessment of these factors by healthcare professionals can allow integration of multidimensional interventions following hospital discharge, which could improve HRQoL for patients weaned from ECMO.
Collapse
Affiliation(s)
- Kang-Hua Chen
- Associate Professor, School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan; Associate Research Fellow, Department of Nursing, Chang Gung Memorial Hospital, Tao-Yuan Branch, Taiwan.
| | - Pei-Shan Lee
- Surgical Intensive Care Unit, Fu Jen Catholic University Hospital, Taipei, Taiwan
| | - Feng-Chun Tsai
- Associate Professor, Department of Cardiovascular Surgery, Chang Gung Memorial Hospital and Chang Gung University, Linkou Branch, Taiwan
| | - Li-Chueh Weng
- Professor, School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan; Research Fellow, Department of General Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taiwan
| | - Shu-Ling Yeh
- Director, Department of Nursing, Chang Gung Memorial Hospital, Tao-Yuan Branch, Taiwan; Adjunct Lecturer, Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan
| | - Huei-Chiun Huang
- Case Manager, Department of Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taiwan
| | - Shu-Siang Lin
- Clinical Nursing Teacher, Department of Nursing, Chang Gung University of Science and Technology Taiwan
| |
Collapse
|
28
|
Elliott A, Dahyia G, Kalra R, Alexy T, Bartos J, Kosmopoulos M, Yannopoulos D. Extracorporeal Life Support for Cardiac Arrest and Cardiogenic Shock. US CARDIOLOGY REVIEW 2021. [DOI: 10.15420/usc.2021.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The rising incidence and recognition of cardiogenic shock has led to an increase in the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). As clinical experience with this therapy has increased, there has also been a rapid growth in the body of observational and randomized data describing the clinical and logistical considerations required to institute a VA-ECMO program with successful clinical outcomes. The aim of this review is to summarize this contemporary data in the context of four key themes that pertain to VA-ECMO programs: the principles of patient selection; basic hemodynamic and technical principles underlying VA-ECMO; contraindications to VA-ECMO therapy; and common complications and intensive care considerations that are encountered in the setting of VA-ECMO therapy.
Collapse
Affiliation(s)
- Andrea Elliott
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN
| | - Garima Dahyia
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN
| | - Rajat Kalra
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN
| | - Tamas Alexy
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN
| | - Jason Bartos
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN
| | - Marinos Kosmopoulos
- Department of Medicine, Division of Cardiology, Center for Resuscitation Medicine, University of Minnesota, Minneapolis, MN
| | - Demetri Yannopoulos
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN
| |
Collapse
|
29
|
Geri G, Aissaoui N, Colin G, Cariou A, Lascarrou JB. Health-related quality of life in critically ill survivors: specific impact of cardiac arrest in non-shockable rhythm. Ann Intensive Care 2021; 11:150. [PMID: 34693481 PMCID: PMC8542521 DOI: 10.1186/s13613-021-00939-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 10/12/2021] [Indexed: 12/24/2022] Open
Abstract
Background Intensive care has a strong impact on health-related quality of life (HRQOL). The specific impact of cardiac arrest in non-shockable rhythm is poorly known. Patients and methods We gathered patients included in two randomized controlled trials (AWARE and HYPERION). The HYPERION trial included ICU-treated non-shockable cardiac arrest patients. The AWARE study included ICU patients requiring mechanical ventilation. We compared the 3-months HRQOL of these patients to those of a large sample of the French general population. Physical and mental dimension were compared. Multivariable linear regression was used to pick up factors associated with HRQOL. Results 72 and 307 patients of the HYPERION and the AWARE studies were compared to 20,574 French controls. ICU patients evidenced lower scores in all the SF-36 dimensions compared to the controls. Similar scores were observed in both HYPERION and AWARe trials. The physical component score was lower in patients from the HYPERION trial compared to those from the AWARE trials and to controls (38.6 [29.6-47.8], 35.4 [27.5-46.4] vs. 53.0 [46.0-56.7], \documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}$$\hbox {p}<0.001$$\end{document}p<0.001). After adjustment for age and gender, HYPERION and AWARE trial status were associated wit lower physical component score. Conclusion Health-related quality of life of unshockable cardiac arrest survivors evaluated at 3 months was similar to ICU survivors and significantly lower than in individuals from general population, especially in the physical dimensions. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00939-w.
Collapse
Affiliation(s)
- Guillaume Geri
- Paris-Saclay University, Versailles, France. .,INSERM UMR1018, CESP, Villejuif, France. .,AfterROSC network, Paris, France.
| | - Nadia Aissaoui
- AfterROSC network, Paris, France.,Medical Intensive Care Unit, Georges Pompidou European Hospital, Paris, France.,Paris University, Paris, France
| | - Gwenhael Colin
- Medical Intensive Care unit, Les Oudairies Hospital, La Roche Sur Yon, France
| | - Alain Cariou
- AfterROSC network, Paris, France.,Paris University, Paris, France.,Medical Intensive Care Unit, Cochin hospital, Paris, France.,INSERM U970, Team 4 Cardiovascular Epidemiology and Sudden Death, Paris Cardiovascular Research Center (PARCC), Paris, France
| | - Jean-Baptiste Lascarrou
- AfterROSC network, Paris, France.,INSERM U970, Team 4 Cardiovascular Epidemiology and Sudden Death, Paris Cardiovascular Research Center (PARCC), Paris, France.,Medical Intensive Care Unit, Hotel Dieu Hospital, Nantes, France
| |
Collapse
|
30
|
Loforte A, Comentale G, Botta L, Gliozzi G, Cavalli GG, Mariani C, Pilato E, Suarez SM, Pacini D. How Would the Authors Treat Their Own Temporary Left Ventricular Failure With Mechanical Circulatory Support? J Cardiothorac Vasc Anesth 2021; 36:1238-1250. [PMID: 34785126 DOI: 10.1053/j.jvca.2021.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/23/2021] [Accepted: 10/15/2021] [Indexed: 12/28/2022]
Abstract
In the last 20 years, mechanical circulatory supports (MCS) have overturned completely the outcomes and the clinical recovery of patients with isolated acute left ventricle failure (iALVF). This usually occurs more frequently than right-sided heart failure or biventricular dysfunction, and it mainly is caused by acute myocardial infarction. The primary role of MCS is to restore the tissue metabolism to preserve the vital organs' function but, on the other hand, they also have to relieve the workload stress on the heart. In this way, they allow not only the heart to recover from the acute event, but MCS also can stabilize the patient toward cardiac transplantation. The short-term MCS devices currently used in clinical practice are the intraaortic balloon pump, the Impella (Abiomed, Danvers, MA), and venoarterial extracorporeal membrane oxygenation (VA-ECMO), but the choice of the right and tailored device for each patient, as well as the timing to use it, is actually one of the most debated topics of MCS management.
Collapse
Affiliation(s)
- Antonio Loforte
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy.
| | - Giuseppe Comentale
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy; Division of Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Naples, Italy
| | - Luca Botta
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
| | - Gregorio Gliozzi
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
| | - Giulio Giovanni Cavalli
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
| | - Carlo Mariani
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
| | - Emanuele Pilato
- Division of Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Naples, Italy
| | - Sofia Martin Suarez
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
| | - Davide Pacini
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
| |
Collapse
|
31
|
Sheikh FH, Craig PE, Ahmed S, Torguson R, Kolm P, Weintraub WS, Molina EJ, Najjar SS, Mohammed SF. Characteristics and Outcomes of Patients with Inflammatory Cardiomyopathies Receiving Mechanical Circulatory Support: An STS-INTERMACS Registry Analysis. J Card Fail 2021; 28:71-82. [PMID: 34474157 DOI: 10.1016/j.cardfail.2021.07.025] [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: 04/29/2021] [Revised: 07/03/2021] [Accepted: 07/28/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Durable mechanical circulatory support (MCS) therapy improves survival in patients with advanced heart failure. Knowledge regarding the outcomes experienced by patients with inflammatory cardiomyopathy (CM) who receive durable MCS therapy is limited. METHODS AND RESULTS We compared patients with inflammatory CM with patients with idiopathic dilated CM enrolled in the STS-INTERMACS registry. Among 19,012 patients, 329 (1.7%) had inflammatory CM and 5978 had idiopathic dilated CM (31.4%). The patients with inflammatory CM were younger, more likely to be White, and women. These patients experienced more preoperative arrhythmias and higher use of temporary MCS. Patients with inflammatory CM had a higher rate of early adverse events (<3 months after device implant), including bleeding, arrhythmias, non-device-related infections, neurologic dysfunction, and respiratory failure. The rate of late adverse events (≥3 months) was similar in the 2 groups. Patients with inflammatory CM had a similar 1-year (80% vs 84%) and 2-year (72% vs 76%, P = .15) survival. Myocardial recovery resulting in device explant was more common among patients with inflammatory CM (5.5% vs 2.3%, P < .001). CONCLUSIONS Patients with inflammatory CM who received durable MCS appear to have a similar survival compared with patients with idiopathic dilated CM despite a higher early adverse event burden. Our findings support the use of durable MCS in an inflammatory CM population.
Collapse
Affiliation(s)
- Farooq H Sheikh
- Department of Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC; Georgetown University School of Medicine, Washington, DC.
| | - Paige E Craig
- Department of Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC
| | - Sara Ahmed
- Department of Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC
| | | | - Paul Kolm
- Department of Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC
| | - William S Weintraub
- Department of Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC
| | - Ezequiel J Molina
- Department of Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC; Georgetown University School of Medicine, Washington, DC
| | - Samer S Najjar
- Department of Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC; Georgetown University School of Medicine, Washington, DC
| | | |
Collapse
|
32
|
Lorusso R, Shekar K, MacLaren G, Schmidt M, Pellegrino V, Meyns B, Haft J, Vercaemst L, Pappalardo F, Bermudez C, Belohlavek J, Hou X, Boeken U, Castillo R, Donker DW, Abrams D, Ranucci M, Hryniewicz K, Chavez I, Chen YS, Salazar L, Whitman G. ELSO Interim Guidelines for Venoarterial Extracorporeal Membrane Oxygenation in Adult Cardiac Patients. ASAIO J 2021; 67:827-844. [PMID: 34339398 DOI: 10.1097/mat.0000000000001510] [Citation(s) in RCA: 149] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Roberto Lorusso
- Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Kiran Shekar
- Adult Intensive Care Unit, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Graeme MacLaren
- Cardio-Thoracic Intensive Care Unit, National University Hospital, Singapore, Singapore
| | - Matthieu Schmidt
- Medical Intensive Care Unit, Hopital La Pitie'-Salpetriere, University Pierre et Marie Curie, Paris, France
| | - Vincent Pellegrino
- Intensive Care Unit, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Bart Meyns
- Cardiac Surgery Unit, Gasthuisberg University Hospital, Catholic University, Leuven, Belgium
| | - Jonathan Haft
- Section of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Leen Vercaemst
- Cardiac Surgery Unit, Gasthuisberg University Hospital, Catholic University, Leuven, Belgium
| | - Federico Pappalardo
- Department of Anesthesia and Intensive Care, IRCCS ISMETT, UPMC, Palermo, Italy
| | - Christian Bermudez
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jan Belohlavek
- 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital, Charles University, Prague, Czech Republic
| | - Xiaotong Hou
- Cardiac Intensive Care, Beijing Anzhem Hospital, Capital Medical University, Beijing, China
| | - Udo Boeken
- Department of Cardiac Surgery, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Dirk W Donker
- Intensive Care Unit, Utrecht University Medical Centre, Utrecht, The Netherlands
- CRPH Cardiovascular & Respiratory Physiology Group, TechMed Centre, Faculty of Science & Technology, University of Twente, Enschede, The Netherlands
| | - Darryl Abrams
- Division of Pulmonology, Allergy and Critical Care, NewYork Presbiterian Hospital, Columbia University, New York, New York
| | - Marco Ranucci
- Cardio-Thoracic and Vascular Anesthesia and ICU Department, IRCCS Policlinico San Donato Hospital, Milan, Italy
| | - Kasia Hryniewicz
- Minneapolis Heart Institute Foundation, Abbot Northwestern University, Minneapolis, Minnesota
| | - Ivan Chavez
- Minneapolis Heart Institute Foundation, Abbot Northwestern University, Minneapolis, Minnesota
| | - Yih-Sharng Chen
- Cardiovascular Centre, National Taiwan University Hospital, Taiwan, Taipei
| | - Leonardo Salazar
- Department of Intensive Care, Fundación Cardiovascular de Colombia, Bucaramanga, Colombia
| | - Glenn Whitman
- Cardiovascular Surgery Intensive Care Unit and Heart Transplant, Johns Hopkins Hospital, Baltimore, Maryland
| |
Collapse
|
33
|
Abstract
PURPOSE OF REVIEW We describe the pathophysiology of cardiogenic shock (CS), from the main pathways to the inflammatory mechanisms and the proteomic features. RECENT FINDINGS Although the classical pathophysiological pathways underlying CS, namely reduced organ perfusion due to inadequate cardiac output and peripheral vasoconstriction, have been well-established for a long time, the role of macro-and micro-hemodynamics in the magnitude of the disease and its prognosis has been investigated extensively only over the last few years. Moreover, to complete the complex picture of CS pathophysiology, the study of cytokine cascade, inflammation, and proteomic analysis has been addressed recently. SUMMARY Understanding the pathophysiology of CS is important to treat it optimally.
Collapse
|
34
|
Plazak ME, Grazioli A, Powell EK, Menne AR, Bathula AL, Madathil RJ, Krause EM, Deatrick KB, Mazzeffi MA. Precannulation International Normalized Ratio is Independently Associated With Mortality in Veno-Arterial Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth 2021; 36:1092-1099. [PMID: 34330572 DOI: 10.1053/j.jvca.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To explore whether precannulation international normalized ratio (INR) is associated with in-hospital mortality in venoarterial extracorporeal membrane oxygenation (VA-ECMO) patients. DESIGN A retrospective, observational cohort study. SETTING A quaternary care academic medical center. PARTICIPANTS Patients with cardiogenic shock on VA-ECMO for >24 hours. INTERVENTIONS None, observational study. MEASUREMENTS AND MAIN RESULTS A total of 188 patients who were on VA-ECMO were included over three years. Patients were stratified into three groups based on their pre-ECMO INR: INR <1.5, INR 1.5 to 1.8, and INR >1.8. For all patients, demographics, comorbidities, and ECMO details were recorded. The study's primary outcome was in-hospital mortality and secondary outcomes included major bleeding, minor bleeding, allogeneic transfusion, ischemic stroke, intracranial hemorrhage, acute renal failure, acute liver failure, gastrointestinal bleeding, intensive care unit and hospital lengths of stay. A multivariate logistic regression was used to determine whether precannulation INR was associated independently with in-hospital mortality. In-hospital mortality differed significantly by INR group (51.6% INR >1.8 v 42.3% INR 1.5-1.8 v 24.3% INR <1.5; p = 0.004). In a multivariate logistic regression model, precannulation INR >1.8 was associated independently with an increased odds of mortality (odds ratio, 2.48; 95% confidence interval, 1.05-6.04) after controlling for sex, Survival after VA- ECMO score, and ECMO indication. An INR within 1.5 to 1.8 did not confer an increased mortality risk. CONCLUSIONS An INR >1.8 before VA-ECMO cannulation is associated independently with in-hospital mortality. Precannulation INR should be considered by clinicians so that ECMO resources can be better allocated and risks of organ failure and intracranial hemorrhage can be better understood.
Collapse
Affiliation(s)
- Michael E Plazak
- Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD
| | - Alison Grazioli
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Elizabeth K Powell
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Ashley R Menne
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Allison L Bathula
- Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD
| | - Ronson J Madathil
- Department of Cardiothoracic Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Eric M Krause
- Department of Cardiothoracic Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Kristopher B Deatrick
- Department of Cardiothoracic Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Michael A Mazzeffi
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD.
| |
Collapse
|
35
|
Tsangaris A, Alexy T, Kalra R, Kosmopoulos M, Elliott A, Bartos JA, Yannopoulos D. Overview of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) Support for the Management of Cardiogenic Shock. Front Cardiovasc Med 2021; 8:686558. [PMID: 34307500 PMCID: PMC8292640 DOI: 10.3389/fcvm.2021.686558] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/11/2021] [Indexed: 12/25/2022] Open
Abstract
Cardiogenic shock accounts for ~100,000 annual hospital admissions in the United States. Despite improvements in medical management strategies, in-hospital mortality remains unacceptably high. Multiple mechanical circulatory support devices have been developed with the aim to provide hemodynamic support and to improve outcomes in this population. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is the most advanced temporary life support system that is unique in that it provides immediate and complete hemodynamic support as well as concomitant gas exchange. In this review, we discuss the fundamental concepts and hemodynamic aspects of VA-ECMO support in patients with cardiogenic shock of various etiologies. In addition, we review the common indications, contraindications and complications associated with VA-ECMO use.
Collapse
Affiliation(s)
- Adamantios Tsangaris
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Tamas Alexy
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Rajat Kalra
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Marinos Kosmopoulos
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
| | - Andrea Elliott
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Jason A Bartos
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States.,Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
| | - Demetris Yannopoulos
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States.,Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
| |
Collapse
|
36
|
Alonso-Fernandez-Gatta M, Gonzalez-Cebrian M, Merchan-Gomez S, Toranzo-Nieto I, Diego-Nieto A, Sanchez PL. Post-traumatic stress disorder symptoms after veno-arterial extracorporeal membrane oxygenator support. Heart Lung 2021; 50:775-779. [PMID: 34217987 DOI: 10.1016/j.hrtlng.2021.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/07/2021] [Accepted: 06/07/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a common long-term outcome after intensive care of critical illness. OBJECTIVES Assess the prevalence and factors associated to PTSD after veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support. METHODS Retrospective analysis of admission data and cross-sectional assessment of PTSD symptoms in adult survivors from admission requiring VA-ECMO support in a referral hospital. People were screened through abbreviated Impact of Event Scale-6 (IES-6). RESULTS Out of 135 VA-ECMO implants performed from 2013 to 2020, 48 (35.6%) patients survived the admission. After a median follow-up of 31.4 [36] months, 34 survivors responded the questionnaire. All patients required sedation and invasive mechanical ventilation. Up to 29.4% of patients had PTSD symptoms. Patients with altered IES-6 items had passed a longer time since admission in ICCU (44±15 vs 30±20 months, p = 0.034). No baseline characteristic or admission-related variables were correlated with IES-6 except the lower time under mechanical ventilation (6.5 [8.5] vs. 8.5 [21] days, p = 0.044). CONCLUSIONS Survivors from admission requiring VA-ECMO support show high prevalence of PTSD symptoms, appearing more frequently when more time has elapsed since admission. Special attention should be paid to psychological symptoms after VA-ECMO support.
Collapse
Affiliation(s)
- Marta Alonso-Fernandez-Gatta
- Cardiology Department, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo San Vicente, 58-182, 37007 Salamanca, Spain.
| | - Miryam Gonzalez-Cebrian
- Cardiology Department, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo San Vicente, 58-182, 37007 Salamanca, Spain
| | - Soraya Merchan-Gomez
- Cardiology Department, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo San Vicente, 58-182, 37007 Salamanca, Spain
| | - Ines Toranzo-Nieto
- Cardiology Department, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo San Vicente, 58-182, 37007 Salamanca, Spain
| | - Alejandro Diego-Nieto
- Cardiology Department, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo San Vicente, 58-182, 37007 Salamanca, Spain
| | - Pedro L Sanchez
- Cardiology Department, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo San Vicente, 58-182, 37007 Salamanca, Spain; CIBER-CV Instituto de Salud Carlos III (ISCIII), Spain
| |
Collapse
|
37
|
Halvorsen K, Jensen JF, Collet MO, Olausson S, Lindahl B, Saetre Hansen B, Lind R, Eriksson T. Patients' experiences of well-being when being cared for in the intensive care unit-An integrative review. J Clin Nurs 2021; 31:3-19. [PMID: 34159663 DOI: 10.1111/jocn.15910] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 05/14/2021] [Accepted: 05/21/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this integrative review was to identify facilitators and barriers to patients' well-being when being cared for in an ICU setting, from the perspective of the patients. BACKGROUND To become critically ill and hospitalised in an ICU is a stressful, chaotic event due to the life-threatening condition itself, as well as therapeutic treatments and the environment. A growing body of evidence has revealed that patients often suffer from physical, psychological and cognitive problems after an ICU stay. Several strategies, such as sedation and pain management, are used to reduce stress and increase well-being during ICU hospitalisation, but the ICU experience nevertheless affects the body and mind. DESIGN; METHODS: Since research exploring patients' sense of well-being in an ICU setting is limited, an integrative review approach was selected. Searches were performed in CINAHL, Medline, Psych Info, Eric and EMBASE. After reviewing 66 studies, 12 studies were included in the integrative review. Thematic analysis was used to analyse the studies. The PRISMA checklist for systematic reviews was used. RESULTS The results are presented under one main theme, 'Well-being as a multidimensional experience-interwoven in barriers and facilitators' and six sub-themes representing barriers to and facilitators of well-being in an ICU. Barriers identified were physical stressors, emotional stressors, environmental disturbances and insecurity relating to time and space. Facilitators were meeting physical needs and activities that included dimensions of a caring and relational environment. CONCLUSION Our main findings were that experiences of well-being were multidimensional and included physical, emotional, relational and environmental aspects, and they were more often described through barriers than facilitators of well-being. RELEVANCE FOR CLINICAL PRACTICE This integrative review has shown that it is necessary to adopt an individual focus on patient well-being in an ICU setting since physical, emotional, relational and environmental stressors might impact each patient differently.
Collapse
Affiliation(s)
| | - Janet F Jensen
- Department of Anesthesiology, Holbaek Hospital, Holbaek, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Marie O Collet
- Intensive Department, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sepideh Olausson
- Institute of Health and Care Sciences, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Berit Lindahl
- Department of Health Sciences and the Institute for Palliative Care, Medical Falucty Lund University, Lund, Sweden.,Faculty of Caring Sciences, Work Life and Social Welfare, Borås University, Borås, Sweden
| | - Britt Saetre Hansen
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Ranveig Lind
- Department of Health and Care Sciences, The Arctic University of Norway, Harstad, Norway.,Research Nurse at Intensive Care Unit, University Hospital of North Norway, Tromsø, Norway
| | - Thomas Eriksson
- Faculty of Caring Sciences, Work Life and Social Welfare, Borås University, Borås, Sweden
| |
Collapse
|
38
|
Diagnosis and Management of Myocarditis: An Evidence-Based Review for the Emergency Medicine Clinician. J Emerg Med 2021; 61:222-233. [PMID: 34108120 DOI: 10.1016/j.jemermed.2021.03.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/17/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Myocarditis is a potentially fatal condition that can be misdiagnosed in the emergency department (ED) setting. OBJECTIVE The purpose of this narrative review article is to provide a summary of the background, pathophysiology, diagnosis, and management of myocarditis, with a focus on emergency clinicians. DISCUSSION Myocarditis occurs when inflammation of the heart musculature causes cardiac dysfunction. Symptoms may range from mild to severe and are often preceded by a viral prodrome. Laboratory assessment and an electrocardiogram can be helpful for the diagnosis, but echocardiography is the ideal test in the ED setting. Some patients may also require advanced imaging, though this will often occur during hospitalization or follow-up. Treatment is primarily focused on respiratory and hemodynamic support. Initial hemodynamic management includes vasopressors and inotropes, whereas more severe cases may require an intra-aortic balloon pump, extracorporeal membrane oxygenation, or a ventricular assist device. Nonsteroidal anti-inflammatory drugs should be avoided while intravenous immunoglobulin is controversial. CONCLUSION Myocarditis is a serious condition with the potential for significant morbidity and mortality. It is important for clinicians to be aware of the current evidence regarding the diagnosis, management, and disposition of these patients.
Collapse
|
39
|
Makhoul M, Heuts S, Mansouri A, Taccone FS, Obeid A, Mirko B, Broman LM, Malfertheiner MV, Meani P, Raffa GM, Delnoij T, Maessen J, Bolotin G, Lorusso R. Understanding the "extracorporeal membrane oxygenation gap" in veno-arterial configuration for adult patients: Timing and causes of death. Artif Organs 2021; 45:1155-1167. [PMID: 34101843 PMCID: PMC8518076 DOI: 10.1111/aor.14006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 05/08/2021] [Accepted: 06/01/2021] [Indexed: 11/28/2022]
Abstract
Timing and causes of hospital mortality in adult patients undergoing veno‐arterial extracorporeal membrane oxygenation (V‐A ECMO) have been poorly described. Aim of the current review was to investigate the timing and causes of death of adult patients supported with V‐A ECMO and subsequently define the “V‐A ECMO gap,” which represents the patients who are successfully weaned of ECMO but eventually die during hospital stay. A systematic search was performed using electronic MEDLINE and EMBASE databases through PubMed. Studies reporting on adult V‐A ECMO patients from January 1993 to December 2020 were screened. The studies included in this review were studies that reported more than 10 adult, human patients, and no mechanical circulatory support other than V‐A ECMO. Information extracted from each study included mainly mortality and causes of death on ECMO and after weaning. Complications and discharge rates were also extracted. Sixty studies with 9181 patients were included for analysis in this systematic review. Overall mortality was 38.0% (95% confidence intervals [CIs] 34.2%‐41.9%) during V‐A ECMO support (reported by 60 studies) and 15.3% (95% CI 11.1%‐19.5%, reported by 57 studies) after weaning. Finally, 44.0% of patients (95% CI 39.8‐52.2) were discharged from hospital (reported by 60 studies). Most common causes of death on ECMO were multiple organ failure, followed by cardiac failure and neurological causes. More than one‐third of V‐A ECMO patients die during ECMO support. Additionally, many of successfully weaned patients still decease during hospital stay, defining the “V‐A ECMO gap.” Underreporting and lack of uniformity in reporting of important parameters remains problematic in ECMO research. Future studies should uniformly define timing and causes of death in V‐A ECMO patients to better understand the effectiveness and complications of this support.
Collapse
Affiliation(s)
- Maged Makhoul
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands.,Cardiac Surgery Unit, Rambam Medical Centre, Haifa, Israel
| | - Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Abdulrahman Mansouri
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Fabio Silvio Taccone
- Department of Intensive Care Medicine, Clinique Universitaire de Bruxelles (CUB) Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Amir Obeid
- Cardiac Surgery Unit, Rambam Medical Centre, Haifa, Israel
| | - Belliato Mirko
- U.O.C. Anestesia e Rianimazione II Cardiopolmonare, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lars Mikael Broman
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | | | - Paolo Meani
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Giuseppe Maria Raffa
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands.,Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Thijs Delnoij
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy.,Intensive Care Department, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jos Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Gil Bolotin
- Cardiac Surgery Unit, Rambam Medical Centre, Haifa, Israel
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| |
Collapse
|
40
|
Khan IR, Saulle M, Oldham MA, Weber MT, Schifitto G, Lee HB. Cognitive, Psychiatric, and Quality of Life Outcomes in Adult Survivors of Extracorporeal Membrane Oxygenation Therapy: A Scoping Review of the Literature. Crit Care Med 2021; 48:e959-e970. [PMID: 32886470 DOI: 10.1097/ccm.0000000000004488] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To perform a scoping literature review of cognitive, psychiatric, and quality of life outcomes in adults undergoing extracorporeal membrane oxygenation for any indication. DATA SOURCES We searched PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, and PsycINFO from inception to June 2019. STUDY SELECTION Observational studies, clinical trials, qualitative studies, and case series with at least 10 adult subjects were included for analysis. Outcomes of interest consisted of general or domain-specific cognition, psychiatric illness, and quality of life measures that included both mental and physical health. DATA EXTRACTION Study selection, data quality assessment, and interpretation of results were performed by two independent investigators in accordance with the PRISMA statement. DATA SYNTHESIS Twenty-two articles were included in this review. Six described cognitive outcomes, 12 described psychiatric outcomes of which two were qualitative studies, and 16 described quality of life outcomes. Cognitive impairment was detected in varying degrees in every study that measured it. Three studies examined neuroimaging results and found neurologic injury to be more frequent in venoarterial versus venovenous extracorporeal membrane oxygenation, but described a variable correlation with cognitive impairment. Rates of depression, anxiety, and post-traumatic stress disorder were similar to other critically ill populations and were related to physical disability after extracorporeal membrane oxygenation. Extracorporeal membrane oxygenation survivors' physical quality of life was worse than population norms but tended to improve with time, while mental quality of life did not differ significantly from the general population. Most studies did not include matched controls and instead compared outcomes to previously published values. CONCLUSIONS Extracorporeal membrane oxygenation survivors experience cognitive impairment, psychiatric morbidity, and worse quality of life compared with the general population and similar to other survivors of critical illness. Physical disability in extracorporeal membrane oxygenation patients plays a significant role in psychiatric morbidity. However, it remains unclear if structural brain injury plays a role in these outcomes and whether extracorporeal membrane oxygenation causes secondary brain injury.
Collapse
Affiliation(s)
- Imad R Khan
- Division of Neurocritical Care, Department of Neurology, University of Rochester Medical Center, Rochester, NY
| | - Michael Saulle
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mark A Oldham
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
| | - Miriam T Weber
- Department of Neurology, University of Rochester Medical Center, Rochester, NY
| | - Giovanni Schifitto
- Department of Neurology, University of Rochester Medical Center, Rochester, NY
| | - Hochang B Lee
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
| |
Collapse
|
41
|
Rroku A, Kottwitz J, Heidecker B. Update on myocarditis - what we know so far and where we may be heading. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2021; 10:455–467. [PMID: 32319308 DOI: 10.1177/2048872620910109] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Affiliation(s)
- Andi Rroku
- Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany
| | | | - Bettina Heidecker
- Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany
| |
Collapse
|
42
|
Sperry AE, Williams M, Atluri P, Szeto WY, Cevasco M, Bermudez CA, Acker MA, Ibrahim M. The Surgeon's Role in Cardiogenic Shock. Curr Heart Fail Rep 2021; 18:240-251. [PMID: 33956313 DOI: 10.1007/s11897-021-00514-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Cardiogenic shock represents a very challenging patient population due to the undifferentiated pathologies presenting as cardiogenic shock, difficult decision-making, prognostication, and ever-expanding support options. The role of cardiac surgeons on this team is evolving. RECENT FINDINGS The implementation of a shock team is associated with improved outcomes in patients with cardiogenic shock. Early deployment of mechanical circulatory support devices may allow an opportunity to rescue these patients. Cardiothoracic surgeons are a critical component of the shock team who can deploy timely mechanical support and surgical intervention in selected patients for optimal outcomes.
Collapse
Affiliation(s)
- Alexandra E Sperry
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew Williams
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marisa Cevasco
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christian A Bermudez
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael A Acker
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael Ibrahim
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| |
Collapse
|
43
|
Kolle A, Irgens EC, Moi AL, Ottesen ØH, Svendsen ØS, Haaverstad R, Johansen VA. The Psychological and HRQoL related Aftermaths of Extra Corporeal Membrane Oxygenation Treatment: A Cross-Sectional Study. Intensive Crit Care Nurs 2021; 65:103058. [PMID: 33867241 DOI: 10.1016/j.iccn.2021.103058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 01/03/2021] [Accepted: 03/17/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To assess symptoms of post-traumatic stress disorder, anxiety, depression and health related quality of life in a sample of adult patients treated with veno-arterial extracorporeal membrane oxygenation. DESIGN AND SETTING This is a cross-sectional study. The population were all patients discharged (2008-2018) from a thoracic surgical intensive ward at a tertiary university hospital in Norway. A sample of 20 patients was recruited. MAIN OUTCOME MEASURES Symptoms of post-traumatic stress disorder were assessed using Impact of Events Scale-Revised, while symptoms of depression and anxiety were assessed using Hospital Anxiety and Depression Scale. RAND 36-Item Short Form Health Survey was applied to measure health-related quality of life. RESULTS Symptoms of post-traumatic stress disorder were reported by 40% of the participants. Twenty percent reported symptoms of depression and anxiety. Compared to the general population, participants reported poorer health-related quality of life on all domains, and significantly worse on the domains physical function, general health and social function. CONCLUSION Patients in our study reported symptoms of post-traumatic stress disorder, anxiety, depression and impaired health-related quality of life following treatment with veno-arterial extra corporeal membrane oxygenation. Addressing possible emotional and psychological distress could represent a potential major improvement in health care provided to this group. Further research is needed to incorporate prophylactic methods, such as identifying vulnerable patients and implement corresponding interventions, into clinical practice.
Collapse
Affiliation(s)
- Aina Kolle
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway; Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
| | - Elsa C Irgens
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway; Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Asgjerd L Moi
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Øyvind H Ottesen
- Forensic Mental Health Department, Haukeland University Hospital, Bergen, Norway
| | - Øyvind S Svendsen
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Rune Haaverstad
- Section of Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Venke A Johansen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway; Resource Centre on Violence, Traumatic Stress and Suicide Prevention, Western Norway (RVTS West), Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
44
|
Extracorporeal Membrane Oxygenation for Fulminant Myocarditis: Increase of Cardiac Enzyme and SOFA Score Is Associated with High Mortality. J Clin Med 2021; 10:jcm10071526. [PMID: 33917387 PMCID: PMC8038703 DOI: 10.3390/jcm10071526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 11/17/2022] Open
Abstract
We aimed to evaluate the outcomes of patients with fulminant myocarditis and investigate the factors associated with mortality. This is a retrospective single-center cohort study that included adult and pediatric patients with fulminant myocarditis treated at Samsung Medical Center between September 2004 and December 2019. The primary outcome was in-hospital mortality. Among 100 patients, 71 underwent veno-arterial extracorporeal membrane oxygenation (ECMO) (ECMO group). Comorbidities were not significantly different between the ECMO and non-ECMO groups. Cardiac enzymes, creatinine, and median sequential organ failure assessment (SOFA) score at intensive care unit admission were significantly different between the groups. Twenty patients (28.7%) in the ECMO group and two (6.9%) in the non-ECMO group died in-hospital (p = 0.02). The significant risk factors of in-hospital mortality were creatine kinase MB fraction (CK-MB) and SOFA score (p = 0.009 and p = 0.001, respectively) in the ECMO group. In the receiver-operating characteristic curve analysis, the cutoffs of SOFA score and CK-MB were 12 and 94.74 ng/mL, respectively. The patients with both variables above the cutoffs showed significantly worse outcomes (p < 0.001). ECMO can be an effective treatment option for fulminant myocarditis. SOFA score and CK-MB are significant risk factors for in-hospital mortality.
Collapse
|
45
|
Cyr S, Guo DX, Marcil MJ, Dupont P, Jobidon L, Benrimoh D, Guertin MC, Brouillette J. Posttraumatic stress disorder prevalence in medical populations: A systematic review and meta-analysis. Gen Hosp Psychiatry 2021; 69:81-93. [PMID: 33582645 DOI: 10.1016/j.genhosppsych.2021.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE PTSD is increasingly recognized following medical traumas although is highly heterogeneous. It is difficult to judge which medical contexts have the most traumatic potential and where to concentrate further research and clinical attention for prevention, early detection and treatment. The objective of this study was to compare PTSD prevalence in different medical populations. METHODS A systematic review of the literature on PTSD following medical traumas was conducted as well as a meta-analysis with final pooled result and 95% confidence intervals presented. A meta-regression was used to investigate the impact of potential effect modifiers (PTSD severity, age, sex, timeline) on study effect size between prevalence studies. RESULTS From 3278 abstracts, the authors extracted 292 studies reporting prevalence. Using clinician-administered reports, the highest 24 month or longer PTSD prevalence was found for intraoperative awareness (18.5% [95% CI=5.1%-36.6%]) and the lowest was found for epilepsy (4.5% [95% CI=0.2%-12.6%]). In the overall effect of the meta-regression, only medical events or procedures emerged as significant (p = 0.006) CONCLUSION: This review provides clinicians with greater awareness of medical contexts most associated with PTSD, which may assist them in the decision to engage in more frequent, earlier screening and referral to mental health services.
Collapse
Affiliation(s)
- Samuel Cyr
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - De Xuan Guo
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Marie-Joëlle Marcil
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Patrice Dupont
- Health Sciences Library, Université de Montréal, Montreal, Quebec, Canada
| | - Laurence Jobidon
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - David Benrimoh
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center, Montreal, Montreal, Quebec, Canada
| | - Judith Brouillette
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
| |
Collapse
|
46
|
Turgeon PY, Massot M, Beaupré F, Belzile D, Beaudoin J, Bernier M, Bourgault C, Germain V, Laliberté C, Morin J, Gervais P, Trahan S, Charbonneau É, Dagenais F, Sénéchal M. Effect of Acute Immunosuppression on Left Ventricular Recovery and Mortality in Fulminant Viral Myocarditis: A Case Series and Review of Literature. CJC Open 2020; 3:292-302. [PMID: 33778446 PMCID: PMC7985012 DOI: 10.1016/j.cjco.2020.10.017] [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: 09/17/2020] [Accepted: 10/30/2020] [Indexed: 12/26/2022] Open
Abstract
Background Fulminant viral myocarditis (FVM) is a rare cause of cardiogenic shock associated with high morbidity and mortality rates. An inappropriately activated immune system results in severe myocardial inflammation. Acute immunosuppressive therapy for FVM therefore gained in popularity and was described in numerous retrospective studies. Methods We conducted an extensive review of the literature and compared it with our single-centre retrospective review of all cases of FVM from 2009-2019 to evaluate the possible effect of acute immunosuppression with intravenous immunoglobulins and/or high dose corticosteroids in patients with FVM. Results We report on 17 patients with a mean age of 46 ± 15 years with a mean left ventricular ejection fraction (LVEF) of 15 ± 9% at admission. Fourteen (82%) of our patients had acute LVEF recovery to ≥ 45% after a mean time from immunosuppression of 74 ± 49 hours (3.1 days). Extracorporeal membrane oxygenation (ECMO) was required in 35% (6/17) of our patients for an average support of 126 ± 37 hours. Overall mortality was 12% (2/17). No patient needed a long-term left ventricular assist device or heart transplant. All surviving patients achieved complete long-term LVEF recovery. Conclusions Our cohort of 17 severely ill patients received acute immunosuppressive therapy and showed a rapid LVEF recovery, short duration of ECMO support, and low mortality rate. Our suggested scheme of investigation and treatment is presented. These results bring more cases of successfully treated FVM with immunosuppression and ECMO to the literature, which might stimulate further prospective trials or a registry.
Collapse
Affiliation(s)
- Pierre Yves Turgeon
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada
| | - Montse Massot
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada
| | - Frédéric Beaupré
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada
| | - David Belzile
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada
| | - Jonathan Beaudoin
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada
| | - Mathieu Bernier
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada
| | - Christine Bourgault
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada
| | - Valérie Germain
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada
| | - Claudine Laliberté
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada
| | - Joëlle Morin
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada
| | - Philippe Gervais
- Department of Infectious Disease, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada
| | - Sylvain Trahan
- Department of Pathology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Éric Charbonneau
- Department of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada
| | - François Dagenais
- Department of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada
| | - Mario Sénéchal
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada
| |
Collapse
|
47
|
Hekimian G, Frere C, Collet JP. [COVID-19 and mechanical circulatory support]. Ann Cardiol Angeiol (Paris) 2020; 69:360-364. [PMID: 33092785 PMCID: PMC7543685 DOI: 10.1016/j.ancard.2020.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/04/2020] [Indexed: 12/15/2022]
Abstract
La principale indication d’assistance chez les patients COVID-19 est le SDRA sévère en échec de traitement conventionnel. Les résultats de l’ECMO veino-veineuse sont comparables dans le COVID-19 à ceux obtenus dans les SDRA d’autres origines. La gestion de l’ECMO durant la pandémie COVID-19 a des spécificités liées à la maladie (comme par exemple la gestion de l’anticoagulation) et à l’allocation des ressources. Plus rarement, la COVID-19 peut se compliquer de défaillance hémodynamique dans le cadre d’une myocardite fulminante ou d’une embolie pulmonaire massive et nécessiter alors la mise en place d’une ECMO veino-artérielle. Bien que les cas rapportés soient peu nombreux, l’assistance circulatoire peut permettre une évolution favorable dans ces 2 indications.
Collapse
Affiliation(s)
- G Hekimian
- Médecine intensive et réanimation, Sorbonne Université, groupe hospitalier Pitié-Salpêtrière (AP-HP), 75013 Paris, France.
| | - C Frere
- Hématologie biologique, Sorbonne Université, groupe hospitalier Pitié-Salpêtrière (AP-HP), 75013 Paris, France.
| | - J-P Collet
- ACTION Study Group, Inserm UMR_S 1166, Institut de cardiologie, Paris Sorbonne Université (UPMC), Pitié-Salpêtrière Hospital (AP-HP), Paris, France.
| |
Collapse
|
48
|
Schrutka L, Rohmann F, Binder C, Haberl T, Dreyfuss B, Heinz G, Lang IM, Felli A, Steinlechner B, Niessner A, Laufer G, Goliasch G, Wiedemann D, Distelmaier K. Discriminatory power of scoring systems for outcome prediction in patients with extracorporeal membrane oxygenation following cardiovascular surgery†. Eur J Cardiothorac Surg 2020; 56:534-540. [PMID: 30789227 DOI: 10.1093/ejcts/ezz040] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 01/09/2019] [Accepted: 01/13/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Although extracorporeal membrane oxygenation (ECMO) represents a rapidly evolving treatment option in patients with refractory heart or lung failure, survival remains poor and appropriate risk stratification challenging because established risk prediction models have not been validated for this specific population. METHODS This observational single-centre registry included a total of 240 patients treated with venoarterial ECMO therapy following cardiovascular surgery and analysed the discriminatory power of the European System of Cardiac Operative Risk Evaluation (EuroSCORE) additive, the EuroSCORE II, the Sequential Organ Failure Assessment (SOFA) score, the Simplified Acute Physiology Score (SAPS) II, the SAPS III, the Acute Physiology and Chronic Health Evaluation (APACHE) II, the Risk of renal failure, Injury to the kidney, Failure of kidney function, Loss of kidney function and End-stage renal failure (RIFLE) classification, the survival after venoarterial ECMO (SAVE) score, the prEdictioN of Cardiogenic shock OUtcome foR AMI patients salvaGed by VA-ECMO (ENCOURAGE) score and the Society of Thoracic Surgeons (STS) risk model for outcome prediction. RESULTS During a median follow-up time of 37 months (interquartile range 19-67), 65% of the patients died. Only the SAVE score and the SAPS II were significantly associated with the 30-day mortality rate with a hazard ratio (HR) of 1.06 [95% confidence interval (CI) 1.02-1.11; P = 0.002] for the SAVE score and an HR of 1.02 (95% CI 1.01-1.03; P = 0.004) for the SAPS II with a modest discriminatory power displayed by a C-index of 0.61 and 0.57, respectively. Seven out of 10 scoring systems revealed significant association with long-term mortality, with the SAVE score and the SAPS II remaining the strongest predictors of long-term mortality with an HR of 1.06 (95% CI 1.03-1.09; P < 0.001, C-index 0.61) for the SAVE score and an HR of 1.02 (95% CI 1.01-1.03; P < 0.001, C-index 0.58) for the SAPS II. CONCLUSIONS Risk assessment based on established risk models in patients with ECMO remains difficult. Only the SAPS II and the SAVE score were exclusively found to be suitable for short- and long-term outcome prediction in this specific vulnerable patient population.
Collapse
Affiliation(s)
- Lore Schrutka
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Felix Rohmann
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christina Binder
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Thomas Haberl
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Ben Dreyfuss
- Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Gottfried Heinz
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Irene M Lang
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Alessia Felli
- Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Barbara Steinlechner
- Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Alexander Niessner
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Günther Laufer
- Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Georg Goliasch
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Dominik Wiedemann
- Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Klaus Distelmaier
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
49
|
Williams TJ, Pellegrino V. ECMO support for viral induced cardiogenic shock: a bridge too far? Eur Respir J 2020; 56:56/3/2002129. [PMID: 32883759 DOI: 10.1183/13993003.02129-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 01/08/2023]
|
50
|
Combes A, Price S, Slutsky AS, Brodie D. Temporary circulatory support for cardiogenic shock. Lancet 2020; 396:199-212. [PMID: 32682486 DOI: 10.1016/s0140-6736(20)31047-3] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/24/2020] [Accepted: 04/29/2020] [Indexed: 12/15/2022]
Abstract
Cardiogenic shock can occur due to acute ischaemic or non-ischaemic cardiac events, or from progression of long-standing underlying heart disease. When addressing the cause of underlying disease, the management of cardiogenic shock consists of vasopressors and inotropes; however, these agents can increase myocardial oxygen consumption, impair tissue perfusion, and are frequently ineffective. An alternative approach is to temporarily augment cardiac output using mechanical devices. The use of these devices-known as temporary circulatory support systems-has increased substantially in recent years, despite being expensive, resource intensive, associated with major complications, and lacking high-quality evidence to support their use. This Review summarises the physiological basis underlying the use of temporary circulatory support for cardiogenic shock, reviews the evidence informing indications and contraindications, addresses ethical considerations, and highlights the need for further research.
Collapse
Affiliation(s)
- Alain Combes
- Sorbonne Université, Institute of Cardiometabolism and Nutrition, Paris, France; Service de Médecine Intensive-Réanimation, Höpitaux Universitaires Pitié Salpêtrière, Assistance Publique-Höpitaux de Paris, Institut de Cardiologie, Paris, France.
| | - Susanna Price
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College, London, UK
| | - Arthur S Slutsky
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Daniel Brodie
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY, USA; Centre for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA
| |
Collapse
|