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Honzawa H, Taniguchi H, Abe T, Takeuchi I, Inoue A, Hifumi T, Sakamoto T, Kuroda Y. Prophylactic distal perfusion catheter and survival in patients with out-of-hospital cardiac arrest: Secondary analysis of the SAVE-J II study. Am J Emerg Med 2024; 78:69-75. [PMID: 38237215 DOI: 10.1016/j.ajem.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/14/2023] [Accepted: 01/08/2024] [Indexed: 03/23/2024] Open
Abstract
PURPOSE The effect of a prophylactic distal perfusion catheter (DPC) after extracorporeal cardiopulmonary resuscitation (ECPR) in patients with out-of-hospital cardiac arrest (OHCA) remains unclear. Therefore, we aimed to clarify the association between prophylactic DPC and prognosis in patients with OHCA undergoing ECPR. MATERIALS AND METHODS A secondary analysis of the Study of Advanced Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan (SAVE-J II) database was performed to compare groups of patients with and without prophylactic DPCs. A multivariate analysis of survival at discharge was performed using factors that were significant in the two-arm comparison. RESULTS A total of 2044 patients were included in the analysis after excluding those who met the exclusion criteria. Survival at discharge was observed in 548 (26.9%) patients. In total, 100 (4.9%) patients developed limb ischemia, among whom 14 (0.7%) required therapeutic intervention. Multivariate analysis showed that prophylactic DPC did not result in a significant difference in survival at discharge (odds ratio: 0.898 [0.652-1.236], p = 0.509). CONCLUSIONS The implementation of prophylactic DPC after ECPR for patients with OHCA may not contribute to survival at discharge.
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Affiliation(s)
- Hiroshi Honzawa
- Emergency Care Department, Yokohama City University Hospital, Yokohama, Japan.
| | - Hayato Taniguchi
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Takeru Abe
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Ichiro Takeuchi
- Emergency Care Department, Yokohama City University Hospital, Yokohama, Japan; Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University school of Medicine, Tokyo, Japan
| | - Yasuhiro Kuroda
- Department of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital, Kagawa, Japan
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Lee Y, Jang I, Hong J, Son YJ. Factors associated with 30-day in-hospital mortality in critically ill adult patients receiving extracorporeal membrane oxygenation: A retrospective cohort study. Intensive Crit Care Nurs 2023; 79:103489. [PMID: 37451086 DOI: 10.1016/j.iccn.2023.103489] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/21/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To identify factors associated with the 30-day in-hospital mortality rate among adult patients requiring extracorporeal membrane oxygenation (ECMO) in intensive care units. RESEARCH METHODOLOGY Retrospective cohort study including 148 patients who underwent ECMO for at least 48 h between March 2010 and August 2021. The patients were divided into survivors and non-survivors based on their 30-day in-hospital survival. We obtained the sociodemographic information and pre- and post-ECMO data from electronic medical records. Kaplan-Meier survival curves and Multivariate Cox proportional hazards regression were used to analyse the data. SETTING A tertiary-care university hospital in South Korea. MAIN OUTCOME MEASURES The 30-day in-hospital mortality rate was the principal outcome measure. RESULTS The 30-day in-hospital mortality rate was 49.3% (n = 73). Kaplan-Meier analysis demonstrated that the duration of ECMO support in the 50th percentile of surviving patients was 13 days. Multivariable Cox regression analysis showed that new-onset renal failure, lower mean arterial pressure, and ECMO weaning failure were associated with an increased 30-day in-hospital mortality risk among patients who received ECMO. Subgroup analysis also revealed a significant association between weaning failure and 30-day in-hospital mortality after adjusting for covariates in patients undergoing veno-arterial ECMO. CONCLUSION Close monitoring of post-ECMO renal function and mean arterial pressure is required to minimize the risk of 30-day in-hospital mortality, especially in adults within the first two weeks of ECMO initiation. Moreover, the success of ECMO weaning should be optimized by collaboration within the ECMO team. IMPLICATIONS FOR CLINICAL PRACTICE Critical care nurses should pay close attention to patients' response to weaning trials as well as alternations in renal function and mean arterial pressure during ECMO support. Furthermore, developing nursing care guidelines for adult patients receiving ECMO and standardized training programs for nurses in intensive care, are required in Korea.
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Affiliation(s)
- Youngeon Lee
- Emergency Intensive Care Unit, Department of Nursing, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, South Korea.
| | - Insil Jang
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok ro, Dongjak-gu, Seoul 06974, South Korea.
| | - Joonhwa Hong
- Department of Thoracic and Cardiovascular Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 84 Heukseok ro, Dongjak-gu, Seoul 06974, South Korea.
| | - Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok ro, Dongjak-gu, Seoul 06974, South Korea.
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3
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Oxygenation Strategies in Critically Ill Patients With COVID-19. Dimens Crit Care Nurs 2021; 40:75-82. [PMID: 33961375 DOI: 10.1097/dcc.0000000000000463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 is the virus that causes coronavirus disease 2019 (COVID-19). COVID-19 is a disease characterized by a range of clinical syndromes including variable degrees of respiratory symptoms from mild respiratory illness and severe interstitial pneumonia to acute respiratory distress syndrome, septic shock, coagulopathies, and multiorgan dysfunction. This virus carries the potential to manifest in a wide range of pulmonary findings and hypoxemias, from mild respiratory symptoms to more severe syndromes, such as acute respiratory distress syndrome. The rapid accumulation of evidence and persistent gaps in knowledge related to the virus presents a host of challenges for clinicians. This creates a complex environment for clinical decision-making. OBJECTIVE To examine oxygenation strategies in critically ill patients with hypoxia who are hospitalized with COVID-19. DISCUSSION These proposed strategies may help to improve the respiratory status and oxygenation of those affected by COVID-19. However, additional high-quality research is needed to provide further evidence for improved respiratory management strategies. Areas of future research should focus on improving understanding of the inflammatory and clotting processes associated with the virus, particularly in the lungs. High-level evidence and randomized controlled trials should target the most effective strategies for improving oxygenation, time requiring mechanical ventilation, and survival for hospitalized patients with COVID-19 presenting with hypoxemia.
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Kurniawati ER, Rutjens VGH, Vranken NPA, Delnoij TSR, Lorusso R, van der Horst ICC, Maessen JG, Weerwind PW. Quality of life following adult veno-venous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review. Qual Life Res 2021; 30:2123-2135. [PMID: 33826058 PMCID: PMC8024673 DOI: 10.1007/s11136-021-02834-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been used successfully for the past decade in adult patients with acute respiratory distress syndrome (ARDS) refractory to conventional ventilatory support. However, knowledge of the health-related quality of life (HRQoL) in VV-ECMO patients is still limited. Thus, this study aimed to provide a comprehensive overview of the HRQoL following VV-ECMO support in ARDS patients. METHODS A systematic search was performed on PubMed and Web of Science databases from January 1st, 2009 to October 19th, 2020. Studies reporting on HRQoL following VV-ECMO for ARDS in adults were included. Two authors independently selected studies, extracted data, and assessed methodological quality. RESULTS Eight studies were eligible for inclusion, consisting of seven observational studies and one randomized controlled trial (total N = 441). All eight studies had a quantitative design and reported 265 VV-ECMO survivors to have a reduced HRQoL compared to a generally healthy population. Follow-up time varied between six months to three years. Additionally, only four studies (total N = 335) compared the HRQoL of VV-ECMO (N = 159) to conventionally treated survivors (N = 176), with one study showing a significantly better HRQoL in VV-ECMO survivors, while three studies were stating comparable HRQoL across groups. Notably, most survivors in these studies appeared to experience varying degrees of anxiety, depression, and post-traumatic stress disorder (PTSD). CONCLUSIONS ARDS survivors supported by VV-ECMO have a decline in HRQoL and suffered from physical and psychological impairments. This HRQoL reduction is comparable or even better to the HRQoL in conventionally treated ARDS survivors.
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Affiliation(s)
- E R Kurniawati
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, the Netherlands.
| | - V G H Rutjens
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - N P A Vranken
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - T S R Delnoij
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.,Department of Cardiology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - R Lorusso
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - I C C van der Horst
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - J G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - P W Weerwind
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
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Jang EJ, Jung SY, Lee HJ, Kim MS, Na KJ, Park S, Park IK, Kang CH, Kim YT. Trends in Extracorporeal Membrane Oxygenation Application and Outcomes in Korea. ASAIO J 2021; 67:177-184. [PMID: 33315655 DOI: 10.1097/mat.0000000000001331] [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: 11/25/2022] Open
Abstract
The use of extracorporeal membrane oxygenation (ECMO) is increasing despite the limited evidence in survival benefit. This study aimed to analyze the changes of in-hospital mortality, medical costs, and other outcomes in ECMO therapy. We used 2004-2017 data from a nationwide healthcare administrative claims database in Korea. Overall, 14,775 ECMO procedures were performed in 14,689 patients at 112 hospitals. We found a 170-fold and a 334-fold increase in the number of ECMO procedures and related costs, respectively. For indications, the performance of ECMO for heart or lung transplantation and respiratory failure increased, whereas that for cardiovascular surgery decreased. The duration of ECMO increased from a median of 3 days (IQR, 2-5 days) in 2004 to 4 days (IQR, 2-9 days) in 2017. The overall in-hospital mortality rate was 68.6%, and this improved over time, especially for lung transplantation and respiratory failure patients. Bleeding-related complications and the transfusion amount also decreased. Hospitals with higher case volume showed better survival outcomes. The median cost per procedure and per day was 26,538 USD (IQR, 14,646-47,862 USD) and 1,560 USD (IQR, 903-2,929 USD), respectively, and increased with time. A trend toward greater resource use and better outcomes requires additional cost-effective analysis based on indications.
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Affiliation(s)
- Eun Jin Jang
- From the Department of Information Statistics, Andong National University, Andong, Gyeongsangbuk-do, Korea
| | - Sun-Young Jung
- Department of Global Innovative Drugs, Graduate School of Chung-Ang University, Dongjak-gu, Seoul, Korea
- College of Pharmacy, Chung-Ang University, Dongjak-gu, Seoul, Korea
| | - Hyun Joo Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital and Seoul National University College of Medicine, Jongro-gu, Seoul, Korea
| | - Myo-Song Kim
- Department of Global Innovative Drugs, Graduate School of Chung-Ang University, Dongjak-gu, Seoul, Korea
- College of Pharmacy, Chung-Ang University, Dongjak-gu, Seoul, Korea
| | - Kwon Joong Na
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital and Seoul National University College of Medicine, Jongro-gu, Seoul, Korea
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital and Seoul National University College of Medicine, Jongro-gu, Seoul, Korea
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital and Seoul National University College of Medicine, Jongro-gu, Seoul, Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital and Seoul National University College of Medicine, Jongro-gu, Seoul, Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital and Seoul National University College of Medicine, Jongro-gu, Seoul, Korea
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