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Duangpakdee P, Sakkarat S, Sangkhathat S. Survival Outcome in Critically Ill Patients Receiving Extracorporeal Membrane Oxygenation Support: Early Experience from a University Hospital in Thailand. Surg J (N Y) 2023; 9:e44-e51. [PMID: 36793996 PMCID: PMC9925292 DOI: 10.1055/s-0043-1761444] [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] [Received: 11/15/2022] [Accepted: 11/30/2022] [Indexed: 02/16/2023] Open
Abstract
Objective Extracorporeal membrane oxygenation (ECMO) is a relatively new technology used for life support in patients with cardiopulmonary failure from various causes. The objective of this study is to review the first 5-year experience in adopting this technology in a teaching hospital in southern Thailand. Methods The data of ECMO-supported patients in Songklanagarind Hospital, from the years 2014 to 2018, were retrospectively reviewed. Data sources were from electronic medical records and the database of the perfusion service. Parameters in focus included prior conditions and indications of ECMO, type of ECMO and cannulation method, complications during and after the treatment, and discharge statuses. Results A total of 83 patients received ECMO life support during the 5-year period and the number of cases per year increased. The proportion of venovenous: venoarterial ECMO in our institute was 49:34 cases and there were three cases who used ECMO as a part of cardiopulmonary resuscitation. Moreover, there were 57 cases who used ECMO for cardiac failure and 26 cases were for respiratory causes, while premature withdrawal was decided in 26 cases (31.3%). Overall survival from ECMO was 35/83 cases (42.2%) and survival to discharge was 32/83 (38.6%). During therapy, ECMO could restore serum pH to the normal range in all cases. Furthermore, those who used ECMO for respiratory failure had significantly higher survival probability (57.7%) when compared to the cardiac counterpart (29.8%, p -value = 0.03). Patients with younger ages also had significantly better survival outcomes. The most common complications were cardiac (75 cases, 85.5%), followed by renal (45 cases, 54.2%), and hematologic systems (38 cases, 45.8%). In those who survived to discharge, average ECMO duration was 9.7 days. Conclusion Extracorporeal life support is a technology that bridges the patients with cardiopulmonary failure to their recovery or definitive surgery. Despite the high complication rate, survival can be expected, especially in respiratory failure cases and relatively young patients.
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Affiliation(s)
- Pongsanae Duangpakdee
- Department of Surgery, Division of Cardio-Thoracic Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand,Address for correspondence Pongsanae Duangpakdee, MD Department of Surgery, Division of Cardio-Thoracic Surgery, Faculty of Medicine, Prince of Songkla UniversityHat Yai, Songkhla 90110Thailand
| | - Sasitorn Sakkarat
- Department of Surgery, Division of Cardio-Thoracic Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Surasak Sangkhathat
- Department of Surgery and Translational Medicine Research Center, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Heinsar S, Jung JS, Colombo SM, Rozencwajg S, Wildi K, Sato K, Ainola C, Wang X, Abbate G, Sato N, Dyer WB, Livingstone SA, Pimenta LP, Bartnikowski N, Bouquet MJP, Passmore M, Vidal B, Palmieri C, Reid JD, Haqqani HM, McGuire D, Wilson ES, Rätsep I, Lorusso R, Suen JY, Bassi GL, Fraser JF. An innovative ovine model of severe cardiopulmonary failure supported by veno-arterial extracorporeal membrane oxygenation. Sci Rep 2021; 11:20458. [PMID: 34650063 PMCID: PMC8516938 DOI: 10.1038/s41598-021-00087-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 09/29/2021] [Indexed: 01/17/2023] Open
Abstract
Refractory cardiogenic shock (CS) often requires veno-arterial extracorporeal membrane oxygenation (VA-ECMO) to sustain end-organ perfusion. Current animal models result in heterogenous cardiac injury and frequent episodes of refractory ventricular fibrillation. Thus, we aimed to develop an innovative, clinically relevant, and titratable model of severe cardiopulmonary failure. Six sheep (60 ± 6 kg) were anaesthetized and mechanically ventilated. VA-ECMO was commenced and CS was induced through intramyocardial injections of ethanol. Then, hypoxemic/hypercapnic pulmonary failure was achieved, through substantial decrease in ventilatory support. Echocardiography was used to compute left ventricular fractional area change (LVFAC) and cardiac Troponin I (cTnI) was quantified. After 5 h, the animals were euthanised and the heart was retrieved for histological evaluations. Ethanol (58 ± 23 mL) successfully induced CS in all animals. cTnI levels increased near 5000-fold. CS was confirmed by a drop in systolic blood pressure to 67 ± 14 mmHg, while lactate increased to 4.7 ± 0.9 mmol/L and LVFAC decreased to 16 ± 7%. Myocardial samples corroborated extensive cellular necrosis and inflammatory infiltrates. In conclusion, we present an innovative ovine model of severe cardiopulmonary failure in animals on VA-ECMO. This model could be essential to further characterize CS and develop future treatments.
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Affiliation(s)
- Silver Heinsar
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Intensive Care Unit, St Andrews War Memorial Hospital, Brisbane, QLD, Australia.,Department of Intensive Care, North Estonia Medical Centre, Tallinn, Estonia
| | - Jae-Seung Jung
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Sebastiano Maria Colombo
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Sacha Rozencwajg
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Medical ICU, Pitié-Salpêtrière University Hospital, INSERM UMRS-1166, Sorbonne Université, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Karin Wildi
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Kei Sato
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Carmen Ainola
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Department of Intensive Care, North Estonia Medical Centre, Tallinn, Estonia
| | - Xiaomeng Wang
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia
| | - Gabriella Abbate
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia
| | - Noriko Sato
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia
| | - Wayne Bruce Dyer
- Research and Development, Australian Red Cross Lifeblood, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Samantha Annie Livingstone
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Leticia Pretti Pimenta
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia
| | - Nicole Bartnikowski
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Science and Engineering Faculty, Queensland University of Technology, Brisbane, QLD, Australia
| | - Mahe Jeannine Patricia Bouquet
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Margaret Passmore
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Bruno Vidal
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia
| | - Chiara Palmieri
- School of Veterinary Science, The University of Queensland, Gatton, Australia
| | - Janice D Reid
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Haris M Haqqani
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Daniel McGuire
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia
| | - Emily Susan Wilson
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Indrek Rätsep
- Department of Intensive Care, North Estonia Medical Centre, Tallinn, Estonia
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jacky Y Suen
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia. .,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. .,Intensive Care Unit, St Andrews War Memorial Hospital, Brisbane, QLD, Australia. .,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. .,Wesley Medical Research, Brisbane, QLD, Australia.
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia. .,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. .,Intensive Care Unit, St Andrews War Memorial Hospital, Brisbane, QLD, Australia. .,Wesley Medical Research, Brisbane, QLD, Australia.
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Lichtenstein KM, Tunuguntla HP, Peng DM, Buchholz H, Conway J. Pediatric ventricular assist device registries: update and perspectives in the era of miniaturized continuous-flow pumps. Ann Cardiothorac Surg 2021; 10:329-338. [PMID: 34159114 DOI: 10.21037/acs-2020-cfmcs-18] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The success of ventricular assist devices (VADs) in the treatment of end-stage heart failure in the adult population has led to industrial innovation in VAD design, focusing on miniaturization and the reduction of complications. A byproduct of these innovations was that newer generation devices could have clinical applications in the pediatric population. Over the last decade, VAD usage in the pediatric population has increased dramatically, and the newer generation continuous flow (CF) devices have begun to supplant the older, pulsatile flow (PF) devices, formerly the sole option for ventricular assist in the pediatric population. However, despite the increase in VAD implants in the pediatric population, patient numbers remain low, and the need to share data between pediatric VAD centers has become that much more important for the continued growth of VAD programs worldwide. The creation of pediatric VAD registries, such as the Pediatric Registry for Mechanical Circulatory Support (PediMACS), the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) and the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) has enabled the collection of aggregate data from VAD centers worldwide, and provides a valuable resource for clinicians and programs, as more and more pediatric heart failure patients are considered candidates for VAD therapy.
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Affiliation(s)
- Kevin M Lichtenstein
- Department of Cardiothoracic Surgery, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Hari P Tunuguntla
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - David M Peng
- Department of Pediatrics, Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Holger Buchholz
- Department of Cardiothoracic Surgery, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Conway
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
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7
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Heinsar S, Rozencwajg S, Suen J, Bassi GL, Malfertheiner M, Vercaemst L, Broman LM, Schmidt M, Combes A, Rätsep I, Fraser JF, Millar JE. Heart failure supported by veno-arterial extracorporeal membrane oxygenation (ECMO): a systematic review of pre-clinical models. Intensive Care Med Exp 2020; 8:16. [PMID: 32451698 PMCID: PMC7248156 DOI: 10.1186/s40635-020-00303-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 05/11/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly being used to treat patients with refractory severe heart failure. Large animal models are developed to help understand physiology and build translational research projects. In order to better understand those experimental models, we conducted a systematic literature review of animal models combining heart failure and VA-ECMO. STUDIES SELECTION A systematic review was performed using Medline via PubMed, EMBASE, and Web of Science, from January 1996 to January 2019. Animal models combining experimental acute heart failure and ECMO were included. Clinical studies, abstracts, and studies not employing VA-ECMO were excluded. DATA EXTRACTION Following variables were extracted, relating to four key features: (1) study design, (2) animals and their peri-experimental care, (3) heart failure models and characteristics, and (4) ECMO characteristics and management. RESULTS Nineteen models of heart failure and VA-ECMO were included in this review. All were performed in large animals, the majority (n = 13) in pigs. Acute myocardial infarction (n = 11) with left anterior descending coronary ligation (n = 9) was the commonest mean of inducing heart failure. Most models employed peripheral VA-ECMO (n = 14) with limited reporting. CONCLUSION Among models that combined severe heart failure and VA-ECMO, there is a large heterogeneity in both design and reporting, as well as methods employed for heart failure. There is a need for standardization of reporting and minimum dataset to ensure translational research achieve high-quality standards.
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Affiliation(s)
- Silver Heinsar
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Chermside, Brisbane, Australia.,Second Department of Intensive Care, North Estonia Medical Centre, Talinn, Estonia
| | - Sacha Rozencwajg
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Chermside, Brisbane, Australia. .,Sorbonne Université, INSERM, UMRS-1166, ICAN Institute of Cardiometabolism and Nutrition, Medical ICU, Pitié-Salpêtrière University Hospital, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.
| | - Jacky Suen
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Chermside, Brisbane, Australia.
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Chermside, Brisbane, Australia
| | - Maximilian Malfertheiner
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Chermside, Brisbane, Australia.,Department of Internal Medicine II, Cardiology and Pneumology, University Medical Center Regensburg, Regensburg, Germany
| | - Leen Vercaemst
- Department of Perfusion, University Hospital Gasthuisberg, Louven, Belgium
| | - Lars Mikael Broman
- ECMO Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Matthieu Schmidt
- Second Department of Intensive Care, North Estonia Medical Centre, Talinn, Estonia
| | - Alain Combes
- Second Department of Intensive Care, North Estonia Medical Centre, Talinn, Estonia
| | - Indrek Rätsep
- Sorbonne Université, INSERM, UMRS-1166, ICAN Institute of Cardiometabolism and Nutrition, Medical ICU, Pitié-Salpêtrière University Hospital, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Chermside, Brisbane, Australia
| | - Jonathan E Millar
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Chermside, Brisbane, Australia.,Wellcome-Wolfson Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
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