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Charlesworth M, Garcia M, Head L, Barker JM, Ashworth AD, Barnard JB, Feddy L, Venkateswaran RV. Venoarterial extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock-A six-year service evaluation. Artif Organs 2020; 44:709-716. [PMID: 31970800 DOI: 10.1111/aor.13647] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/03/2019] [Accepted: 01/14/2020] [Indexed: 12/12/2022]
Abstract
Only a small number of English hospitals provide postcardiotomy venoarterial extracorporeal membrane oxygenation (VA-ECMO) and there are doubts about its efficacy and safety. The aim of this service evaluation was to determine local survival rates and report on patient demographics. This was a retrospective service evaluation of prospectively recorded routine clinical data from a tertiary cardiothoracic center in the United Kingdom offering services including cardiac and thoracic surgery, heart and lung transplantation, venovenous extracorporeal membrane oxygenation (VV-ECMO) for respiratory failure, and all types of mechanical circulatory support. In six years, 39 patients were supported with VA-ECMO for refractory postcardiotomy cardiogenic shock (PCCS). We analyzed survival data and looked for associations between survival rates and patient characteristics. The intervention was venoarterial-ECMO in patients with PCCS either following weaning from cardiopulmonary bypass or following a trial of inotropes and intra-aortic balloon counterpulsation on the intensive care unit. 30-day, hospital discharge, 1-year and 2-year survivals were 51.3%, 41%, 37.5%, and 38.5%, respectively. The median (IQR [range]) duration of support was 6 (4-9 [1-35]) days. Nonsurvival was associated with advanced age, shorter intensive care length of stay, and the requirement for postoperative hemofiltration. Reasonable survival rates can be achieved in selected patients who may have been expected to have a worse mortality without VA-ECMO. We suggest postoperative VA-ECMO should be available to all patients undergoing cardiac surgery be it in their own center or through an established pathway to a specialist center.
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Affiliation(s)
- Michael Charlesworth
- Department of Cardiothoracic Anaesthesia, Critical Care and ECMO, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Miguel Garcia
- Department of Cardiothoracic Anaesthesia, Critical Care and ECMO, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Laura Head
- Department of Cardiothoracic Anaesthesia, Critical Care and ECMO, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Julian M Barker
- Department of Cardiothoracic Anaesthesia, Critical Care and ECMO, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Alan D Ashworth
- Department of Cardiothoracic Anaesthesia, Critical Care and ECMO, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - James B Barnard
- Department of Cardiothoracic Surgery and Transplantation, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Lee Feddy
- Department of Cardiothoracic Anaesthesia, Critical Care and ECMO, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Rajamiyer V Venkateswaran
- Department of Cardiothoracic Surgery and Transplantation, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Department of Cardiovascular Science, University of Manchester, Manchester, UK
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Charlesworth M, Agarwal S. Recycling old data – an ethical and pragmatic way to generate new evidence? Anaesthesia 2019; 74:1087-1090. [DOI: 10.1111/anae.14648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2019] [Indexed: 12/14/2022]
Affiliation(s)
- M. Charlesworth
- Department of Cardiothoracic Anaesthesia Wythenshawe Hospital Manchester University Hospitals NHS Foundation Trust ManchesterUK
| | - S. Agarwal
- Department of Cardiothoracic Anaesthesia Manchester Royal Infirmary Manchester University Hospitals NHS Foundation Trust Manchester UK
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Carlisle JB. Discounting risk prediction models - a reply. Anaesthesia 2019; 74:537-538. [DOI: 10.1111/anae.14621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hepple DJ, Durrand JW, Bouamra O, Godfrey P. Impact of a physician-led pre-hospital critical care team on outcomes after major trauma. Anaesthesia 2018; 74:473-479. [DOI: 10.1111/anae.14501] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2018] [Indexed: 01/22/2023]
Affiliation(s)
- D. J. Hepple
- Northern School of Anaesthesia and Intensive Care Medicine; Newcastle UK
| | - J. W. Durrand
- Northern School of Anaesthesia and Intensive Care Medicine; Newcastle UK
| | - O. Bouamra
- The Trauma Audit and Research Network; Faculty of Biology Medicine and Health; The University of Manchester; UK
| | - P. Godfrey
- Department of Anaesthesia; James Cook University Hospital; Middlesbrough UK
- Great North Air Ambulance Service; Darlington UK
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5
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Charlesworth M, Glossop AJ. Strategies for the prevention of postoperative pulmonary complications. Anaesthesia 2018; 73:923-927. [DOI: 10.1111/anae.14288] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2018] [Indexed: 12/23/2022]
Affiliation(s)
- M. Charlesworth
- Department of Anaesthesia; Wythenshawe Hospital; Manchester UK
| | - A. J. Glossop
- Department of Anaesthesia and Intensive Care Medicine; Sheffield Teaching Hospitals NHS Foundation Trust; Sheffield UK
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