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Rojas-Espinoza M, Aguilar-Mejía C, Muñoz-Moreno JM. Post-myocardial Infarction Ventricular Septal Rupture Complicated by Cardiogenic Shock Stage D: A Successful Case of Extracorporeal Membrane Oxygenation as a Bridge to Delayed Surgical Repair. Cureus 2023; 15:e50574. [PMID: 38222231 PMCID: PMC10788080 DOI: 10.7759/cureus.50574] [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: 12/15/2023] [Indexed: 01/16/2024] Open
Abstract
Ventricular septal rupture (VSR) after myocardial infarction is often complicated by cardiogenic shock (CS) with high in-hospital mortality rates. Early use of preoperative venoarterial extracorporeal membrane oxygenation (VA ECMO) and delayed surgical repair have demonstrated lower mortality rates; however, the optimal timing of surgical intervention remains controversial. We report the case of a 53-year-old man with CS stage D due to post-myocardial infarction VSR, who was successfully treated with VA ECMO as a bridge to delayed surgical repair. This case highlights the complexity of determining the optimal timing for surgical intervention in these patients and emphasizes the benefits of early use of VA ECMO for preoperative stabilization in patients with CS and multiorgan failure.
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Peña AD, Moreno-Angarita A, Estacio M, Bautista DF, Quintero IF, Olaya S, Cadavid EA. Veno-arterial extracorporeal membrane oxygenation as a perioperative support to redo cardiac surgery for inoperable adult patients: a case series. Eur Heart J Case Rep 2023; 7:ytad569. [PMID: 38130866 PMCID: PMC10733174 DOI: 10.1093/ehjcr/ytad569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/01/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023]
Abstract
Background The present article describes three cases of patients in cardiogenic shock (CS) with previous cardiac surgery that made them initially inoperable. Perioperative support with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) improved haemodynamic status and results in these high-risk patients. Case summary Case 1 is a 57-year-old male morbidly obese with previous aortic valve replacement (AVR) who presented with chest pain and developed cardiac arrest. Cardiopulmonary resuscitation and femoral VA-ECMO were initiated. Three days later, a redo AVR was performed. Veno-arterial extracorporeal membrane oxygenation was maintained for 12 days, followed by 7 days of veno-venous ECMO for complete recovery. Case 2 features a 39-year-old male with two previous mitral valve replacements (MVRs). The first is due to papillary muscle rupture, and the second is due to endocarditis of the mitral prosthesis. He presented with CS and pulmonary oedema. Emergency surgery was performed and the patient was then placed in VA-ECMO. Weaning off was achieved 3 days after surgery. Case 3 is a 21-year-old female with a previous MVR due to rheumatic disease. She presented with CS, severe mitral prosthesis stenosis, and a pulmonary embolism. Femoral VA-ECMO was initiated, and one day later, she underwent a redo MVR operation. Extracorporeal membrane oxygenation was discontinued 4 days later. Discussion Dysfunctional prosthetic valves leading to CS may benefit from a redo cardiac operation supported by a perioperative VA-ECMO to optimize haemodynamic status. Despite the results from risk prediction scores, this approach has the potential to reduce operative mortality in initial inoperable patients and allow a definitive redo cardiac surgery.
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Affiliation(s)
- Alvaro Diego Peña
- Departamento de Cirugía, Servicio de Cardiovascular, Fundación Valle del Lili, Cali, Colombia
| | - Alejandro Moreno-Angarita
- Departamento de Cirugía, Servicio de Cardiovascular, Fundación Valle del Lili, Cali, Colombia
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Mayra Estacio
- Departamento de Medicina Interna, Fundación Valle del Lili, Cali, Colombia
| | | | | | - Stephany Olaya
- Departamento de Cirugía, Servicio de Cardiovascular, Fundación Valle del Lili, Cali, Colombia
| | - Eduardo Alberto Cadavid
- Departamento de Cirugía, Servicio de Cardiovascular, Fundación Valle del Lili, Cali, Colombia
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Jacob A, Okafor DK, Bhattacharyya S, Wong K. Buying time! VA-ECMO as a bridge to successful reoperative cardiac surgery in a case of traumatic tricuspid valve injury. J Surg Case Rep 2023; 2023:rjad597. [PMID: 37936676 PMCID: PMC10627349 DOI: 10.1093/jscr/rjad597] [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: 09/08/2023] [Accepted: 10/10/2023] [Indexed: 11/09/2023] Open
Abstract
Cardiac surgery performed on patients in cardiogenic shock is associated with a high mortality and morbidity. Preoperative Extra Corporeal Membrane Oxygenation (ECMO) in cardiogenic shock gives critically-ill patients a chance for surgical intervention and is associated with better surgical outcomes. We present a 29-year-old male who had a ventricular septal defect closure as a child and presented with multi-organ injuries following polytrauma. He was in cardiogenic shock despite maximal inotropic support. Transesophageal echocardiography demonstrated torrential tricuspid regurgitation (TR) from a flail tricuspid valve (TV) leaflet as the cause of cardiogenic shock. He was stabilized on Veno-Arterial ECMO and underwent reoperative cardiac surgery. Intra-operatively, the anterior leaflet of his TV and its papillary muscle was detached from the right ventricle. He had a successful tissue TV replacement. Early surgery was indicated to treat right ventricular failure due to torrential TR, but due to his restricting non-cardiac injuries, ECMO was successfully used as a short-term support strategy and as a bridge to definitive surgery.
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Affiliation(s)
- Abiah Jacob
- Barts Heart Centre, St.Bartholomew’s Hospital, West Smithfield, EC1A 7BE London, United Kingdom
| | - Donatus K Okafor
- Barts Heart Centre, St.Bartholomew’s Hospital, West Smithfield, EC1A 7BE London, United Kingdom
| | - Sanjeev Bhattacharyya
- Barts Heart Centre, St.Bartholomew’s Hospital, West Smithfield, EC1A 7BE London, United Kingdom
- University College London Hospital, 235 Euston Rd., NW1 2BU London, United Kingdom
| | - Kit Wong
- Barts Heart Centre, St.Bartholomew’s Hospital, West Smithfield, EC1A 7BE London, United Kingdom
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Prasad A, Brehm C, Singbartl K. The impact of preservation and recovery of renal function on survival after veno-arterial extracorporeal life support: A retrospective cohort study. Artif Organs 2023; 47:554-565. [PMID: 36325712 DOI: 10.1111/aor.14449] [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: 07/28/2022] [Revised: 09/23/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Veno-arterial extracorporeal life support (V-A ECLS) has become a cornerstone in the management of critical cardiogenic shock, but it can also precipitate organ injury, e.g., acute kidney injury (AKI). Available studies highlight the effect of non-cardiac organ injury on patient outcomes. Only very little is known about the impact of non-cardiac organ recovery on patient survival. AKI occurs frequently during cardiogenic shock and carries a poor prognosis. We have developed descriptive models to hypothesize on the role of AKI severity versus that of recovery of renal function for patient survival. METHODS Retrospective, observational study including 175 patients who were successfully decannulated from V-A ECLS. We assessed AKI severity using the "Kidney Disease: Improving Global Outcomes" (KDIGO) criteria. We defined recovered or preserved renal function (RPRF) prior to decannulation from V-A ECLS as 0 (AKI with no improvement) or 1 (no AKI or AKI with improvement). We classified patient outcomes as alive or dead at hospital discharge. RESULTS 78% (n = 138) of all patients survived hospital discharge of which 38% (n = 67) never developed AKI. After adjusting for shock severity and non-renal organ injury, RPRF emerged as an independent predictor of survival in both the overall cohort [OR (95% CI) - 4.11 (1.72-9.79)] and the AKI-only sub-cohort [OR (95% CI) - 5.18 (1.8-14.92)]. Neither maximum KDIGO stage nor KDIGO stage at the end of V-A ECLS was independently associated with survival. CONCLUSIONS Our model identifies RPRF, but not AKI severity, as an independent predictor of hospital survival in patients undergoing V-A ECLS for cardiogenic shock. We hypothesize that recovered or preserved non-cardiac organ function during V-A ECLS is crucial for patient survival.
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Affiliation(s)
- Amit Prasad
- Heart and Vascular Institute, PennState Health, Hershey, Pennsylvania, USA
| | - Christoph Brehm
- Heart and Vascular Institute, PennState Health, Hershey, Pennsylvania, USA
| | - Kai Singbartl
- Department of Critical Care Medicine, Mayo Clinic, Phoenix, Arizona, USA
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Exploration of the Utility of Speckle-Tracking Echocardiography During Mechanical Ventilation and Mechanical Circulatory Support. Crit Care Explor 2022; 4:e0666. [PMID: 35372843 PMCID: PMC8970088 DOI: 10.1097/cce.0000000000000666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This narrative review aims to discuss the potential applicability of speckle-tracking echocardiography (STE) in patients under mechanical ventilation (MV) and mechanical circulatory support (MCS). Both its benefits and limitations were considered through critical analyses of the current available evidence.
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Yu X, Yang Y, Zhang W, Guo Z, Shen J, Xu Z, Zhang H, Wang W. Postcardiotomy Extracorporeal Membrane Oxygenation in Neonates. Thorac Cardiovasc Surg 2021; 69:e41-e47. [PMID: 34327689 PMCID: PMC8324001 DOI: 10.1055/s-0041-1730034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/07/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) provides circulatory support in children with congenital heart disease, particularly in the setting of cardiopulmonary failure and inability to wean from cardiopulmonary bypass. This study summarized the clinical application of ECMO in the treatment of heart failure after cardiac surgery in neonates. MATERIALS AND METHODS Clinical data of 23 neonates who received ECMO support in our center from January 2017 to June 2019 were retrospectively analyzed. RESULTS Twenty-three neonates, aged from 0 to 25 days and weight between 2,300 and 4,500 g, with heart failure postcardiotomy were supported with ECMO. The successful weaning rate was 78.26% and discharge rate was 52.17%. Bleeding and residual malformation were the most common complications. The univariate analysis showed that nonsurvivors were related to the factors such as higher lactate value of ECMO 12 and 24 hours (p = 0.008 and 0.001, respectively), longer time to lactate normalization (p = 0.001), lactate > 10 mmol/L before ECMO (p = 0.01), lower weight (p = 0.01), longer ECMO duration (p = 0.005), lower platelet count (p = 0.001), more surgical site bleeding (p = 0.001), and surgical residual malformation (p = 0.04). Further logistic regression analysis revealed that higher lactate value of ECMO 24 hours (p = 0.003), longer ECMO duration (p = 0.015), and surgical site bleeding (p = 0.025) were independent risk factors. CONCLUSION ECMO was an effective technology to support the neonates with cardiopulmonary failure after open heart surgery. Control the lactate acidosis and surgical site bleeding event may be helpful for patients' recovery.
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Affiliation(s)
- Xindi Yu
- Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yinyu Yang
- Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei Zhang
- Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zheng Guo
- Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jia Shen
- Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhuoming Xu
- Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haibo Zhang
- Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei Wang
- Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Perioperative Extracorporeal Membrane Oxygenation for Refractory Cardiopulmonary Failure Complicating Papillary Muscle Rupture. Heart Lung Circ 2020; 30:303-309. [PMID: 33092963 DOI: 10.1016/j.hlc.2020.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/14/2020] [Indexed: 11/23/2022]
Abstract
The prognosis of papillary muscle rupture (PMR) leading to acute mitral regurgitation, pulmonary oedema, and cardiogenic shock remains dismal, with survival dependent on prompt recognition and surgical intervention. The use of extracorporeal membrane oxygenation (ECMO) for circulatory and/or respiratory support in critically ill patients failing conventional treatment has significantly increased in the past few years, mainly owing to technology improvements that have rendered the provision of this technique simpler and safer. In this report, four cases of refractory cardiopulmonary collapse complicating ischaemic and traumatic PMR successfully managed perioperatively with ECMO are presented. In this context, a review of the potential role of perioperative ECMO support for cardiogenic shock secondary to cardiac mechanical complications is also provided.
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8
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Biersteker TE, Boogers MJ, de Lind van Wijngaarden RA, Groenwold RH, Trines SA, van Alem AP, Kirchhof CJ, van Hof N, Klautz RJ, Schalij MJ, Treskes RW. Use of Smart Technology for the Early Diagnosis of Complications After Cardiac Surgery: The Box 2.0 Study Protocol. JMIR Res Protoc 2020; 9:e16326. [PMID: 32314974 PMCID: PMC7201318 DOI: 10.2196/16326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/19/2019] [Accepted: 02/26/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF), sternal wound infection, and cardiac decompensation are complications that can occur after cardiac surgery. Early detection of these complications is clinically relevant, as early treatment is associated with better clinical outcomes. Remote monitoring with the use of a smartphone (mobile health [mHealth]) might improve the early detection of complications after cardiac surgery. OBJECTIVE The primary aim of this study is to compare the detection rate of AF diagnosed with an mHealth solution to the detection rate of AF diagnosed with standard care. Secondary objectives include detection of sternal wound infection and cardiac decompensation, as well as assessment of quality of life, patient satisfaction, and cost-effectiveness. METHODS The Box 2.0 is a study with a prospective intervention group and a historical control group for comparison. Patients undergoing cardiac surgery at Leiden University Medical Center are eligible for enrollment. In this study, 365 historical patients will be used as controls and 365 other participants will be asked to receive either The Box 2.0 intervention consisting of seven home measurement devices along with a video consultation 2 weeks after discharge or standard cardiac care for 3 months. Patient information will be analyzed according to the intention-to-treat principle. The Box 2.0 devices include a blood pressure monitor, thermometer, weight scale, step count watch, single-lead electrocardiogram (ECG) device, 12-lead ECG device, and pulse oximeter. RESULTS The study started in November 2018. The primary outcome of this study is the detection rate of AF in both groups. Quality of life is measured with the five-level EuroQol five-dimension (EQ-5D-5L) questionnaire. Cost-effectiveness is calculated from a society perspective using prices from Dutch costing guidelines and quality of life data from the study. In the historical cohort, 93.9% (336/358) completed the EQ-5D-5L and patient satisfaction questionnaires 3 months after cardiac surgery. CONCLUSIONS The rationale and design of a study to investigate mHealth devices in postoperative cardiac surgery patients are presented. The first results are expected in September 2020. TRIAL REGISTRATION ClinicalTrials.gov NCT03690492; http://clinicaltrials.gov/show/NCT03690492. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/16326.
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Affiliation(s)
- Tom E Biersteker
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Mark J Boogers
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Rolf Hh Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Serge A Trines
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Anouk P van Alem
- Department of Cardiology, Haaglanden Medisch Centrum, Den Haag, Netherlands
| | | | - Nicolette van Hof
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Robert Jm Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Roderick W Treskes
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
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Extracorporeal Life Support in Adult Patients: A Global Perspective of the Last Decade. Dimens Crit Care Nurs 2019; 38:123-130. [PMID: 30946118 DOI: 10.1097/dcc.0000000000000351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Extracorporeal life support (ECLS) is an external medical device to treat critically ill patients with cardiovascular and respiratory failure. In a nutshell, ECLS is only a "bridging" mechanism that provides life support while the heart and/or the lungs is recovering either by therapeutic medical interventions, transplantation, or spontaneously. Extracorporeal life support has been developed since 1950s, and many studies were conducted to improve ECLS techniques, but unfortunately, the survival rate was not improved. Because of Dr Bartlett's success in using ECLS to treat neonates with severe respiratory distress in 1975, ECLS is made as a standard lifesaving therapy for neonates with severe respiratory distress. However, its use for adult patients remains debatable. The objectives of this study are to outline and provide a general overview of the use of ECLS especially for adult patients for the past 10 years and to elaborate on the challenges encountered by each stakeholder involved in ECLS. The data used for this study were extracted from the ELSO Registry Report of January 2018. Results of this study revealed that the number of ECLS centers and the use of ECLS are increasing over the year for the past decade. There was also a shift of the patient's age category from neonatal to adult patients. However, the survival rates for adult patients are relatively low especially for cardiac and extracorporeal cardiopulmonary resuscitation cases. To date, the complications are still the major challenge of ECLS. Other challenges encountered by the stakeholders in ECLS are the limited amount of well-trained and experienced ECLS teams and centers, the limited government expenditure on health, and the lack of improvement and development of ECLS techniques and devices. Further studies are needed to evaluate the value of ECLS for adult patients.
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10
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Successful Extracorporeal Membrane Oxygenation (ECMO) Use without Systemic Anticoagulation for Acute Respiratory Distress Syndrome in a Patient with Aneurysmal Subarachnoid Hemorrhage. Case Rep Neurol Med 2019; 2019:9537453. [PMID: 31360563 PMCID: PMC6652035 DOI: 10.1155/2019/9537453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/24/2019] [Indexed: 11/17/2022] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is an important life-saving technology for patients with severe acute respiratory distress syndrome (ARDS). Unfortunately, ECMO has been traditionally contraindicated in patients with hemorrhagic neurologic diseases. The recent improvement in ECMO devices, increased utilization and experience with venovenous ECMO technologies among healthcare teams, and the use of ECMO without anticoagulation has expanded the potential populations that may benefit from ECMO. We present a case of successful utilization of venovenous ECMO for severe respiratory failure secondary to ARDS in a patient with aneurysmal subarachnoid hemorrhage and severe, episodic cerebral vasospasm. We also discuss important limitations and considerations for future successful use of ECMO in hemorrhagic stroke. This case report highlights the potential for this life-saving technology in patients with hemorrhagic stroke.
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Salna M, Ikegami H, Willey JZ, Garan AR, Cevasco M, Chan C, Takayama H, Colombo PC, Naka Y, Takeda K. Transcranial Doppler is an effective method in assessing cerebral blood flow patterns during peripheral venoarterial extracorporeal membrane oxygenation. J Card Surg 2019; 34:447-452. [DOI: 10.1111/jocs.14060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/03/2019] [Accepted: 04/08/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Michael Salna
- Division of Cardiothoracic SurgeryColumbia University Medical CenterNew York New York
| | - Hirohisa Ikegami
- Division of Cardiothoracic SurgeryRutgers Robert Wood Johnson Medical SchoolNew Brunswick New Jersey
| | - Joshua Z Willey
- Division of NeurologyColumbia University Medical CenterNew York New York
| | - Arthur R Garan
- Division of CardiologyColumbia University Medical CenterNew York New York
| | - Marisa Cevasco
- Division of Cardiothoracic SurgeryColumbia University Medical CenterNew York New York
| | - Christine Chan
- Division of Cardiothoracic SurgeryColumbia University Medical CenterNew York New York
| | - Hiroo Takayama
- Division of Cardiothoracic SurgeryColumbia University Medical CenterNew York New York
| | - Paolo C Colombo
- Division of CardiologyColumbia University Medical CenterNew York New York
| | - Yoshifumi Naka
- Division of Cardiothoracic SurgeryColumbia University Medical CenterNew York New York
| | - Koji Takeda
- Division of Cardiothoracic SurgeryColumbia University Medical CenterNew York New York
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12
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Ares GJ, Buonpane C, Helenowski I, Reynolds M, Hunter CJ. Outcomes and associated ethical considerations of long-run pediatric ECMO at a single center institution. Pediatr Surg Int 2019; 35:321-328. [PMID: 30683989 PMCID: PMC6433597 DOI: 10.1007/s00383-019-04443-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE Survival of neonatal and pediatric patients undergoing extracorporeal membrane oxygenation (ECMO) ≥ 21 days has not been well described. We hypothesized that patients would have poor survival and increased long-term complications. METHODS Retrospective, single center, review and case analysis. Tertiary-care university children's hospital including neonatal, pediatric and cardiac intensive care units. After institutional review board approval, the charts of all patients < 18 years of age undergoing ECMO for ≥ 21 continuous days were performed, and they were compared to comparative patients undergoing shorter runs. Overall survival, incidence of complications, and post-discharge recovery were recorded. RESULTS Overall survival was 36% in patients undergoing ≥ 21 days of ECMO (N = 14). 5/8 patients with cardiopulmonary failure from acquired etiologies survived versus 0/6 patients with congenital anomalies. 1/5 survivors achieved complete recovery with no neurologic deficits. The remaining survivors suffer from multiple medical and neurodevelopmental morbidities. CONCLUSION ECMO support for ≥ 21 days is associated with poor survival, particularly in neonates with congenital anomalies. Long-term outcomes for survivors ought to be carefully weighed and discussed with parents given the high incidence of neurologic morbidities in this population.
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Affiliation(s)
- Guillermo J. Ares
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, 211 E Chicago Avenue, Box 63, Chicago, IL 60611, USA,Department of Surgery, University of Illinois at Chicago, 840 South Wood Street, Suite 376‑CSN, Chicago, IL 60612, USA
| | - Christie Buonpane
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, 211 E Chicago Avenue, Box 63, Chicago, IL 60611, USA
| | - Irene Helenowski
- Feinberg School of Medicine, Northwestern University, 310 East Superior Street, Morton 4‑685, Chicago, IL 60611, USA
| | - Marleta Reynolds
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, 211 E Chicago Avenue, Box 63, Chicago, IL 60611, USA
| | - Catherine J. Hunter
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, 211 E Chicago Avenue, Box 63, Chicago, IL 60611, USA,Feinberg School of Medicine, Northwestern University, 310 East Superior Street, Morton 4‑685, Chicago, IL 60611, USA
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13
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Lazar HL. Repeat extracorporeal membrane oxygenation support-Are the results better the second time around? J Card Surg 2018; 33:576-577. [PMID: 30043396 DOI: 10.1111/jocs.13777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Harold L Lazar
- Division of Cardiac Surgery, the Boston University School of Medicine, Boston, Massachusetts
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14
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Brady JJ, Kwapnoski Z, Lyden E, Ryan T, Merritt-Genore H. Outcomes in patients requiring repeat extracorporeal membrane oxygenation. J Card Surg 2018; 33:572-575. [DOI: 10.1111/jocs.13776] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- John Joseph Brady
- Department of Cardiothoracic Surgery; University of Nebraska Medical Center; Omaha Nebraska
| | | | - Elizabeth Lyden
- Department of Biostatistics; University of Nebraska Medical Center; Omaha Nebraska
| | - Timothy Ryan
- Department of Cardiothoracic Surgery; University of Nebraska Medical Center; Omaha Nebraska
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15
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Gangahanumaiah S, Scarr BC, Buckland MR, Pilcher DV, Paraskeva MA, McGiffin DC. Suicide right ventricle after lung transplantation for pulmonary vascular disease. J Card Surg 2018; 33:412-415. [DOI: 10.1111/jocs.13725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Shivanand Gangahanumaiah
- Department of Cardiothoracic Surgery, Lung Transplantation, Anaesthesia and Intensive Care; The Alfred Hospital; Melbourne Victoria Australia
| | - Bronwyn C. Scarr
- Department of Cardiothoracic Surgery, Lung Transplantation, Anaesthesia and Intensive Care; The Alfred Hospital; Melbourne Victoria Australia
| | - Mark R. Buckland
- Department of Cardiothoracic Surgery, Lung Transplantation, Anaesthesia and Intensive Care; The Alfred Hospital; Melbourne Victoria Australia
| | - David V. Pilcher
- Department of Cardiothoracic Surgery, Lung Transplantation, Anaesthesia and Intensive Care; The Alfred Hospital; Melbourne Victoria Australia
- School of Public Health and Preventive Medicine; Monash University; The Australian and New Zealand Intensive Care Research Centre; Melbourne Victoria Australia
| | - Miranda A. Paraskeva
- Department of Cardiothoracic Surgery, Lung Transplantation, Anaesthesia and Intensive Care; The Alfred Hospital; Melbourne Victoria Australia
| | - David C. McGiffin
- Department of Cardiothoracic Surgery, Lung Transplantation, Anaesthesia and Intensive Care; The Alfred Hospital; Melbourne Victoria Australia
- Faculty of Medicine; Central Clinical School; Nursing and Health; Monash University; Melbourne Victoria Australia
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16
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Lazar HL. The use of extracorporeal membrane oxygenation in type A aortic dissections-Long run for a short slide? J Card Surg 2017; 32:826. [PMID: 29169213 DOI: 10.1111/jocs.13248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Harold L Lazar
- Division of Cardiac Surgery, Boston University School of Medicine, Boston, Massachusetts
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