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Wang C, Zhang Y. Commentary: Serum total bilirubin with hospital survival in adults during extracorporeal membrane oxygenation. Front Med (Lausanne) 2022; 9:1022207. [PMID: 36250096 PMCID: PMC9554216 DOI: 10.3389/fmed.2022.1022207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Chunxia Wang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Pediatric Extracorporeal Life Support Center, Institute of Pediatric Infection, Immunity, and Critical Care Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Pediatric Critical Care, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Chunxia Wang
| | - Yucai Zhang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Pediatric Extracorporeal Life Support Center, Institute of Pediatric Infection, Immunity, and Critical Care Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Pediatric Critical Care, Shanghai Jiao Tong University, Shanghai, China
- Yucai Zhang
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Kozakov K, Philipp A, Lunz D, Lubnow M, Provaznik Z, Keyser A, Rupprecht L, Schmid C, Schopka S. Multi-organ dysfunction syndrome in patients undergoing extracorporeal life support. Artif Organs 2022; 46:1912-1922. [PMID: 35470442 DOI: 10.1111/aor.14272] [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: 12/03/2021] [Revised: 01/30/2022] [Accepted: 04/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Multiple organ failure is a common complication in patients undergoing ECLS significantly affecting patient outcomes. Gaining knowledge about the mechanisms of onset, clinical course, risk factors, and potential therapeutic targets is highly desirable. METHODS Data of 354 patients undergoing ECLS with one-, two, three-, and four organ failures were retrospectively analyzed. Incidence of multiple organ dysfunction (MODS), its impact on survival, risk factors for its occurrence, and the impact of proinflammatory mediators on the occurrence of MODS in patients undergoing ECLS were investigated. RESULTS The median follow-up was 66 (IQR 6; 820) days. 245 (69.2%) patients could be weaned from ECLS, 30-day survival and 1-year survival were 194 (54.1%) and 157 (44.4%), respectively. The duration of mechanical support was 4 (IQR 2; 7) days in the median. Increasing severity of MODS resulted in significant prolongation of mechanical circulatory support and worsening of the outcome. Liver dysfunction had the strongest impact on patient mortality (OR = 2.5) and survival time (19 vs 367 days). The serum concentration of analyzed interleukins rose significantly with each, additional organ affected by dysfunction (p < 0.001). All analyzed proinflammatory cytokines showed significant predictivity relative to the occurrence of MODS with interleukin 8 serum level prior to ECLS showing the strongest predictive potential for the occurrence of MODS (AUC 0.78). CONCLUSION MODS represents a frequent complication in patients undergoing ECLS with a significant impact on survival. Proinflammatory cytokines show prognostic capacity regarding the occurrence and severity of multi-organ dysfunction.
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Affiliation(s)
- Kostiantyn Kozakov
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Alois Philipp
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Dirk Lunz
- Department of Anaesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Matthias Lubnow
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Zdenek Provaznik
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Andreas Keyser
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Leopold Rupprecht
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Christof Schmid
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Simon Schopka
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
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Patangi SO, Shetty RS, Shanmugasundaram B, Kasturi S, Raheja S. Veno-arterial extracorporeal membrane oxygenation: Special reference for use in 'post-cardiotomy cardiogenic shock' - A review with an Indian perspective. Indian J Thorac Cardiovasc Surg 2021; 37:275-288. [PMID: 33191992 PMCID: PMC7647874 DOI: 10.1007/s12055-020-01051-7] [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: 06/23/2020] [Revised: 08/14/2020] [Accepted: 09/07/2020] [Indexed: 11/16/2022] Open
Abstract
The ultimate goals of cardiovascular physiology are to ensure adequate end-organ perfusion to satisfy the local metabolic demand, to maintain homeostasis and achieve 'milieu intérieur'. Cardiogenic shock is a state of pump failure which results in tissue hypoperfusion and its associated complications. There are a wide variety of causes which lead to this deranged physiology, and one such important and common scenario is the post-cardiotomy state which is encountered in cardiac surgical units. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an important modality of managing post-cardiotomy cardiogenic shock with variable outcomes which would otherwise be universally fatal. VA-ECMO is considered as a double-edged sword with the advantages of luxurious perfusion while providing an avenue for the failing heart to recover, but with the problems of anticoagulation, inflammatory and adverse systemic effects. Optimal outcomes after VA-ECMO are heavily reliant on a multitude of factors and require a multi-disciplinary team to handle them. This article aims to provide an insight into the pathophysiology of VA-ECMO, cannulation techniques, commonly encountered problems, monitoring, weaning strategies and ethical considerations along with a literature review of current evidence-based practices.
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Affiliation(s)
- Sanjay Orathi Patangi
- Department of Anaesthesia and Intensive Care, Narayana Institute of Cardiac Sciences, 258/A Hosur Road, Bommasandra Industrial Area, Anekal Taluk, Bengaluru, Karnataka 560099 India
| | - Riyan Sukumar Shetty
- Department of Anaesthesia and Intensive Care, Narayana Institute of Cardiac Sciences, 258/A Hosur Road, Bommasandra Industrial Area, Anekal Taluk, Bengaluru, Karnataka 560099 India
| | - Balasubramanian Shanmugasundaram
- Department of Anaesthesia and Intensive Care, Narayana Institute of Cardiac Sciences, 258/A Hosur Road, Bommasandra Industrial Area, Anekal Taluk, Bengaluru, Karnataka 560099 India
| | - Srikanth Kasturi
- Department of Cardiothoracic Surgery, Narayana Institute of Cardiac Sciences, Bengaluru, India
| | - Shivangi Raheja
- Department of Cardiothoracic Surgery, Narayana Institute of Cardiac Sciences, Bengaluru, India
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Liang L, Liu L, Zhang Y, Fan X, Tao L. The association between postoperative complications and prognosis in patients receiving extracorporeal membrane oxygenation in cardiac care unit. Am J Transl Res 2021; 13:1685-1691. [PMID: 33841690 PMCID: PMC8014358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/11/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the association between postoperative complications and prognosis in critically illed patients receiving extracorporeal membrane oxygenation (ECMO), so as to improve the survival rate of patients in cardiac care unit (CCU). METHODS 43 patients who received adjuvant therapy with ECMO in our hospital were retrospectively collected and divided into survival group (n=23) and death group (n=20) according to their survival and death during hospitalization. Patients in both groups were treated with ECMO adjuvant therapy. The levels of serum total bilirubin (STB), alanine transaminase (ALT), creatine (Cr), lactic acid (Lac) and urine volume in two groups were evaluated, and the postoperative complications of two groups were observed. RESULTS ECMO was performed as adjuvant therapy in both groups. The serum levels of STB, ALT, Cr and Lac in survival group were significantly lower than those in death group (P < 0.05). The number of complications such as hemorrhage, infection, renal failure, multiple organ failure (n>3) and ischemic necrosis of lower extremities in survival group was significantly less than that in death group. CONCLUSION ECMO can significantly improve the survival rate of patients in CCU. When the serum levels of STB, ALT, Cr and Lac decrease and urine volume increases, liver and kidney function injury is mild, with less postoperative complications and good prognosis. Therefore, monitoring STB, ALT, Cr, Lac and urine volume is able to adjust treatment plan in time, reduce postoperative complications and improve prognosis quality, thus has great positive clinical significance.
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Affiliation(s)
- Liwen Liang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Airforce Military Medical University Xi'an 710032, Shaanxi, China
| | - Liyuan Liu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Airforce Military Medical University Xi'an 710032, Shaanxi, China
| | - Yamin Zhang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Airforce Military Medical University Xi'an 710032, Shaanxi, China
| | - Xiaoying Fan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Airforce Military Medical University Xi'an 710032, Shaanxi, China
| | - Ling Tao
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Airforce Military Medical University Xi'an 710032, Shaanxi, China
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Lim HS, Ranasinghe A, Quinn D, Chue C, Mascaro J. Outcomes of temporary mechanical circulatory support in cardiogenic shock due to end-stage heart failure. J Intensive Care Soc 2021; 23:170-176. [DOI: 10.1177/1751143720988706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background There are few reports of mechanical circulatory support (MCS) in patients with cardiogenic shock (CS) due to end-stage heart failure (ESHF). We evaluated our institutional MCS strategy and compared the outcomes of INTERMACS 1 and 2 patients with CS due to ESHF. Methods Retrospective analysis of prospectively collected data (November 2014 to July 2019) from a single centre. ESHF was defined by a diagnosis of HF prior to presentation with CS. Other causes of CS (eg: acute myocardial infarction) were excluded. We compared the clinical course, complications and 90-day survival of patients with CS due to ESHF in INTERMACS profile 1 and 2. Results We included 60 consecutive patients with CS due to ESHF Differences in baseline characteristics were consistent with the INTERMACS profiles. The duration of MCS was similar between INTERMACS 1 and 2 patients (14 (10–33) vs 15 (7–23) days, p = 0.439). There was no significant difference in the number of patients with complications that required intervention. Compared to INTERMACS 2, INTERMACS 1 patients had more organ dysfunction on support and significant lower 90-day survival (66% vs 34%, p = 0.016). Conclusion Our temporary MCS strategy, including earlier intervention in patients with CS due to ESHF at INTERMACS 2 was associated with less organ dysfunction and better 90-day survival compared to INTERMACS 1 patients.
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Affiliation(s)
- Hoong Sern Lim
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Aaron Ranasinghe
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - David Quinn
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Colin Chue
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jorge Mascaro
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Bilirubin-A Possible Prognostic Mortality Marker for Patients with ECLS. J Clin Med 2020; 9:jcm9061727. [PMID: 32503278 PMCID: PMC7356548 DOI: 10.3390/jcm9061727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/13/2020] [Accepted: 06/02/2020] [Indexed: 01/14/2023] Open
Abstract
Extracorporeal life support (ECLS) is a promising therapeutic option for patients with refractory cardiogenic shock. However, as the mortality rate still remains high, there is a need for early outcome parameters reflecting therapy success or futility. Therefore, we investigated whether liver enzyme levels could serve as prognostic mortality markers for patients with ECLS. The present study is a retrospective single-center cohort study. Adult patients >18 years of age who received ECLS therapy between 2011 and 2018 were included. Bilirubin, glutamic-oxaloacetic transaminase (GOT), and glutamic-pyruvic-transaminase (GPT) serum levels were analyzed at day 5 after the start of the ECLS therapy. The primary endpoint of this study was all-cause in-hospital mortality. A total of 438 patients received ECLS during the observation period. Based on the inclusion criteria, 298 patients were selected for the statistical analysis. The overall mortality rate was 42.6% (n = 127). The area under the curve (AUC) in the receiver operating characteristic curve (ROC) for bilirubin on day 5 was 0.72 (95% confidence interval (CI): 0.66–0.78). Cox regression with multivariable adjustment revealed a significant association between bilirubin on day 5 and mortality, with a hazard ratio (HR) of 2.24 (95% CI: 1.53–3.30). Based on the results of this study, an increase in serum bilirubin on day 5 of ECLS therapy correlates independently with mortality.
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Hamiko M, Slottosch I, Scherner M, Gestrich C, Wahlers T, Putensen C, Mellert F, Treede H, Dewald O, Duerr GD. Timely extracorporeal membrane oxygenation assist reduces mortality after bypass surgery in patients with acute myocardial infarction. J Card Surg 2019; 34:1243-1255. [DOI: 10.1111/jocs.14258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Marwan Hamiko
- Department of Cardiac SurgeryUniversity Clinical CentreBonn Germany
| | - Ingo Slottosch
- Department of Cardiothoracic SurgeryUniversity HospitalMagdeburg Germany
| | - Max Scherner
- Department of Cardiothoracic SurgeryUniversity HospitalMagdeburg Germany
| | | | - Thorsten Wahlers
- Department of Cardiothoracic SurgeryUniversity HospitalCologne Germany
| | - Christian Putensen
- Department of Anaesthesiology and Intensive‐Care MedicineUniversity Clinical CentreBonn Germany
| | - Fritz Mellert
- Department of Cardiac SurgeryUniversity Clinical CentreBonn Germany
| | - Hendrik Treede
- Department of Cardiac SurgeryUniversity Clinical CentreBonn Germany
| | - Oliver Dewald
- Department of Cardiac SurgeryUniversity Clinical CentreBonn Germany
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Extracorporeal membrane oxygenation in patients with heart transplantation : A clinical prognosis analysis. Herz 2019; 45:739-744. [PMID: 31410515 DOI: 10.1007/s00059-019-04843-9] [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: 06/23/2019] [Revised: 07/07/2019] [Accepted: 07/15/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is indicated for bridging to heart transplantation, graft failure, and right heart failure after heart transplantation. This study explored risk factors affecting the clinical prognosis of cardiac transplantation patients treated with ECMO during the perioperative period. METHODS Data on 28 heart transplantation patients with ECMO obtained from January 2012 to January 2018 in the People's Hospital of Zhongshan City were retrospectively analyzed. RESULTS A total of 25 patients (20 male and 5 female) were finally included. Heart transplantation was performed mainly due to cardiomyopathy (77.8%). Of the treated patients, 18 (72%) survived and were discharged, 4 were treated with cardiopulmonary resuscitation (CPR) before ECMO, and 3 died in hospital. There were no differences between the surviving and death group donors (N-terminal pro b‑type natriuretic peptide [NT-proBNP], creatine kinase-muscle/brain [CK-MB], warm ischemia time of donated heart, cold ischemia time of donated heart, total ischemia time of donated heart, and donor type). In univariate analysis, body mass index (BMI), length of stay in the intensive care unit (ICU), and CPR were relevant prognostic factors for heart transplantation patients with ECMO. Multi-factor logistic regression showed that CPR before ECMO (odds ratio, OR, 49.45; 95% confidence interval, CI, [1.37, 1781.6]; P = 0.033) is an independent risk factor influencing prognosis. CONCLUSION ECMO is an important life support method for patients before and after heart transplantation surgery. Obesity, poor preoperative cardiac function, and considerable intraoperative red blood cell transfusion may influence prognosis. Extracardiac compression before ECMO is an independent risk factor for prognosis.
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Predictors of mid-term outcomes in patients undergoing implantation of a ventricular assist device directly after extracorporeal life support. Eur J Cardiothorac Surg 2018; 55:773-779. [DOI: 10.1093/ejcts/ezy351] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/23/2018] [Accepted: 09/13/2018] [Indexed: 01/07/2023] Open
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