1
|
Mazuru V, Mang S, Ajouri J, Muellenbach RM, Bals R, Feth M, Zeiner C, Wengenmayer T, Lepper PM, Rixecker TM, Seiler F. External Validation of the PREdiction of Survival on Extracorporeal Membrane Oxygenation Therapy (PRESET) Score: A Single Center Cohort Experience. ASAIO J 2024:00002480-990000000-00480. [PMID: 38728743 DOI: 10.1097/mat.0000000000002226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
Acute respiratory distress syndrome (ARDS) is a life-threatening condition affecting >10% of intensive care unit (ICU) patients worldwide with a mortality of up to 59% depending on severity. Extracorporeal membrane oxygenation (ECMO) is a potentially life-saving procedure in severe ARDS but is technically and financially challenging. In recent years, various scoring systems have been proposed to select patients most likely to benefit from ECMO, with the PREdiction of Survival on ECMO Therapy (PRESET) score being one of the most used. We collected data from 283 patients with ARDS of various etiology who underwent veno-venous (V-V) ECMO therapy at a German tertiary care ICU from January 2012 to December 2022. Median age in the cohort was 56 years, and 64.31% were males. The in-hospital mortality rate was 50.88% (n = 144). The median (25%; 75% quartile) severity scores were 38 (31; 49) for Simplified Acute Physiology Score (SAPS) II, 12 (10; 13) for Sequential Organ Failure Assessment (SOFA) and 7 (5; 8) for PRESET. Simplified Acute Physiology Score-II displayed the best prognostic value (area under the receiver operating characteristic [AUROC]: 0.665 [confidence interval (CI): 0.574-0.756; p = 0.046]). Prediction performance was weak in all analyzed scores despite good calibration. Simplified Acute Physiology Score-II had the best discrimination after adjustment of our original cohort. The use of scores explored in this study for patient selection for eligibility for V-V ECMO is not recommendable.
Collapse
Affiliation(s)
- Vitalie Mazuru
- From the Department of Internal Medicine V - Pneumology, Allergology and Critical Care Medicine, Saarland University Medical Center and University of Saarland, Homburg, Germany
| | - Sebastian Mang
- From the Department of Internal Medicine V - Pneumology, Allergology and Critical Care Medicine, Saarland University Medical Center and University of Saarland, Homburg, Germany
| | - Jonas Ajouri
- Department of Anaesthesiology and Critical Care Medicine, Klinikum Kassel, Germany
| | - Ralf M Muellenbach
- Department of Anaesthesiology and Critical Care Medicine, Klinikum Kassel, Germany
| | - Robert Bals
- From the Department of Internal Medicine V - Pneumology, Allergology and Critical Care Medicine, Saarland University Medical Center and University of Saarland, Homburg, Germany
| | - Maximilian Feth
- Department of Anesthesiology, Critical Care, Emergency and Pain Medicine, Military Medical Center Ulm, Ulm, Germany
| | - Carsten Zeiner
- From the Department of Internal Medicine V - Pneumology, Allergology and Critical Care Medicine, Saarland University Medical Center and University of Saarland, Homburg, Germany
| | - Tobias Wengenmayer
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp M Lepper
- Department of Emergency Medicine, Saarland University Medical Center and University of Saarland, Homburg, Germany
| | - Torben M Rixecker
- From the Department of Internal Medicine V - Pneumology, Allergology and Critical Care Medicine, Saarland University Medical Center and University of Saarland, Homburg, Germany
| | - Frederik Seiler
- From the Department of Internal Medicine V - Pneumology, Allergology and Critical Care Medicine, Saarland University Medical Center and University of Saarland, Homburg, Germany
| |
Collapse
|
2
|
Leitner M, Borchardt K, Rixecker TM, Jaumann IT, Küppers F, Bals R, Lepper PM, Kühnle JL. [Cave Canem! Diarrhea, thrombocytopenia and acute kidney injury in an immunosuppressed woman]. Med Klin Intensivmed Notfmed 2024; 119:233-235. [PMID: 37945757 DOI: 10.1007/s00063-023-01077-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/15/2023] [Accepted: 09/26/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Maximilian Leitner
- Klinik für Innere Medizin V - Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66421, Homburg, Deutschland.
| | - Kai Borchardt
- Klinik für Innere Medizin V - Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66421, Homburg, Deutschland
| | - Torben M Rixecker
- Klinik für Innere Medizin V - Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66421, Homburg, Deutschland
| | - Isabella T Jaumann
- Klinik für Innere Medizin IV - Nieren- und Hochdruckkrankheiten, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - Frederic Küppers
- Klinik für Innere Medizin IV - Nieren- und Hochdruckkrankheiten, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - Robert Bals
- Klinik für Innere Medizin V - Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66421, Homburg, Deutschland
| | - Philipp M Lepper
- Klinik für Innere Medizin V - Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66421, Homburg, Deutschland
| | - Jeannine L Kühnle
- Klinik für Innere Medizin V - Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66421, Homburg, Deutschland
| |
Collapse
|
3
|
Mang S, Reichert L, Muellenbach RM, Riesner J, Lotz C, Supady A, Mutlak H, Bals R, Rixecker TM, Becker AP, Leitner M, Zeiner C, Danziger G, Meybohm P, Seiler F, Lepper PM. Transfer of Veno-venous Extracorporeal Membrane Oxygenation Patients With COVID-19 Associated Acute Respiratory Distress Syndrome. ASAIO J 2023; 69:789-794. [PMID: 37146598 PMCID: PMC10627394 DOI: 10.1097/mat.0000000000001954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
Interhospital transport of acute respiratory distress syndrome (ARDS) patients bears transport-associated risks. It is unknown how interhospital extracorporeal membrane oxygenation (ECMO) transfer of COVID-19 patients by mobile ECMO units affects ARDS mortality. We compared the outcome of 94 COVID-19 patients cannulated in primary care hospitals and retrieved by mobile ECMO-teams to that of 84 patients cannulated at five German ECMO centers. Patients were recruited from March 2020 to November 2021. Twenty-six transports were airborne, 68 were land-based. Age, sex, body-mass-index, Simplified Acute Physiology Score (SAPS) II, days invasively ventilated, and P/F-Ratio before ECMO initiation were similar in both groups. Counting only regional transports (≤250 km), mean transport distance was 139.5 km ± 17.7 km for helicopter (duration 52.5 ± 10.6 minutes) and 69.8 km ± 44.1 km for ambulance or mobile intensive care unit (duration 57.6 ± 29.4 minutes). Overall time of vvECMO support (20.4 ± 15.2 ECMO days for transported patients vs. 21.0 ± 20.5 for control, p = 0.83) and days invasively ventilated (27.9 ± 18.1 days vs. 32.6 ± 25.1 days, p = 0.16) were similar. Overall mortality did not differ between transported patients and controls (57/94 [61%] vs. 51/83 [61%], p = 0.43). COVID-19 patients cannulated and retrieved by mobile ECMO-teams have no excess risk compared with patients receiving vvECMO at experienced ECMO centers. Patients with COVID-19-associated ARDS, limited comorbidities, and no contraindication for ECMO should be referred early to local ECMO centers.
Collapse
Affiliation(s)
- Sebastian Mang
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Lena Reichert
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Ralf M. Muellenbach
- Department of Anesthesiology and Critical Care Medicine, Campus Kassel of the University of Southampton, Kassel, Germany
| | - Jonathan Riesner
- Department of Anesthesiology and Critical Care Medicine, Campus Kassel of the University of Southampton, Kassel, Germany
| | - Christopher Lotz
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Alexander Supady
- Department of Internal medicine, Cardiology, Intensive Care and Emergency Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Haitham Mutlak
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Sana Klinikum Offenbach, Offenbach, Germany
| | - Robert Bals
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Torben M. Rixecker
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - André P. Becker
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Maximilian Leitner
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Carsten Zeiner
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Guy Danziger
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Patrick Meybohm
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Frederik Seiler
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Philipp M. Lepper
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| |
Collapse
|
4
|
Rixecker TM, Lepper PM, Mang S, Espig P, Brill K, Thurner L, Bittenbring JT. Daratumumab for a Patient With Refractory Antineutrophil Cytoplasmatic Antibody-Associated Vasculitis. JAMA Intern Med 2023; 183:615-618. [PMID: 37036724 PMCID: PMC10087091 DOI: 10.1001/jamainternmed.2023.0152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/04/2023] [Indexed: 04/11/2023]
Abstract
This case reports on a patient with antineutrophil cytoplasmatic antibody–associated vasculitis and severe pulmonary and cutaneous involvement who received conventional therapy that failed and who was rescued by daratumumab therapy.
Collapse
Affiliation(s)
- Torben M. Rixecker
- Department of Internal Medicine 5 (Pneumology, Allergology, and Intensive Care Medicine), Saarland University Medical School, Homburg, Germany
| | - Philipp M. Lepper
- Department of Internal Medicine 5 (Pneumology, Allergology, and Intensive Care Medicine), Saarland University Medical School, Homburg, Germany
| | - Sebastian Mang
- Department of Internal Medicine 5 (Pneumology, Allergology, and Intensive Care Medicine), Saarland University Medical School, Homburg, Germany
| | - Pascal Espig
- Department of Internal Medicine 5 (Pneumology, Allergology, and Intensive Care Medicine), Saarland University Medical School, Homburg, Germany
| | - Katharina Brill
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology, and Rheumatology), Saarland University Medical School, Homburg, Germany
| | - Lorenz Thurner
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology, and Rheumatology), Saarland University Medical School, Homburg, Germany
| | - Joerg Thomas Bittenbring
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology, and Rheumatology), Saarland University Medical School, Homburg, Germany
| |
Collapse
|