Clinical course and long-term outcome following venoarterial extracorporeal life support-facilitated interhospital transfer of patients with circulatory failure

Schopka, Simon; Philipp, Alois; Hilker, Michael; Müller, Thomas; Zimmermann, Markus; Arlt, Matthias; Rupprecht, Leopold; Schmid, Çhristof; Lunz, Dirk

doi:10.1016/j.resuscitation.2015.05.021

Cited by 18 publications

(13 citation statements)

References 14 publications

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“…The high-risk nature of the patient population undergoing VA-ECMO is reflected by the findings of this analysis, with an overall survival-to-discharge rate of 43.0%. This is in line with the data presented in the literature (13)(14)(15)(16).…”

Section: Contemporary Outcomes Of Va-ecmo Administrationsupporting

confidence: 93%

Outcomes of venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock: systematic review and meta-analysis

Wilson-Smith¹,

Bogdanova²,

Roydhouse³

et al. 2019

Ann. Cardiothorac. Surg.

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Background: Despite advances in management techniques and medical therapy, refractory cardiogenic shock remains a life-threatening condition with high mortality rates. The present systematic review and meta-analysis aims to explore the outcomes associated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) use in the setting of refractory cardiogenic shock, stratified per survivorship. Methods: A literature search was performed using three electronic databases from the date of their inception up to June 2018. The literature search and subsequent data extraction were performed by two independent reviewers. Digitized survival data were extracted from Kaplan-Meier curves in order to recreate the original patient data using an iterative algorithm and were subsequently aggregated for analysis. Results: Fifty-two studies were included, with 44 undergoing quantitative analysis. A total of 17,515 patients were identified, with a mean age of 58.4±9.4 years and a mean duration of ECMO support of 5.1±2.6 days; 68.7% of the patients were male. Aggregated survival rates at 1, 2, 3 and 5 years were 36.7%, 34.8%, 33.8% and 29.9%, respectively. Conclusions: The present systematic review illustrates the expected survival results for VA-ECMO in the intermediate-to long-term. Extended follow-up and standardized reporting measures are urgently needed in order to carry out more definitive subgroup analyses.

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Section: Contemporary Outcomes Of Va-ecmo Administrationsupporting

confidence: 93%

Outcomes of venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock: systematic review and meta-analysis

Wilson-Smith¹,

Bogdanova²,

Roydhouse³

et al. 2019

Ann. Cardiothorac. Surg.

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“…The main indication for ECLS is intractable hemodynamic instability with evidence of insufficient organ perfusion despite inotropic and vasopressor support. Institutional ECLS management, indications and limitations have been described by Lunz et al and Schopka et al previously. Exclusion criteria for the present study were lack of documentation of pre‐fHb values, death within 24 hours after ECLS implantation, ECLS support due to inability to wean from cardiopulmonary bypass (post‐cardiotomy ECLS), and patient age <18 years.…”

Section: Methodsmentioning

confidence: 99%

“…Extracorporeal life support (ECLS), also referred to as veno‐arterial extracorporeal membrane oxygenation (vaECMO) is increasingly used for urgent hemodynamic stabilization in patients with profound cardiogenic shock (CS) or in cardiac arrest (CA) . Advances in technology and improvement of patient management made ECLS an increasingly discussed and utilized resuscitation tool in specialized centers.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of hemolysis and metabolic acidosis in patients with circulatory failure supported with extracorporeal life support: a marker for survival?

Lehle

Lubnow

Philipp

et al. 2017

European J of Heart Fail

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Aims Elevated levels of plasma free hemoglobin (fHb) indicate red blood cell (RBC) damage. The aim of this study was to analyze the prevalence of hemolysis and metabolic acidosis in patients on extracorporeal life support (ECLS) and to investigate whether it is a marker for outcome. Methods and Results This retrospective analysis included 215 adult patients with cardiac failure treated with ECLS. The cohort was divided into three groups: ECLS (1) during ongoing cardiopulmonary resuscitation (CPR, n = 110); (2) after CPR with return of spontaneous circulation and sustained cardiogenic shock (n = 45); (3) in severe cardiogenic shock without previous CPR (n = 60). Lactate, arterial pH value and fHb were measured daily before (pre‐fHb) and during ECLS. CPR caused a pronounced increase in pre‐fHb (group1, 318 (138/586) mg/L; group2, 212 (107/439) mg/L; group3, 79 (53/232) mg/L; p < 0.001). Within 24 hours on ECLS, fHb declined significantly. Compared to group 3 without CPR, group1 and 2 had a lower pH value (group1, 7.10 (6.93/7.20); group2, 7.21 (7.16/7.27); group3, 7.28 (7.20/7.35); p < 0.001), and an increased lactate level (group1, 88 (55/129) mg/dL; group2, 76 (36/111) mg/dL; group3, 52 (25/83) mg/dL; p < 0.0001). Multivariante analysis showed that pre‐fHb had no prognostic value for survival. Only a low pre‐lactate was a surrogate marker for successful weaning (p < 0.0001) and discharge from hospital (p = 0.0028). Conclusions CPR was associated with a strongly increased fHb irrespective of ECLS. Implantation of ECLS did not aggravate hemolysis but instead decreased it within 24 hours. In this study low pre‐fHb had no predictive value for survival.

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“…ECMO management, indications and limitations have been described previously [1,13,14]. Our ECMO center mainly used four different ECMO systems.…”

Section: Study Populationmentioning

confidence: 99%

Factors associated with hemolysis during extracorporeal membrane oxygenation (ECMO)—Comparison of VA- versus VV ECMO

et al. 2020

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Venovenous (VV) and venoarterial (VA) extracorporeal membrane oxygenation (ECMO) are effective support modalities to treat critically ill patients. ECMO-associated hemolysis remains a serious complication. The aim was to disclose similarities and differences in VAand VV ECMO-associated hemolysis. This is a retrospective single-center analysis (January 2012 to September 2018) including 1,063 adult consecutive patients (VA, n = 606; VV, n = 457). Severe hemolysis (free plasma hemoglobin, fHb > 500 mg/l) during therapy occurred in 4% (VA) and 2% (VV) (p�0.001). VV ECMO showed significantly more hemolysis by pump head thrombosis (PHT) compared to VA ECMO (9% vs. 2%; p�0.001). Pretreatments (ECPR, cardiac surgery) of patients who required VA ECMO caused high fHb pre levels which aggravates the proof of ECMO-induced hemolysis (median (interquartile range), VA: fHb pre: 225.0 (89.3-458.0); VV: fHb pre: 72.0 (42.0-138.0); p�0.001). The survival rate to discharge from hospital differed depending on ECMO type (40% (VA) vs. 63% (VV); p�0.001). Hemolysis was dominant in VA ECMO patients, mainly caused by different indications and not by the ECMO support itself. PHT was the most severe form of ECMOinduced hemolysis that occurs in both therapies with low frequency, but more commonly in VV ECMO due to prolonged support time. OPEN ACCESS Citation: Appelt H, Philipp A, Mueller T, Foltan M, Lubnow M, Lunz D, et al. (2020) Factors associated with hemolysis during extracorporeal membrane oxygenation (ECMO)-Comparison of VA-versus VV ECMO. PLoS ONE 15(1): e0227793.

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Clinical course and long-term outcome following venoarterial extracorporeal life support-facilitated interhospital transfer of patients with circulatory failure

Cited by 18 publications

References 14 publications

Outcomes of venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock: systematic review and meta-analysis

Outcomes of venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock: systematic review and meta-analysis

Prevalence of hemolysis and metabolic acidosis in patients with circulatory failure supported with extracorporeal life support: a marker for survival?

Factors associated with hemolysis during extracorporeal membrane oxygenation (ECMO)—Comparison of VA- versus VV ECMO

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