Complication patterns in patients undergoing venoarterial extracorporeal membrane oxygenation in intensive care unit: Multiple correspondence analysis and hierarchical ascendant classification

Abstract

BackgroundTreatment by venoarterial extracorporeal membrane oxygenation (VA-ECMO) is widely used today, even though it is associated with high risks of complications and death. While studies have focused on the relationship between some of these complications and the risk of death, the relationship between different complications has never been specifically examined, despite the fact that the occurrence of one complication is known to favor the occurrence of others. Our objective was to describe the relationship between complications in patients undergoing VA-ECMO in intensive care unit (ICU) and to identify, if possible, patterns of patients according to complications.Methods and findingsAs part of a retrospective cohort study, we conducted a multiple correspondence analysis followed by a hierarchical ascendant classification in order to identify patterns of patients according to main complications (sepsis, thromboembolic event, major transfusion, major bleeding, renal replacement therapy) and in-ICU death. Our cohort of 145 patients presented an in-ICU mortality rate of 50.3%. Morbidity was high, with 36.5% of patients presenting three or more of the five complications studied. Multiple correspondence analysis revealed a cumulative inertia of 76.9% for the first three dimensions. Complications were clustered together and clustered close to death, prompting the identification of four patterns of patients according to complications, including one with no complications.ConclusionsOur study, based on a large cohort of patients undergoing VA-ECMO in ICU and presenting a mortality rate comparable to that reported in the literature, identified numerous and often interrelated complications. Multiple correspondence analysis and hierarchical ascendant classification yielded clusters of patients and highlighted specific links between some of the complications studied. Further research should be conducted in this area.

Concurrent Use of Renal Replacement Therapy during Extracorporeal Membrane Oxygenation Support: A Systematic Review and Meta-Analysis

“…In total, 25 studies detailing 5896 adult patients that reported on the use of RRT and ECMO were included ( Table 1 ) [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. Twenty-four studies were observational in nature [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ], while one study was a randomised controlled trial (RCT) [ 52 ]. For our quantitative analysis, we included 24 observational studies (5855 patients), while the findings of the RCT were reported separately.…”

“…The pooled overall mortality ( Figure 1 ) in patients due to the use of RRT on ECMO (24 studies) was 62.9% (95% CI: 56.0–69.6%). Subgroup analysis found no significant differences ( p = 0.57) between in-hospital mortality (14 studies, 60.1%, 95% CI: 50.1–69.8%) [ 31 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 42 , 43 , 45 , 48 , 49 , 50 ], ICU mortality (3 studies, 67.3%, 95% CI: 60.1–74.1%) [ 28 , 29 , 32 ], 30-day mortality (3 studies, 68.4%, 95% CI: 58.0–77.9%) [ 41 , 44 , 47 ], and 90-day mortality (3 studies, 57.0%, 95% CI: 17.6–92.0%) [ 30 , 40 , 46 ]. Only one study mentioned overall mortality [ 51 ].…”

“…The presence of RRT was associated with a significant increase in mortality (19 studies, Relative Risk (RR): 1.81, 95% CI: 1.56–2.08, p < 0.001, Figure 2 ) when compared to patients on ECMO alone. After removing the only outlier detected by LOO, [ 28 ] this increased risk of mortality remained significant (RR: 1.84, 95% CI: 1.63–2.08, p < 0.001), with significant publication bias ( P egger = 0.02). Additionally, the pooled mortality among patients ( Figure S6 ) with ECMO durations of less than 7 days (3 studies) was 66.5% (95% CI: 54.5–77.5%), compared to 41.5% (95% CI: 33.3–49.9%, p < 0.001) for those with ECMO durations of more than 7 days (4 studies).…”

経皮的心肺補助装置が有用だった偶発性低体温症による心肺停止の1例(A case of cardiopulmonary arrest due to accidental hypothermia that was treated effectively with extracorporeal membrane oxygenation)

“…V–A ECMOで懸念される合併症として，血栓性の合併症と出血性の合併症が挙げられる。V–A ECMOを施行することで5.3%の患者で脳梗塞を発症するが，生命予後には関連しないとする報告 や，約半数に死亡に関連する多量の出血性合併症を起こすとの報告 もある。初療の時点で重症頭部外傷が否定できない場合や，FAST陽性例では，V–A ECMOの導入に慎重にならざるを得ない。…”

Sepsis and ECMO

“…ECMO can be either veno-venous cannulation (VV), which is used predominantly in hypoxic respiratory failure states like acute respiratory distress syndrome or veno-arterial cannulation (VA), which is the main or preferred modality for cardiac support system like postoperative cardiac surgery and cardiogenic shock. The survival rate for VV-ECMO is 60% and for VA-ECMO is 45% when death is imminent [1][2][3][4]. Sepsis can be a reason for initiating ECMO, and on the other hand, patients can develop sepsis on ECMO too.…”