Early Blood Pressure Variables Associated With Improved Outcomes in VA-ECLS

Rali, Aniket S; Ranka, Sagar; Butcher, Amy; Shah, Zubair; Tonna, Joseph E.; Anders, Marc; Brinkley, Marshal D.; Siddiqi, Hasan K.; Punnoose, L.; Wigger, M.; Sacks, Suzanne Brown; Pedrotty, Dawn M.; Ooi, Henry; Bacchetta, Matthew; Hoffman, Jordan; McMaster, William C.; Balsara, Keki R.; Shah, Ashish S.; Menachem, Jonathan N.; Schlendorf, Kelly; Lindenfeld, JoAnn; Zalawadiya, Sandip

doi:10.1016/j.jchf.2022.04.003

Cited by 19 publications

(27 citation statements)

References 18 publications

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“…The CS patients in this cohort were mostly men diagnosed with coronary artery disease, and the majority of them underwent cardiac procedures. The in-hospital mortality rate of this cohort was 49.5%, which was consistent with a previous report of 43%-60% [25][26][27][28][29]. The simplification of VA-ECMO implantation and the gradually matured strategy benefited an increasing number of patients with CS, regardless of the treatment period or clinical outcomes.…”

Section: Discussionsupporting

confidence: 89%

Phenotyping Refractory Cardiogenic Shock Patients Receiving Venous-arterial Extracorporeal Membrane Oxygenation with Machine Learning Algorithms

Hou

Wang

et al. 2023

Preprint

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Background: Refractory cardiogenic shock (CS) patients receiving venous-arterial extracorporeal membrane oxygenation (VA-ECMO) have a wide range of mortality, machine algorithm methods may explain the potential heterogeneity of these patients. Methods: Between January 2018 and May 2021, 210 patients with CS who were receiving VA-ECMO support were enrolled and analyzed retrospectively. The k-means consensus agnostic algorithm was used. Patients were divided into three clusters based on covariates, such as platelet count (PLT), aspartic acid transaminase (AST), Interleukin-6 (IL-6), prothrombin time (PT), and serum lactate level 24 hours after ECMO initiation. The clinical and laboratory profiles were analyzed. Results: Among 210 CS with CS receiving ECMO, 148 (70.5%) were men, with a median age of 62 years (interquartile range (IQR): 53-67). Overall, 104 (49.5%) patients survived to discharge with 142 (67.6%) survived on ECMO. The patients were phenotyped into three clusters: (1) "platelet preserved (I)" Phenotype (36 [17.1%] patients), characterized by a preserved platelet count; (2) "hyperinflammatory (II)" phenotype (72 [34.3%] patients), characterized by a significant inflammatory response with higher Interleukin-6 (IL-6), and Interleukin-10 (IL-10) levels; and (3) "hepatic-renal (III)" phenotype (102 [48.6%] patients), characterized by unfavorable conditions in creatinine, aspartic acid transaminase, alanine aminotransferase, direct bilirubin, and prothrombin time. The in-hospital mortality rates were 25.0%, 52.8%, and 55.9% for phenotypes I, II, and III, respectively (P = 0.005). Conclusion: The consensus k-means algorithm analysis identified three phenotypes in refractory patients with CS receiving VA-ECMO: "platelet preserved," "hyperinflammatory," and "hepatic-renal." The phenotypes are associated with the clinical profile and mortality, allowing treatment strategies for subsets of patients with CS receiving ECMO to be developed.

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Section: Discussionsupporting

confidence: 89%

Phenotyping Refractory Cardiogenic Shock Patients Receiving Venous-arterial Extracorporeal Membrane Oxygenation with Machine Learning Algorithms

Hou

Wang

et al. 2023

Preprint

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“…A recent analysis of the ELSO Registry revealed that in patients with various forms of cardiogenic shock supported by VA-ECMO, early improvements of pulse pressure and systolic blood pressure following ECMO initiation were associated with improved mortality. 17 While this report did not evaluate medications used to support blood pressure or cardiac contractility, the results of this analysis are consistent with the results reported within our study, as both indicate the degree of hemodynamic derangement or vasoplegia following initiation of ECMO support are associated with clinical outcomes and expected survival.…”

Section: Discussionsupporting

confidence: 87%

“…A recent analysis of the ELSO Registry revealed that in patients with various forms of cardiogenic shock supported by VA-ECMO, early improvements of pulse pressure and systolic blood pressure following ECMO initiation were associated with improved mortality. 17 While this report did not evaluate Values reported as n (%) or mean ± standard deviation. ECMO, extracorporeal membrane oxygenation; ICU, intensive care unit; VIS, vasoactive-inotropic score.…”

Section: Discussionmentioning

confidence: 92%

Evaluation of Vasoactive-Inotropic Score and Survival to Decannulation in Adult Patients on Venoarterial Extracorporeal Life Support: An Observational Cohort Study

et al. 2023

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Extracorporeal life support with venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used to assist circulation in patients with severe cardiogenic shock or cardiac arrest. The vasoactive-inotropic score (VIS) is a standardized calculation of vasoactive medication support which uses coefficients for each medication that converts them to an equivalent value. The purpose of this study was to assess the VIS as an early prognostication tool for survival to decannulation patients on adult VA-ECMO support. This was a single-center, observational cohort study of adult patients who received VA-ECMO support compared based on their survival to decannulation. The primary endpoint was the VIS at hour 24 postcannulation. Among the 265 patients included in this study, 140 patients (52.8%) survived to decannulation of VA-ECMO. At 24 hours postcannulation, a lower VIS was observed in the group that survived decannulation (6.5 ± 7.5 vs. 12.3 ± 16.9; p < 0.001). Multivariate analysis performed also demonstrates an association between 24-hour VIS and survival to decannulation (odds ratio 0.95; 95% confidence interval, 0.91-0.95). This study suggests that the 24-hour VIS may be an early prognostic indicator in patients on VA-ECMO patients.

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“…Overall, 54 studies (58%) found no statistical association between race and/or ethnicity and outcome (37–76), while 36 (39%) observed adverse outcomes in populations from underrepresented/diverse racial or ethnic backgrounds (Black/African American, Asian, Hispanic, or “other”/“non-Caucasian”/“non-White”). Of citations identifying adverse outcomes, 8 (22%) used univariate (77–84) and 28 (78%) used multivariate analyses. Of multivariate analyses, diverse populations, compared with nondiverse/White patients, were independently associated with mortality (26, 27, 29, 30, 32, 35, 85–100), adverse neurologic outcomes (101), or prolonged ECMO duration (34).…”

Section: Resultsmentioning

confidence: 99%

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

Moynihan

Dorste

Alizadeh

et al. 2023

Critical Care Medicine

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Objectives: To map the scope, methodological rigor, quality, and direction of associations between social determinants of health (SDoH) and extracorporeal membrane oxygenation (ECMO) utilization or outcomes. Data Sources: PubMed, Web of Science, Embase, and Cochrane Library databases were systematically searched for citations from January 2000 to January 2023, examining socioeconomic status (SES), race, ethnicity, hospital and ECMO program characteristics, transport, and geographic location (context) with utilization and outcomes (concept) in ECMO patients (population). Study Selection: Methodology followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping review extension. Two reviewers independently evaluated abstracts and full text of identified publications. Exclusion criteria included non-English, unavailable, less than 40 patients, and periprocedural or mixed mechanical support. Data Extraction: Content analysis used a standardized data extraction tool and inductive thematic analysis for author-proposed mediators of disparities. Risk of bias was assessed using the Quality in Prognosis Studies tool. Data Synthesis: Of 8,214 citations screened, 219 studies were identified. Primary analysis focuses on 148 (68%) including race/ethnicity/SES/payer variables including investigation of ECMO outcomes 114 (77%) and utilization 43 (29%). SDoH were the primary predictor in 15 (10%). Overall quality and methodologic rigor was poor with advanced statistics in 7%. Direction of associations between ECMO outcomes or utilization according to race, ethnicity, SES, or payer varied. In 38% adverse outcomes or lower use was reported in underrepresented, under-resourced or diverse populations, while improved outcomes or greater use were observed in these populations in 7%, and 55% had no statistically significant result. Only 26 studies (18%) discussed mechanistic drivers of disparities, primarily focusing on individual- and hospital-level rather than systemic/structural factors. Conclusions: Associations between ECMO utilization and outcomes with SDoH are inconsistent, complicated by population heterogeneity and analytic shortcomings with limited consideration of systemic contributors. Findings and research gaps have implications for measuring, analyzing, and interpreting SDoH in ECMO research and healthcare.

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Early Blood Pressure Variables Associated With Improved Outcomes in VA-ECLS

Cited by 19 publications

References 18 publications

Phenotyping Refractory Cardiogenic Shock Patients Receiving Venous-arterial Extracorporeal Membrane Oxygenation with Machine Learning Algorithms

Phenotyping Refractory Cardiogenic Shock Patients Receiving Venous-arterial Extracorporeal Membrane Oxygenation with Machine Learning Algorithms

Evaluation of Vasoactive-Inotropic Score and Survival to Decannulation in Adult Patients on Venoarterial Extracorporeal Life Support: An Observational Cohort Study

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

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