Extracorporeal membrane oxygenation postcardiotomy: “With great power comes great responsibility”

Arora, Rakesh C.; Wischmeyer, Paul E.; Singal, Rohit K.

doi:10.1016/j.jtcvs.2016.09.065

Cited by 4 publications

(1 citation statement)

References 7 publications

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“…However, the use of VA-ECMO creates a risk of prolonging life-sustaining therapy in patients in whom further treatment is not indicated [ 3 , 4 , 5 ]. Therefore, intensive ongoing research focuses on identifying explicit biomarkers of cardiac recovery that could be used in the management of the therapy plan of the ECMO recipient, including early estimated triage to the possibility of weaning of ECMO, heart transplantation/LVAD candidacy or avoiding unnecessary prolongation of life-sustaining therapy [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Troponin T and Survival following Cardiac Surgery in Patients Supported with Extracorporeal Membrane Oxygenation for Post-Cardiotomy Shock

Celińska-Spodar,

Załęska Kocięcka,

Kowalik

et al. 2023

Diagnostics

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Background: While troponin is an established biomarker of cardiac injury, its prognostic significance in post-cardiotomy cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation (PCCS–VA-ECMO) remains unclear. Objective: This study aimed to assess the correlation between early post-operative troponin T levels and both short-term and long-term mortality outcomes in this cohort. Methods: We evaluated 1457 troponin T measurements from 102 PCCS–VA-ECMO patients treated from 2013 to 2018 at a specialized cardio-surgical and transplantation center. Emphasis was placed on troponin concentrations at 24–48 h post-surgery, post-VA-ECMO implantation, and peak troponin levels in relation to VA-ECMO weaning, as well as 90-day and one-year mortality. Results: No significant association was observed between troponin T levels post-VA-ECMO implantation and 90-day mortality (median: 1338 ng/L for overall, 1529 ng/L for survivors vs. 1294 ng/L for non-survivors; p = 0.146) or between peak troponin levels and 90-day mortality (median: 3583 ng/L for overall, 3337 ng/L for survivors vs. 3666 ng/L for non-survivors; p = 0.709). Comprehensive multivariate models showed no correlation between troponin levels and various mortality endpoints. Notably, age, procedure urgency, type, LVEF pre-surgery, Euroscore II, prior cardiac arrest, and VA-ECMO duration were not linked with troponin release. Hemodiafiltration emerged as the strongest mortality risk factor [HR 2.4]. Conclusions: Isolated early Troponin T release and peak troponin T were not associated, while organ complications were linked with VA-ECMO weaning or short- and long-term prognosis. The results underscore the multi-organ implications of PCCS in determining survival.

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Section: Introductionmentioning

confidence: 99%

Troponin T and Survival following Cardiac Surgery in Patients Supported with Extracorporeal Membrane Oxygenation for Post-Cardiotomy Shock

Celińska-Spodar,

Załęska Kocięcka,

Kowalik

et al. 2023

Diagnostics

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Structured review of post-cardiotomy extracorporeal membrane oxygenation: part 1—Adult patients

Lorusso

Raffa

Alenizy

et al. 2019

The Journal of Heart and Lung Transplantation

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The Challenges of Venoarterial ECMO for Postcardiotomy Shock

Hessel

Betz

2021

Journal of Cardiothoracic and Vascular Anesthesia

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Venoarterial extracorporeal membrane oxygenation (VA ECMO) commonly is used to manage cardiogenic shock after cardiac surgery, transcatheter aortic valve replacement, 1,2 cardiac catheterization procedures, and cardiac arrest. 3,4 Anesthesiologists often are involved in the management of these patients both in the operating room and in critical care settings. However, its use raises many medical, ethical, and economic challenges. 5,6 Several articles, 7-14 editorials, 15,16 and a pro/con debate 17,18 related to ECMO after cardiac surgery have appeared this year in this Journal of Cardiothoracic and Vascular Anesthesia. In this issue of the Journal, Tohme et al. addressed the problem of "weaning-related shock" after use of peripheral VA ECMO in adults after cardiac surgery (heart transplant in 40%, valve surgery in 23%, coronary artery bypass graft in 16%, and other types of surgery in 21%). 19 Their study was designed to study the outcome of attempts at weaning from extracorporeal membrane oxygenation (ECMO) and identify risk factors for failure. In this retrospective, single-center (a French university hospital), observational study conducted between 2015 and 2017, they reported the outcomes of 146 patients. Prior to attempted weaning, about 33% of 301 patients receiving ECMO after cardiac surgery died and were excluded from evaluation. Of the 146 who were weaned, 38% developed post-weaningÀrelated shock (73% on day of weaning and all within 4 days). Twenty-two percent required return to ECMO. The intensive care unit mortality in those who developed postweaning shock was 42%, which was >5 times that in those who did not develop post-weaning shock (7%). Post-weaning shock was attributed to sepsis in most patients (53%) (pneumonia in 75%, bacteremia in 46%, implantation site infection 32%, catheter infection 20%; all more common than in those without weaning-related shock), and less commonly due to right ventricular failure (11%), arrhythmias (7%), hemorrhage (4%), or unidentified (16%). Only 2 risk factors were identified on multivariate logistic regression analysis: history of pulmonary hypertension and norepinephrine infusion at time of weaning.

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Extracorporeal membrane oxygenation postcardiotomy: “With great power comes great responsibility”

Cited by 4 publications

References 7 publications

Troponin T and Survival following Cardiac Surgery in Patients Supported with Extracorporeal Membrane Oxygenation for Post-Cardiotomy Shock

Troponin T and Survival following Cardiac Surgery in Patients Supported with Extracorporeal Membrane Oxygenation for Post-Cardiotomy Shock

Structured review of post-cardiotomy extracorporeal membrane oxygenation: part 1—Adult patients

The Challenges of Venoarterial ECMO for Postcardiotomy Shock

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