Extracorporeal membrane oxygenation with multiple-organ failure: Can molecular adsorbent recirculating system therapy improve survival?

Sparks, Bailey E.; Cavarocchi, Nicholas C.; Hirose, Hitoshi

doi:10.1016/j.healun.2016.09.014

Cited by 17 publications

(17 citation statements)

References 10 publications

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“…Comparisons for continuous data were based on Wilcoxon rank‐sum test for nonnormally distributed variables and Student’s t ‐test for normally distributed variables, respectively. We performed a subgroup analysis by dividing the patients into two groups according to the cut‐off bilirubin value of ≥10 mg/dL . Statistical significance was defined as P value <0.05.…”

Section: Methodsmentioning

confidence: 99%

Blood Purification With CytoSorb in Critically Ill Patients: Single‐Center Preliminary Experience

et al. 2018

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The CytoSorb adsorber, a blood purification therapy, is able to remove molecules in the 5-60 kDa range which comprises the majority of inflammatory mediators and some endogenous molecules. We aimed to evaluate CytoSorb therapy on clinical outcomes in critically ill patients. A retrospective case series study, from February 2016 to May 2017, was performed in 40 patients with multiple organ failure who received CytoSorb treatment. There were 28 patients with cardiogenic shock, 2 with septic shock, 9 with acute respiratory distress syndrome, and 1 with liver failure. Nineteen patients (47%) underwent extracorporeal membrane oxygenation, 11 (27%) had an intra-aortic balloon pump, 9 (22%) were implanted with Impella, 6 (15%) had a ventricular assist device, and 18 (45%) were treated with continuous veno-venous hemofiltration. After CytoSorb treatment, total bilirubin decreased from 11.6 ± 9.2 to 6.8 ± 5.1 mg/dL (P = 0.005), lactate from 12.1 ± 8.7 to 2.9 ± 2.5 mmol/L (P < 0.001), CPK from 2416 (670-8615) to 281 (44-2769) U/L (P <0.001) and LDH from 1230 (860-3157) to 787 (536-1148) U/L (P <0.001). The vasoactive-inotropic score after 48 h of treatment was reduced to 10 points, P = 0.009. Thirty-day mortality was 55% and ICU mortality was 52.5% at expected ICU mortality of 80%. Our study shows that CytoSorb treatment is effective in reducing bilirubin, lactate, CPK and LDH, in critically ill patients mainly due to cardiogenic shock. There is a need for randomized controlled trials to conclude on the potential benefits blood purification with CytoSorb in critically ill patients.

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Section: Methodsmentioning

confidence: 99%

Blood Purification With CytoSorb in Critically Ill Patients: Single‐Center Preliminary Experience

et al. 2018

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“…Ischaemic hepatitis and liver congestion are self-limiting, and measures which improve cardiac function can restore liver perfusion and aid recovery [ 55 ]. Molecular adsorbent recirculation system therapy may be considered in the setting of ALF as it has been noted to accelerate recovery of liver function and improve survival [ 63 ].…”

Section: Discussionmentioning

confidence: 99%

Veno-arterial extracorporeal membrane oxygenation: Special reference for use in ‘post-cardiotomy cardiogenic shock’ — A review with an Indian perspective

Patangi

Shetty

Shanmugasundaram

et al. 2020

Indian J Thorac Cardiovasc Surg

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The ultimate goals of cardiovascular physiology are to ensure adequate end-organ perfusion to satisfy the local metabolic demand, to maintain homeostasis and achieve ‘milieu intérieur’. Cardiogenic shock is a state of pump failure which results in tissue hypoperfusion and its associated complications. There are a wide variety of causes which lead to this deranged physiology, and one such important and common scenario is the post-cardiotomy state which is encountered in cardiac surgical units. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an important modality of managing post-cardiotomy cardiogenic shock with variable outcomes which would otherwise be universally fatal. VA-ECMO is considered as a double-edged sword with the advantages of luxurious perfusion while providing an avenue for the failing heart to recover, but with the problems of anticoagulation, inflammatory and adverse systemic effects. Optimal outcomes after VA-ECMO are heavily reliant on a multitude of factors and require a multi-disciplinary team to handle them. This article aims to provide an insight into the pathophysiology of VA-ECMO, cannulation techniques, commonly encountered problems, monitoring, weaning strategies and ethical considerations along with a literature review of current evidence-based practices.

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“…From the above, hyperbilirubinemia induces oxidative stress and apoptosis in many organs, which is associated with poor outcomes in patients supported by ECMO. A recent study reported that molecular adsorbent recirculating system in patients on ECMO safely accelerated recovery of liver function, reduced plasma bilirubin level and improved survival . The molecular adsorbent recirculating system may be useful in patients on ECMO suffering hyperbilirubinemia.…”

Section: Discussionmentioning

confidence: 99%

Incidence, Risk Factors, and Outcomes of Hyperbilirubinemia in Adult Cardiac Patients Supported by Veno‐Arterial ECMO

et al. 2017

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The aims of this study were to evaluate the incidence, risk factors, and outcomes of hyperbilirubinemia in cardiac patients with veno-arterial (VA) ECMO. Data on 89 adult patients with cardiac diseases who received VA ECMO implantation in our hospital were retrospectively reviewed. All patients were divided into the following three groups: 24 in normal group (N, total bilirubin [TBIL] ≤3 mg/dL), 30 in high bilirubin group (HB, 6 mg/dL ≥ TBIL > 3 mg/dL), and 35 in severe high bilirubin group (SHB, TBIL > 6 mg/dL). lg(variables + 1) was performed for nonnormally distributed variables. The incidence of hyperbilirubinemia (>3 mg/dL) was 73%. In a multiple linear regression analysis, lg(peak TBIL + 1) was significantly associated with lg(peak AST + 1) (b-coefficient 0.188, P = 0.001), lg(peak pFHb + 1) (b-coefficient 0.201, P = 0.003), and basic TBIL (b-coefficient 0.006, P = 0.009). Repeated measurement analysis of variance revealed that the main effect for three groups in pFHb and lg(AST + 1) was significant at first 3 days during ECMO. The patients in SHB had low platelets during ECMO and low in-hospital survival rate. Hyperbilirubinemia remains common in patients with VA ECMO and is associated with low platelets and high in-hospital mortality. Hemolysis and liver dysfunction during ECMO and basic high bilirubin levels are risk factors of hyperbilirubinemia.

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Extracorporeal membrane oxygenation with multiple-organ failure: Can molecular adsorbent recirculating system therapy improve survival?

Cited by 17 publications

References 10 publications

Blood Purification With CytoSorb in Critically Ill Patients: Single‐Center Preliminary Experience

Blood Purification With CytoSorb in Critically Ill Patients: Single‐Center Preliminary Experience

Veno-arterial extracorporeal membrane oxygenation: Special reference for use in ‘post-cardiotomy cardiogenic shock’ — A review with an Indian perspective

Incidence, Risk Factors, and Outcomes of Hyperbilirubinemia in Adult Cardiac Patients Supported by Veno‐Arterial ECMO

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