Predictors of mortality following extracorporeal membrane oxygenation support in an unselected, critically ill patient population

Édes, István; Németh, Balázs Tamás; Hartyánszky, István; Szilveszter, Bálint; Kulyassa, Péter; Fazekas, Levente; Pólos, Miklós; Németh, Endre; Becker, David M.; Merkely, Béla

doi:10.5114/aic.2021.109149

Cited by 7 publications

(7 citation statements)

References 27 publications

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“…Some studies demonstrated that malignancy, history of revascularization, duration of cardiac arrest, heart failure, male gender, pH < 7.3, age ≥65 years, and low BMI are predictors for mortality in ECMO patients. 17,18 Chen and colleagues found that long-term mortality was associated with older age, left main disease, and high VIS. 19 Burrel and coworkers found that higher lactate, ischemic heart disease, renal replacement, and higher bilirubin predicted mortality after venoarterial ECMO.…”

Section: Discussionmentioning

confidence: 99%

Venoarterial extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock: The impact of cannulation strategy on survival

et al. 2022

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Background The optimal venoarterial extracorporeal membrane oxygenation (VA ECMO) cannulation strategy in patients with postcardiotomy cardiogenic shock is still debatable. Studies evaluating the effect of cannulation strategy on long-term survival are scarce. Objectives We investigated the impact of central versus peripheral cannulation strategy for ECMO insertion on hospital outcomes and survival in postcardiotomy cardiogenic shock patients. Methods This retrospective study involved 101 patients who had either central or peripheral ECMO due to postcardiotomy shock between June 2009 and December 2020. Study endpoints were limb ischemia, bleeding, blood transfusion, wound infection, and overall survival. Results Eighty-four patients received central (c) ECMO, and 17 patients had peripheral (p) ECMO. In the group of pECMO, limb ischemia was significantly higher (5 [29.41%] vs 6 [7.14%]; p = .01). Other endpoints were similar in both groups. Thirty-day mortality was nonsignificantly different between both cohorts (cECMO 34 [41.67%] vs pECMO 10 [58.82%]; p = .29). However, overall survival was better with cECMO (Log-rank p = .02). Patients’ age [HR: 1.04 (95% CI: 1.02–1.06); p = .001], pECMO [HR: 1.98 (95% CI: 1.11–3.55), p = .002] and presence of infective endocarditis [HR: 3.54 (95% CI: 1.52–8.24), p = .03] were significant predictors of overall mortality. Conclusions Peripheral ECMO was associated with an increased risk of limb ischemia; however, bleeding, blood transfusion, infection, and 30-day mortality were comparable to central ECMO. Central cannulation was associated with a better 1-year survival rate. Therefore, central cannulation might be the preferred strategy for patients with postcardiotomy cardiogenic shock.

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Section: Discussionmentioning

confidence: 99%

Venoarterial extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock: The impact of cannulation strategy on survival

et al. 2022

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“…Nonetheless, in the absence of internationally accepted CS ACS pVA-ECMO initialization guidelines, our center has developed its own protocol (Figure 2), based on available literature data and empirical findings from our own clinical study using one of the largest single-center databases among the specialized institutions worldwide (34). The protocol considers multiple factors, such as clinical condition, age, low-flow times, and comorbidities.…”

Section: Patient Selectionmentioning

confidence: 99%

Acute coronary syndrome associated cardiogenic shock in the catheterization laboratory: peripheral veno-arterial extracorporeal membrane oxygenator management and recommendations

Ehrenberger,

Németh,

Kulyassa

et al. 2023

Front. Med.

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Cardiogenic shock (CS) in acute coronary syndrome (ACS) is a critical disease with high mortality rates requiring complex treatment to maximize patient survival chances. Emergent coronary revascularization along with circulatory support are keys to saving lives. Mechanical circulatory support may be instigated in severe, yet still reversible instances. Of these, the peripheral veno-arterial extracorporeal membrane oxygenator (pVA-ECMO) is the most widely used system for both circulatory and respiratory support. The aim of our work is to provide a review of our current understanding of the pVA-ECMO when used in the catheterization laboratory in a CS ACS setting. We detail the workings of a Shock Team: pVA-ECMO specifics, circumstances, and timing of implantations and discuss possible complications. We place emphasis on how to select the appropriate patients for potential pVA-ECMO support and what characteristics and parameters need to be assessed. A detailed, stepwise implantation algorithm indicating crucial steps is also featured for practitioners in the catheter laboratory. To provide an overall aspect of pVA-ECMO use in CS ACS we further gave pointers including relevant human resource, infrastructure, and consumables management to build an effective Shock Team to treat CS ACS via the pVA-ECMO method.

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“…The availability and application numbers of extracorporeal life support (ECLS) and extracorporeal membrane oxygenation (ECMO) are continuously increasing in cardiac surgery centers [ 1 , 2 ]. Even though ECLS and ECMO are complex therapies that require high-level specialized centers, the first multidisciplinary guideline for the organization and application of ECMO therapy for cardiocirculatory support was published in 2021 [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Early Application of ECMO after Sudden Cardiac Arrest to Prevent Further Deterioration: A Review and Case Report

Kiss

Nagy

Pál-Jakab

et al. 2023

JCM

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ECMO has become a therapeutic modality for in- and out-of-hospital scenarios and is also suitable as a bridging therapy until further decisions and interventions can be made. Case report: A 27-year-old male patient with mechanical aortic valve prothesis had a sudden cardiac arrest (SCA). ROSC had been achieved after more than 60 min of CPR and eight DC shocks due to ventricular fibrillation (VF). The National Ambulance Service unit transported the patient to our clinic for further treatment. Due to the trauma and therapeutic INR, a CT scan was performed and ruled out bleeding. Echocardiography described severely decreased left ventricular function. Coronary angiography was negative. Due to the therapeutic refractory circulatory and respiratory failure against intensive care, VA-ECMO implantation was indicated. After four days of ECMO treatment, the patient’s circulation was stabilized without neurological deficit, and the functions of the end organs were normalized. Cardiac MRI showed no exact etiology behind SCA. ICD was implanted due to VF and SCA. The patient was discharged after 19 days of hospitalization. Conclusion: This case report points out that the early application of mechanical circulatory support could be an outcome-determinant therapeutic modality. Post-resuscitation care includes cardiorespiratory stabilization, treatment of reversible causes of malignant arrhythmia, and secondary prevention.

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Predictors of mortality following extracorporeal membrane oxygenation support in an unselected, critically ill patient population

Cited by 7 publications

References 27 publications

Venoarterial extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock: The impact of cannulation strategy on survival

Venoarterial extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock: The impact of cannulation strategy on survival

Acute coronary syndrome associated cardiogenic shock in the catheterization laboratory: peripheral veno-arterial extracorporeal membrane oxygenator management and recommendations

Early Application of ECMO after Sudden Cardiac Arrest to Prevent Further Deterioration: A Review and Case Report

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