Survival and Outcomes After Cardiac Arrest With VA-ECMO Rescue Therapy

Schurr, James W.; Noubani, Mohammad; Santore, Lee Ann; Rabenstein, Andrew P.; Dhundale, Kathleen; Fitzgerald, Jillian; Cahill, Jan; Bilfinger, Thomas V.; Seifert, F.; McLarty, Allison

doi:10.1097/shk.0000000000001809

Cited by 6 publications

(5 citation statements)

References 31 publications

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“…1 Many studies predicting the survival of patients supported with VA-ECMO have been published to date. [2][3][4][5][6][7][8] Different comorbidities, laboratory, invasive hemodynamic, and imaging parameters have been proposed in various models predicting VA-ECMO survival. [2][3][4][5] On the contrary, only a handful of publications address weaning off VA-ECMO and the postdecannulation period with high variability in definitions of weaning variables and outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4][5][6][7][8] Different comorbidities, laboratory, invasive hemodynamic, and imaging parameters have been proposed in various models predicting VA-ECMO survival. [2][3][4][5] On the contrary, only a handful of publications address weaning off VA-ECMO and the postdecannulation period with high variability in definitions of weaning variables and outcomes. [6][7][8] Although patients experiencing post-decannulation decompensation could be re-cannulated, a recent analysis of 1818 patients from the ELSO registry demonstrated a decrease in survival with each additional ECMO run.…”

Section: Introductionmentioning

confidence: 99%

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Cause of In-Hospital Death After Weaning from Venoarterial-Extracorporeal Membrane Oxygenation

Bjelic

Kumar

et al. 2022

J Intensive Care Med

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Purpose A survival gap between weaning from venoarterial-extracorporeal membrane oxygenation (VA-ECMO) and the hospital discharge has been consistently reported. The aim of this study is to investigate the clinical features of patients who underwent successful VA-ECMO decannulation at our institution and to identify the major contributors responsible for adverse outcomes. Methods We retrospectively reviewed all patients supported with VA-ECMO in our institution between January 2013 and June 2020. Only patients that survived VA-ECMO and underwent successful decannulation were included and dichotomized based on survival to hospital discharge: non-survivors versus survivors. The primary study outcome was the cause of death after successful VA-ECMO decannulation. Results Of the 262 adult patients who underwent VA-ECMO decannulation, 72 (27.5%) patients did not survive to hospital discharge. Non-survivors were older (62 vs. 54 years, p < 0.001) and suffering from many pre-existing comorbidities. Pneumonia and sepsis were the most frequent infectious complication and almost twice as likely in non-survivors. Major causes of death were: cardiovascular (31.9%), infections (25.0%) and neurological (20.8%). The survival curve demonstrated that 51.4% of our patients died within 8 days after decannulation. Multivariate analysis identified older age, central venous cannulation, pulmonary bleeding and infection, dialysis after VA-ECMO, sepsis, and ischemic stroke (OR = 7.86, 95% CI: 2.76-2.43, p < 0.001) as factors significantly predisposing to patients’ death. Conclusion In our study, one-third of patients decannulated off VA-ECMO did not survive to hospital discharge due to end-stage heart failure, infections or neurological injury. The first 8 post-decannulation days were recognized as a critical period where thorough strategies to prevent acquired infections and cautious support of end-organ function should be warranted. Future large-scale trials are needed to confirm our results.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cause of In-Hospital Death After Weaning from Venoarterial-Extracorporeal Membrane Oxygenation

Bjelic

Kumar

et al. 2022

J Intensive Care Med

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“…Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an extracorporeal life support (ECLS) technique that oxygenates blood externally. In the context of CS, it provides comprehensive cardiopulmonary support, maintains hemodynamic stability, and alleviates cardiac load (11)(12)(13)(Fig. 1A).…”

Section: Introductionmentioning

confidence: 99%

Venoarterial Extracorporeal Membrane Oxygenation Reduces Myocardial and Mitochondrial Damage in Acute Myocardial Infarction

Ni,

Dong,

Zhu

et al. 2024

Shock

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Background Myocardial infarction (MI) is a common cardiovascular disease with a high fatality rate once accompanied by cardiogenic shock. The efficacy of extracorporeal membrane oxygenation (ECMO) in treating myocardial infarction is controversial. Methods MI was induced by ligating the left anterior descending artery in adult male rats. Groups were defined as follows: MI group, reperfusion for 90 min after 30 min of left anterior descending artery (LAD) occlusion; MI + ECMO group, reperfusion and ECMO were performed for 90 min immediately after 30 min of LAD occlusion; prolonged MI + ECMO group, ECMO was used immediately after 30 minutes of occlusion with persistent occlusion of the LAD for an additional 30 minutes, followed by 90 minutes of reperfusion. The myocardial infarct size and mitochondrial morphology and function data were collected and compared of each group. Results The ECMO groups had a smaller myocardial infarct size and larger percentage ejection fraction. Compared with the prolonged MI + ECMO group, the immediate reperfusion group had a lower percentage of infarct size (63.28% versus 17.97% versus 31.22%, MI versus MI + ECMO versus prolonged MI + ECMO). Mitochondria isolated from the ischemic zone showed an intact mitochondrial structure, including fewer voids and broken crists, and preserved activity of mitochondrial complex II and complex IV in ECMO groups. Conclusions ECMO support in myocardial infarction can reduce myocardial injury despite delayed coronary reperfusion.

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“…The number of patients undergoing ECMO therapy in the ED is increasing as a number of recent studies show that the use of ECMO can improve outcomes in patients with cardiac arrests—mainly survival without neurologic deficit. 4 , 5 However, the ET in most EDs is still at the preliminary stage, and ECMO-induced complications are common, the success rate of weaning from ECMO is not relatively high. Patient safety issues remain a serious challenge for the ET of ED.…”

Section: Introductionsmentioning

confidence: 99%

Concern for Patient Safety Culture of ECMO Team in Emergency Department: A Cross-Sectional Survey

Zhou

Xiao

et al. 2022

INQUIRY

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To evaluate the patient safety culture status of the ECMO team in the emergency department of a tertiary care hospital. A cross-sectional survey was conducted in the emergency department of Xiangya Hospital from September 1st to 30th, 2021. The Chinese version of HSOPSC electronic questionnaire was administered to all staff involved in ECMO management and initiation. A total of 152 ECMO team members completed the survey. Among the 12 dimensions of patient safety culture, 4 dimensions recorded relatively high positive response rates (>50%): organizational learning-continuous improvement (87.1%), teamwork within units (86.8%), feedback and communication about errors (58.5%), and supervisor/manager expectations and actions promoting patient safety (55.6%). 8 dimensions recorded relatively low positive response rates (<50%): nonpunitive responses to errors (24.1%), hospital handoffs and transitions (27.1%), staffing (28.6%), the frequency of event reporting (32.4%), teamwork across units (33.2%), communication openness (39.7%), management support for patient safety (48.7%), and overall perceptions of patient safety (49.3%). The overall level of patient safety culture was measured at 47.6%. The ECMO team should immediately address issues of nonpunitive responses to errors, hospital handoffs and transitions, and staffing to improve the safety of ECMO. Going forward, the head of the ECMO team should regard patient safety culture as a top priority, improve staff satisfaction, standardize the transfer and handover process, and create a blame-free environment to facilitate event reporting.

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Survival and Outcomes After Cardiac Arrest With VA-ECMO Rescue Therapy

Cited by 6 publications

References 31 publications

Cause of In-Hospital Death After Weaning from Venoarterial-Extracorporeal Membrane Oxygenation

Cause of In-Hospital Death After Weaning from Venoarterial-Extracorporeal Membrane Oxygenation

Venoarterial Extracorporeal Membrane Oxygenation Reduces Myocardial and Mitochondrial Damage in Acute Myocardial Infarction

Concern for Patient Safety Culture of ECMO Team in Emergency Department: A Cross-Sectional Survey

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