Advanced Age as a Predictor of Survival and Weaning in Venoarterial Extracorporeal Oxygenation: A Retrospective Observational Study

Lee, Woo Surng; Kim, YoHan; Choi, Hyun–Hee; Kim, Hyoungsoo; Lee, Sunhee; Lee, HeeSung; Chee, Hyun Keun; Kim, Junseok; Lee, Song-Am; Kim, YongHun; Cho, Seong-Joon; Ryu, Se-Min; Park, SungMin

doi:10.1155/2017/3505784

Cited by 12 publications

(14 citation statements)

References 74 publications

(58 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We suggest that such younger-old patients should not be excluded from E-CPR use [38]. We consider 75 years of age an exclusion criterion for E-CPR use in our institution, similar to most other authors [17,32,38,39], because of the low rate of benefits from E-CPR in such old-old patients.…”

Section: Discussionmentioning

confidence: 55%

Can we predict patient outcome before extracorporeal membrane oxygenation for refractory cardiac arrest?

Siao

Chiu

et al. 2020

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

Background: Refractory cardiac arrest resistant to conventional cardiopulmonary resuscitation (C-CPR) has a poor outcome. Although previous reports showed that extracorporeal cardiopulmonary resuscitation (E-CPR) can improve the clinical outcome, there are no clinically applicable predictors of patient outcome that can be used prior to the implementation of E-CPR. We aimed to evaluate the use of clinical factors in patients with refractory cardiac arrest undergoing E-CPR to predict patient outcome in our institution. Methods: This is a single-center retrospective study. We report 112 patients presenting with refractory cardiac arrest resistant to C-CPR between January 2012 and November 2017. All patients received E-CPR for continued life support when a cardiogenic etiology was presumed. Clinical factors associated with patient outcome were analyzed. Significant pre-ECMO clinical factors were extracted to build a patient outcome risk prediction model. Results: The overall survival rate at discharge was 40.2, and 30.4% of patients were discharged with good neurologic function. The six-month survival rate after hospital discharge was 36.6, and 25.9% of patients had good neurologic function 6 months after discharge. We stratified the patients into low-risk (n = 38), medium-risk (n = 47), and high-risk groups (n = 27) according to the TLR score (low-flow Time, cardiac arrest Location, and initial cardiac arrest Rhythm) that we derived from pre-ECMO clinical parameters. Compared with the medium-risk and high-risk groups, the low-risk group had better survival at discharge (65.8% vs. 42.6% vs. 0%, p < 0.0001) and at 6 months (60.5% vs. 38.3% vs. 0%, p = 0.0001). The low-risk group also had a better neurologic outcome at discharge (50% vs. 31.9% vs. 0%, p = 0.0001) and 6 months after discharge (44.7% vs. 25.5% vs. 0%, p = 0.0003) than the medium-risk and high-risk groups. Conclusions: Patients with refractory cardiac arrest receiving E-CPR can be stratified by pre-ECMO clinical factors to predict the clinical outcome. Larger-scale studies are required to validate our observations.

show abstract

Section: Discussionmentioning

confidence: 55%

Can we predict patient outcome before extracorporeal membrane oxygenation for refractory cardiac arrest?

Siao

Chiu

et al. 2020

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

show abstract

“…However, to limit biases due to the absence of randomization, we used a multivariate logistic regression model with a propensity score analysis. Although several definitions of VA-ECMO weaning success have been proposed [11, 29, 30], we adopted the definition used in the recent study by Distelmeier et al [10]. Aortic velocity–time integral and left ventricular ejection fraction were not collected in the control group.…”

Section: Limitationsmentioning

confidence: 99%

Impact of levosimendan on weaning from peripheral venoarterial extracorporeal membrane oxygenation in intensive care unit

Vally

Ferdynus

Persichini

et al. 2019

Ann. Intensive Care

View full text Add to dashboard Cite

BackgroundFew data are available on the impact of levosimendan in refractory cardiogenic shock patients undergoing peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO). The aim of this study was to evaluate the impact of levosimendan on VA-ECMO weaning in patients hospitalized in intensive care unit (ICU).MethodsThis retrospective cohort study was conducted in a French university hospital from 2010 to 2017. All patients hospitalized in ICU undergoing VA-ECMO were consecutively evaluated.ResultsA total of 150 patients undergoing VA-ECMO were eligible for the study. Thirty-eight propensity-matched patients were evaluated in the levosimendan group and 65 in the non-levosimendan group. In patients treated with levosimendan, left ventricular ejection fraction had increased from 21.5 ± 9.1% to 30.7 ± 13.5% (P < 0.0001) and aortic velocity–time integral from 8.9 ± 4 cm to 12.5 ± 3.8 cm (P = 0.002) 24 h after drug infusion. After propensity score matching, levosimendan was the only factor associated with a significant reduction in VA-ECMO weaning failure rates (hazard ratio = 0.16; 95% confidence interval 0.04–0.7; P = 0.01). Kaplan–Meier survival curves showed that survival rates at 30 days were 78.4% for the levosimendan group and 49.5% for the non-levosimendan group (P = 0.02). After propensity score matching analysis, the difference in 30-day mortality between the two groups was not significant (hazard ratio = 0.55; 95% confidence interval 0.27–1.10; P = 0.09).ConclusionsOur results suggest that levosimendan was associated with a beneficial effect on VA-ECMO weaning in ICU patients.

show abstract

“…Some authors have proposed that successful weaning should be defined as 30-day survival without (re)implantation of another mechanical support device [5,7,8]. Other groups have limited the critical time frame to 48 [9,10] or even 24 h [11,12] after decannulation.…”

Section: Failure To Wean From Va Ecmomentioning

confidence: 99%

The ABCDE approach to difficult weaning from venoarterial extracorporeal membrane oxygenation

2022

View full text Add to dashboard Cite

Venoarterial extracorporeal membrane oxygenation (VA ECMO) has been increasingly applied in patients with cardiogenic shock in recent years. Nevertheless, many patients cannot be successfully weaned from VA ECMO support and 1-year mortality remains high. A systematic approach could help to optimize clinical management in favor of weaning by identifying important factors in individual patients. Here, we provide an overview of pivotal factors that potentially prevent successful weaning of VA ECMO. We present this through a rigorous approach following the relatable acronym ABCDE, in order to facilitate widespread use in daily practice.

show abstract

Advanced Age as a Predictor of Survival and Weaning in Venoarterial Extracorporeal Oxygenation: A Retrospective Observational Study

Cited by 12 publications

References 74 publications

Can we predict patient outcome before extracorporeal membrane oxygenation for refractory cardiac arrest?

Can we predict patient outcome before extracorporeal membrane oxygenation for refractory cardiac arrest?

Impact of levosimendan on weaning from peripheral venoarterial extracorporeal membrane oxygenation in intensive care unit

The ABCDE approach to difficult weaning from venoarterial extracorporeal membrane oxygenation

Contact Info

Product

Resources

About