Clinical Features and Outcomes in Adults With Cardiogenic Shock Supported by Extracorporeal Membrane Oxygenation

Carroll, Brett J.; Shah, Ravi; Murthy, Venkatesh L.; McCullough, Stephen; Reza, Nosheen; Thomas, Sunu S.; Song, Tae Ho; Newton‐Cheh, Christopher; Camuso, Janice; MacGillivray, Thomas E.; Sundt, Thoralf M.; Semigran, Marc J.; Lewis, Gregory D.; Baker, Joshua N.; García, José Pérez

doi:10.1016/j.amjcard.2015.08.030

Cited by 61 publications

(27 citation statements)

References 29 publications

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“…Previous studies have demonstrated a good outcome (hospital discharge rate up to 75%) in VA‐ECMO for pure biventricular failure such as acute fulminant myocarditis, or right ventricular failure such as pulmonary embolism . However, hospital discharge rates in predominant left ventricular failure such as acute myocardial infarction may be lower …”

Section: Discussionmentioning

confidence: 99%

Isolated left ventricular failure is a predictor of poor outcome in patients receiving veno‐arterial extracorporeal membrane oxygenation

Uil

Jewbali

Heeren³

et al. 2017

European J of Heart Fail

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Aims We investigated survival according to the nature of heart failure (isolated left, vs isolated right, vs biventricular heart failure) in patients undergoing extracorporeal membrane oxygenation (ECMO) for refractory cardiogenic shock of different causes. Methods and results This single‐center study included 132 patients with acute myocardial infarction (20%), acute on chronic heart failure (14%), post cardiotomy (17%), cardiac allograft failure (8%), pulmonary embolism (16%), and acute nonischemic heart failure (25%). Ventricular function was a priori assessed by transthoracic echocardiography (isolated left (26%), isolated right (22%), or biventricular heart failure (52%)). The primary endpoint was all‐cause mortality at 90 days and long‐term. Predictors for adverse outcome were identified by univariate and multivariate Cox regression analysis. Median duration of ECMO support was 6 [3–9] days. Ninety‐day survival was 51% (isolated LV failure 32% vs. isolated RV failure 62% vs. biventricular failure 55%, p = 0.04). The presence of isolated left ventricular failure was a predictor for 90‐day mortality, irrespective of diagnosis and SAVE score. In patients who survived 90 days following ECMO implantation, long‐term (4‐year) survival was excellent (95%, no difference between subgroups). Conclusion Isolated left ventricular failure was an independent predictor for 90‐day outcome.

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Section: Discussionmentioning

confidence: 99%

Isolated left ventricular failure is a predictor of poor outcome in patients receiving veno‐arterial extracorporeal membrane oxygenation

Uil

Jewbali

Heeren³

et al. 2017

European J of Heart Fail

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“…3 Indeed, VA-ECMO after adult cardiac surgery is associated with higher risk of in-hospital mortality compared with other conditions. 26,31,38 This negative prognostic effect may be explained by the combined impact of the underlying cardiac disease and the extent of the surgical procedure along with any possible concomitant technical complication occurring during surgery. Despite this, VA-ECMO confirmed its value in salvaging a significant number of patients who would have most certainly died without mechanical cardiopulmonary resuscitation.…”

Section: Discussionmentioning

confidence: 99%

Meta-Analysis of the Outcome After Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation in Adult Patients

Biancari

Perrotti

Dalén

et al. 2018

Journal of Cardiothoracic and Vascular Anesthesia

100

104

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“…At this point, a refined decision-making based on the assessment of reversibility of end-organ damage and patient's overall prognosis is necessary. A continuation of therapy and weaning should be limited to patients with a fair prognosis [43]. Basically, it is important to have regular multidisciplinary discussions involving intensivist, surgeons, cardiologists, patient, and relatives before and during the whole weaning process.…”

Section: Basic Requirements For Promising Weaning Attemptsmentioning

confidence: 99%

Update on Weaning from Veno-Arterial Extracorporeal Membrane Oxygenation

Lüsebrink

Stremmel

Stark

et al. 2020

JCM

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Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides temporary cardiac and respiratory support and has emerged as an established salvage intervention for patients with hemodynamic compromise or shock. It is thereby used as a bridge to recovery, bridge to permanent ventricular assist devices, bridge to transplantation, or bridge to decision. However, weaning from VA-ECMO differs between centers, and information about standardized weaning protocols are rare. Given the high mortality of patients undergoing VA-ECMO treatment, it is all the more important to answer the many questions still remaining unresolved in this field Standardized algorithms are recommended to optimize the weaning process and determine whether the VA-ECMO can be safely removed. Successful weaning as a multifactorial process requires sufficient recovery of myocardial and end-organ function. The patient should be considered hemodynamically stable, although left ventricular function often remains impaired during and after weaning. Echocardiographic and invasive hemodynamic monitoring seem to be indispensable when evaluating biventricular recovery and in determining whether the VA-ECMO can be weaned successfully or not, whereas cardiac biomarkers may not be useful in stratifying those who will recover. This review summarizes the strategies of weaning of VA-ECMO and discusses predictors of successful and poor weaning outcome.

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Clinical Features and Outcomes in Adults With Cardiogenic Shock Supported by Extracorporeal Membrane Oxygenation

Cited by 61 publications

References 29 publications

Isolated left ventricular failure is a predictor of poor outcome in patients receiving veno‐arterial extracorporeal membrane oxygenation

Isolated left ventricular failure is a predictor of poor outcome in patients receiving veno‐arterial extracorporeal membrane oxygenation

Meta-Analysis of the Outcome After Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation in Adult Patients

Update on Weaning from Veno-Arterial Extracorporeal Membrane Oxygenation

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