Five-Year results of 219 consecutive patients treated with extracorporeal membrane oxygenation for refractory postoperative cardiogenic shock

Doll, Nicolas; Kiaii, Bob; Borger, Michael A.; Bucerius, Jan; Krämer, Klaus; Schmitt, D; Walther, Thomas; Mohr, Friedrich W.

doi:10.1016/s0003-4975(03)01329-8

Cited by 288 publications

(254 citation statements)

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“…[1][2][3][4][5][6][7][8][9] It has also been used in the treatment of acute cardiac failure due to cardiogenic shock (acute myocardial infarction, ischemic and nonischemic cardiomyopathy, myocarditis, pulmonary embolus, and cardiac arrest) and for postcardiotomy syndromes (failure to wean from cardiopulmonary bypass following cardiac surgery). 1,2,[10][11][12] ECMO is now also used in adults as a rescue therapy to bridge to heart, lung, or heart-lung transplant, as rescue therapy from primary graft dysfunction (PGD) after transplant, and to bridge patients with acute cardiac failure to support with a ventricular assist device. [13][14][15][16][17][18] ECMO is effective, but the rates of therapy-related morbidity and mortality are high, and ECMO is associated with significant resource utilization.…”

Section: Adults Treated With Extracorporeal Membrane Oxygenationmentioning

confidence: 99%

Discharge Outcome in Adults Treated With Extracorporeal Membrane Oxygenation

Guttendorf¹,

Boujoukos²,

Ren³

et al. 2014

American Journal of Critical Care

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A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Describe the medical indications for the use of extracorporeal membrane oxygenation (ECMO ACNP-BCBackground Extracorporeal membrane oxygenation (ECMO) is used for critically ill patients when conventional treatments for cardiac or respiratory failure are unsuccessful. Objectives To describe patient and treatment characteristics and discharge outcome for ECMO patients, determine which characteristics are associated with good (survival) versus poor (death before hospital discharge) outcomes, and compare characteristics of patients with cardiac versus respiratory failure indicating ECMO. Methods Single-center, retrospective review of all adult patients treated with ECMO from 2005 through 2009. Results A total of 212 patients received ECMO for cardiac (n = 126) or respiratory (n = 86) failure. Mean age was 51 (SD, 14.5) years; support duration was 135 (SD, 149) hours. Survival to discharge was 33% overall; 50% for respiratory indication and 21% for cardiac indication patients. Patients with poor outcomes were older (53 vs 47 years, P = .007), more likely to require cardiovascular support before ECMO (99% vs 91%; P = .02), and had more transfusions (48 vs 24 units, P = .005) and complications (99% vs 87%; P < .001) than did patients with good outcomes. For cardiac patients, older age was associated with poor outcome (poor, 55 vs good, 48 years; P = .01). For respiratory patients, poor outcome was associated with more ventilator days before ECMO (poor, 6 vs good, 3; P = .01), higher peak inspiratory pressure (poor, 39 vs good, 35 cm H 2 O; P = .02), and lower pulmonary compliance (poor, 19 vs good, 25 mL/cm H 2 O; P = .008). Conclusions Patients with respiratory indications for ECMO experienced better survival than did cardiac patients. Increasing age was associated with poor outcome. Complications, regardless of ECMO indication, were common and associated with poor outcome.

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Section: Adults Treated With Extracorporeal Membrane Oxygenationmentioning

confidence: 99%

Discharge Outcome in Adults Treated With Extracorporeal Membrane Oxygenation

Guttendorf¹,

Boujoukos²,

Ren³

et al. 2014

American Journal of Critical Care

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“…Previous studies showed a poor prognosis for adult patients with ECMO support and AKI, which is one of the major complications that contributes to a high mortality in adult patients following cardiac surgery [1,[4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Acute kidney injury in adult postcardiotomy patients with extracorporeal membrane oxygenation: evaluation of the RIFLE classification and the Acute Kidney Injury Network criteria

Yan

Jia

et al. 2009

European Journal of Cardio-Thoracic Surgery

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Introduction: Acute kidney injury (AKI) is one of the major complications in adult postcardiotomy patients on extracorporeal membrane oxygenation (ECMO) support. The RIFLE (the Risk of renal failure, Injury to the kidney, Failure of kidney function, Loss of kidney function and EndStage Kidney Disease) classification and the Acute Kidney Injury Network (AKIN) criteria were proposed to identify and classify AKI recently. This study aims to evaluate the occurrence of AKI during the initial 48 h of ECMO support by using both the RIFLE classification and the AKIN criteria, and to determine which scoring tool has better capability for predicting hospital mortality of adult postcardiotomy patients with ECMO support. Methods: From 2004 to 2008, 67 patients (!18 years) who received extracorporeal membrane oxygenation support after undergoing cardiac surgery were enrolled and retrospectively evaluated. Results: The average age was 50.5 AE 13.6 years; 48 patients (72%) were male. According to the RIFLE classification and the AKIN criteria, the incidence of AKI during first 48 h after receiving ECMO support was 81% and 85%, respectively. The overall mortality was 51% and the hospital mortality was much higher among patients who received renal replacement therapy (RRT) than in patients not receiving RRT (73% vs 32%, p = 0.001). Either class-Failure for the RIFLE classification (odds ratio (OR) = 12.6, 95% confidence interval (CI) = 2.2-72.3, p = 0.005) or the Stage 3 for the AKIN (OR = 30.8, 95% CI = 3.3-287.2, p = 0.003) was found to be independently associated with the hospital mortality. The area under the receiver operator characteristic (ROC) curve for hospital mortality was 0.738 for the RIFLE classification ( p = 0.001) and was 0.799 for the AKIN criteria ( p < 0.001). No significant differences were found in both the incidence of AKI and the hospital mortality of AKI by using the RIFLE/AKIN criteria. Conclusions: Acute kidney injury is a major complication and associated with high mortality in adult patients who received ECMO support after undergoing cardiac surgery. Both the RIFLE classification and the AKIN criteria have good short-term prognostic capability in these populations and either class-Failure for the RIFLE classification or the Stage 3 for the AKIN were found to be independently associated with the hospital mortality. However, it does not seem that the AKIN criteria have greater sensitivity and specificity, compared with the RIFLE classification in this study population. #

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“…Another way, how to achieve LV unloading, may be by either surgical or less effective percutaneous venting of LV (Meani et al, 2017). Additionally, an indirect LV unloading with intra-aortic balloon pump has been reported with variable success in VA-ECMO patients with partially preserved cardiac contractility (Doll et al, 2004). Finally, very promising possibility is adding Impella device that represents an alternative option to support antegrade flow from LV to aorta (Cheng et al, 2013), however it is not routinely available particularly due to its cost.…”

Section: Discussionmentioning

confidence: 99%