Gender‐related differences in treatment and outcome of extracorporeal cardiopulmonary resuscitation‐patients

Gaisendrees, Christopher; Djordjevic, Ilija; Sabashnikov, Anton; Adler, Christoph; Eghbalzadeh, Kaveh; Ivanov, Borko; Walter, Sebastian; Braumann, Simon; Wörmann, Jonas; Suhr, Laura; Gerfer, Stephen; Baldus, Stephan; Mader, Navid; Wahlers, Thorsten

doi:10.1111/aor.13844

Cited by 12 publications

(14 citation statements)

References 31 publications

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“…Furthermore, the female gender was severely underrepresented in our analysis. The impact of gender on outcomes after CPR in general and eCPR is a topic worthy of further investigation 31 …”

Section: Discussionmentioning

confidence: 99%

“…The impact of gender on outcomes after CPR in general and eCPR is a topic worthy of further investigation. 31…”

Section: Discussionmentioning

confidence: 99%

“…• Hemoglobin < 8 g/dl ECMO cannulas are implanted via femoral vessels in Seldinger's technique, as already published by our study group. [12][13][14][15] Extracorporeal circulation is established by using a Rotaflow centrifugal pump (Maquet, Rastatt, Germany) with a Quadrox membrane oxygenator (Maquet, Rastatt, Germany) and the PLS2050 circuit system (Maquet, Rastatt, Germany). We use a standard 8 Fr.…”

Section: Introductionmentioning

confidence: 99%

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Impact of left ventricular unloading using a peripheral Impella®‐pump in eCPR patients

et al. 2021

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Background Extracorporeal cardiopulmonary resuscitation (eCPR) is a rapidly growing treatment strategy due to increasing survival rates in selected patients. Additional left ventricular mechanical unloading, using a transfemoral micro‐axial blood pump (Impella® Denver, Massachusetts, USA), might improve patients’ outcomes. In this regard, we sought to investigate patients who suffered OHCA (out‐of hospital cardiac arrest) or IHCA (in‐hospital cardiac arrest) with subsequent eCPR via VA‐ECMO (veno‐arterial extracorporeal membrane oxygenation) and concomitant Impella® implantation based on survival and feasibility of ECMO weaning. Methods From January 2016 until December 2020, 108 patients underwent eCPR at our institution. Data prior to eCPR and early outcome parameters were analyzed comparing patients who were supported with an additional Impella® (2.5 or CP) (ECMO+Impella®, n = 18) and patients without additional (ECMO, n = 90) support during V‐A ECMO therapy. The primary endpoint was in‐hospital mortality; secondary endpoints were, among others: ECMO explantation, need for hemodialysis, stroke, and need for blood transfusions. Results Low‐flow time was significantly lower in the ECMO+Impella group (60 min vs. 55 min, p = .01). All‐cause mortality was significantly lower in the ECMO+Impella® group (82% vs. 56%, p = .01). The time of circulatory support was shorter in the ECMO cohort (2.0 ± 1.73 vs. 4.76 ± 2.88 p = .05). ECMO decannulation was significantly more feasible in patients with ECMO+Impella® (72% vs. 32%, p = .01). Patients treated with additional Impella® showed significantly more acute kidney injury with the need for dialysis (72% vs. 18%, p ≤ .01). Conclusion Concomitant Impella® support might positively influence survival and ECMO weaning in eCPR patients. Treatment‐associated complications such as the need for dialysis were more common in this highly selected patient group. Further studies with larger numbers are necessary to evaluate the clinical relevance of concomitant LV‐unloading in eCPR patients using an Impella® device.

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“…Furthermore, the female gender was severely underrepresented in our analysis. The impact of gender on outcomes after CPR in general and eCPR is a topic worthy of further investigation 31 …”

Section: Discussionmentioning

confidence: 99%

“…The impact of gender on outcomes after CPR in general and eCPR is a topic worthy of further investigation. 31…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of left ventricular unloading using a peripheral Impella®‐pump in eCPR patients

et al. 2021

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“…Recently, our study group reported on sex-related differences in ECPR patients. 21 However, patient collectives are not comparable because the difference in the underlying disease and transfer of conclusions is impaired. For ECMO patients in general, there is evidence that the female gender is associated with a higher limb ischemia rate due to the smaller body surface in combination with smaller diameter of femoral vessels in women.…”

Section: Discussionmentioning

confidence: 99%

Gender-related propensity score match analysis of ECMO therapy in postcardiotomy cardiogenic shock in patients after myocardial revascularization

et al. 2021

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Background: Gender is known to influence the pathophysiology and pathogenesis of the coronary vascular disease. Data on gender-related differences in patients with veno-arterial extracorporeal membrane oxygenation due to postcardiotomy cardiogenic shock is lacking in current literature. We aimed to analyze the impact of gender on intraoperative and short-term outcomes of vaECMO patients after coronary surgery and postcardiotomy cardiogenic shock. Methods: Between 2006 and 2017, a total of 92 patients with PCS after CABG underwent vaECMO-implantation at our institution. After a 1:1 propensity score match (PSM) for relevant preoperative data, we identified a cohort of 32 patients, 16 males, and 16 females. Periprocedural and short-term outcome data were analyzed with respect to sex differences. Results: The mean age was 64 ± 11 years, and 79% ( n = 73) were male patients. Clinical outcomes showed a 30-day all-cause mortality of 64% ( n = 59). After PSM, male patients showed a significantly smaller number of arterial grafts (0.4 ± 0.53 male vs 1.1 ± 0.7 female; p = 0.037). Thirty-day all-cause mortality did not differ between the groups (56% male vs 75% female; p = 0.262). In general, short-term outcome data were comparable without significant differences for the matched groups. Conclusion: Gender has no impact on patients with vaECMO therapy due to PCS in isolated coronary surgery.

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“…ECPR is performed in the interdisciplinary consensus of the participating disciplines. The decision to cannulate is based on participating physicians' judgment, following institutional criteria: eCPR inclusion criteria (12)(13)(14)(15). Extracorporeal circulation is established by using a Rotaflow centrifugal pump (Maquet, Rastatt, Germany) with a Quadrox membrane oxygenator (Maquet, Rastatt, Germany) and the PLS2050 circuit system (Maquet, Rastatt, Germany).…”

Section: Ecpr Protocol University Hospital Colognementioning

confidence: 99%

Impact of left ventricular unloading using a transfemoral micro-axial pump in eCPR patients

Gaisendrees¹,

Djordjevic²,

Sabashnikov³

et al. 2020

Preprint

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Objectives: Extracorporeal cardiopulmonary resuscitation (eCPR) is a rapidly growing treatment strategy due to increasing survival rates in selected patients. Additional left ventricular mechanical unloading, using a transfemoral micro-axial blood pump (Impella®), might improve patients' outcomes. In this regard, we sought to investigate patients who suffered OHCA (out-of hospital cardiac arrest) or IHCA (in-hospital cardiac arrest) with subsequent eCPR (extracorporeal cardiopulmonary resuscitation) via VA-ECMO (veno-arterial extracorporeal membrane oxygenation) and concomitant Impella® implantation. Methods: From January 2016 until December 2019, 71 patients underwent eCPR at our institution. Data prior eCPR and early outcome parameters were analyzed comparing patients who were supported with an additional transfemoral micro-axial blood pump (ECMO+Impella®, n= 7) and patients without additional (ECMO, n=64) support during VA-ECMO therapy. Results: Baseline data did not significantly differ between groups. All-cause mortality was significantly lower in the ECMO+Impella® group (83% vs. 29%, p= 0.01). The time of circulatory support was shorter in the ECMO+Impella® cohort (3.16±2.09 vs. 6.5±2.79, p=0.01). Additionally, ECMO weaning was significantly more feasible in patients with ECMO+Impella® (71% vs. 29%, p =0.02). Patients treated with additional Impella® showed more acute kidney injury (AKI) with the need for dialysis (71% vs. 21%, p=0.09). Conclusion: From our data, concomitant Impella® support might increase survival and successful ECMO weaning in eCPR patients. Treatment associated complications such as AKI were more common in this highly selected patient group. Further studies with larger numbers are necessary to evaluate concomitant LV-unloading's clinical relevance in eCPR patients, using an Impella® device.

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Gender‐related differences in treatment and outcome of extracorporeal cardiopulmonary resuscitation‐patients

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 12 publications

References 31 publications

Impact of left ventricular unloading using a peripheral Impella®‐pump in eCPR patients

Impact of left ventricular unloading using a peripheral Impella®‐pump in eCPR patients

Gender-related propensity score match analysis of ECMO therapy in postcardiotomy cardiogenic shock in patients after myocardial revascularization

Impact of left ventricular unloading using a transfemoral micro-axial pump in eCPR patients

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