Mechanical support with venoarterial extracorporeal membrane oxygenation (ECMO-VA): Short-term and long-term prognosis after a successful weaning

García-Gigorro, Renata; Renes-Carreño, E.; Pérez-Vela, J.L.; Marín-Mateos, Helena; Gutiérrez, Julián; Corrés-Peiretti, M.A.; Delgado, Juan; Sota, Enrique Pérez-de la; Cortina-Romero, José M.; Montejo-González, Juan Carlos

doi:10.1016/j.medine.2017.10.006

Cited by 9 publications

(7 citation statements)

References 30 publications

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“…In this study, in-hospital mortality for patients who underwent successful ECMO weaning was improved significantly (18.3%) compared with that in previous studies in the same cohort (33.6% in all CS cohort 8 , and 52.2% in ECMO-treated patients with CS 6 ) and other studies that reported in-hospital mortality after ECMO weaning as high as 30% 16 , 17 . However, in-hospital mortality was not negligible even after successful ECMO weaning.…”

Section: Discussioncontrasting

confidence: 44%

Predictors of in-hospital mortality after successful weaning of venoarterial extracorporeal membrane oxygenation in cardiogenic shock

Jeong,

Kook,

Lee

et al. 2023

Sci Rep

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Limited knowledge exists regarding the predictors of mortality after successful weaning of venoarterial extracorporeal membrane oxygenation (ECMO). We aimed to identify predictors of in-hospital mortality in patients with cardiogenic shock (CS) after successful weaning from ECMO. Data were obtained from a multicenter registry of CS. Successful ECMO weaning was defined as survival with minimal mean arterial pressure (> 65 mmHg) for > 24 h after ECMO removal. The primary outcome was in-hospital mortality after successful ECMO weaning. Among 1247 patients with CS, 485 received ECMO, and 262 were successfully weaned from ECMO. In-hospital mortality occurred in 48 patients (18.3%). Survivors at discharge differed significantly from non-survivors in age, cardiovascular comorbidities, cause of CS, left ventricular ejection fraction, and use of adjunctive therapy. Five independent predictors for in-hospital mortality were identified: use of continuous renal replacement therapy (odds ratio 5.429, 95% confidence interval [CI] 2.468–11.940; p < 0.001), use of intra-aortic balloon pump (3.204, 1.105–9.287; p = 0.032), diabetes mellitus (3.152, 1.414–7.023; p = 0.005), age (1.050, 1.016–1.084; p = 0.003), and left ventricular ejection fraction after ECMO insertion (0.957, 0.927–0.987; p = 0.006). Even after successful weaning of ECMO, patients with irreversible risk factors should be recognized, and careful monitoring should be done for sign of deconditioning.

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Section: Discussioncontrasting

confidence: 44%

Predictors of in-hospital mortality after successful weaning of venoarterial extracorporeal membrane oxygenation in cardiogenic shock

Jeong,

Kook,

Lee

et al. 2023

Sci Rep

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“…However, successful weaning from VA-ECMO does not necessarily guarantee favourable outcomes. Up to one-third of patients who met centre-specific definition of successful weaning of VA-ECMO did not survive until discharge [46 ▪ ,47,48]. In a cohort of patients with AMI-CS, Fried et al [49 ▪ ] identified prompt revascularization, TIMI 3 flow in the culprit artery and lower serum lactate as independent predictors of recovery during VA-ECMO support.…”

Section: Bridge To Recoverymentioning

confidence: 99%

The role of temporary mechanical circulatory support as a bridge to advanced heart failure therapies or recovery

Oren

Zilinyi²,

Lotan³

et al. 2022

Current Opinion in Cardiology

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Purpose of reviewTemporary mechanical circulatory support (tMCS) has become central in the treatment of refractory cardiogenic shock and can be used to bridge patients to durable MCS, heart transplant or recovery. This review will discuss contemporary data regarding bridging strategies utilizing tMCS.Recent findingsThere has been significant growth in tMCS use recently, driven by increased familiarity with tMCS devices, and increased experience with both implantation and management. Identifying goals of therapy at the time of therapy initiation can facilitate better outcomes. The three primary goals are bridge to recovery, bridge to heart transplantation or bridge to durable left ventricular assist device. Bridging to recovery requires adequate treatment of underlying conditions and optimization of haemodynamics. Bridging to heart transplantation has become more frequent following changes to the heart allocation policy. Despite early concerns, patients bridge with tMCS, including ventricular-arterial extracorporeal membrane oxygenation, do not appear to have worse posttransplant outcomes. When bridging to durable mechanical circulatory support, tMCS can be used to enhance end-organ dysfunction and improve perioperative outcomes. In situations in which none of these goals are attainable, palliative care plays a critical role to identify patient wishes and assist with withdrawal of care when necessary.SummaryThe use of tMCS, as a bridge to recovery or heart replacement therapy in patients with refractory cardiogenic shock has grown significantly over the past decade. Multiple device choices are available and must be chosen appropriately to address the specific situation and the goals of therapy.

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“…Various studies have reported different mortality rates of ECMO in patients with cardiogenic shock. Overall the results have been virtually heterogenous and the in-hospital mortality rate ranged from 40% to 60 % [22][23][24][25][26][27]. Recent clinical trials comparing the efficacy of VA-ECMO and optimal medical treatment demonstrated that using ECMO in patients with cardiogenic shock did not improve early and long-term mortality [28,29].…”

Section: Discussionmentioning

confidence: 99%

In Patients with Cardiogenic Shock Extracorporeal Membrane Oxygenator (ECMO) Is Associated with Very High All Cause Inpatient Mortality Rate

Movahed,

Soltani Moghadam,

Hashemzadeh

2024

Preprint

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Background: The goal of this study was to evaluate the effect of Extracorporeal Membrane Oxygenator (ECMO) on mortality in patients with cardiogenic shock excluding Impella and IABP use. Method: The large Nationwide Inpatient Sample (NIS) database was utilized to study any association between the use of ECMO in adults over age of 18 on mortality and complications with a diagnosis of cardiogenic shocks. Results: ICD-10 codes for ECMO, and cardiogenic shock for available years 2016-2020 were utilized. A total of 796,585 (age 66.5±14.4) patients had a diagnosis of cardiogenic shock excluding Impella. 13,160 (age 53.7±15.4) were treated with ECMO without IABP . Total inpatient mortality without any device was 32.7%. It was 47.9% with ECMO. Using multivariate analysis adjusting for 47 variables such as age, gender, race, lactic acidosis, three-vessel intervention, left main myocardial infarction, cardiomyopathy, systolic heart failure, acute ST-elevation myocardial infarction, peripheral vascular disease, chronic renal disease, etc., ECMO utilization remained highly associated with mortality (OR: 1.78, CI: 1.6-1.9, p

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Mechanical support with venoarterial extracorporeal membrane oxygenation (ECMO-VA): Short-term and long-term prognosis after a successful weaning

Cited by 9 publications

References 30 publications

Predictors of in-hospital mortality after successful weaning of venoarterial extracorporeal membrane oxygenation in cardiogenic shock

Predictors of in-hospital mortality after successful weaning of venoarterial extracorporeal membrane oxygenation in cardiogenic shock

The role of temporary mechanical circulatory support as a bridge to advanced heart failure therapies or recovery

In Patients with Cardiogenic Shock Extracorporeal Membrane Oxygenator (ECMO) Is Associated with Very High All Cause Inpatient Mortality Rate

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