New-Onset Atrial Arrhythmias Are Independently Associated With In-Hospital Mortality in Veno-Venous Extracorporeal Membrane Oxygenation

Li, Cecilia; Pajoumand, Mehrnaz; Lambert, Kerry; Najia, Laila; Bathula, Allison; Mazzeffi, Michael; Galvagno, Samuel M.; Tabatabai, Ali; Grazioli, Alison; Dahi, Siamak; Hochberg, Eric; Plazak, Michael E

doi:10.1053/j.jvca.2021.12.012

Cited by 3 publications

(2 citation statements)

References 29 publications

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“…The loss of atrial function induces a 20% drop in cardiac output, which impairs oxygen delivery [ 12 ]. Recently, Li et al reported that new-onset atrial arrhythmias are a frequent complication during VV ECMO and are independently associated with odds ratio for in-hospital mortality as high as 2.21 CI 95 [1.08–4.55], with an interesting early temporal association of atrial arrhythmias with ECMO initiation (median time to onset of 1.7 days after ECMO deployment) [ 13 , 14 ]. Otherwise, the worst conditions clinicians would have to manage are refractory ventricular arrhythmias and cardiac arrest.…”

Section: Introductionmentioning

confidence: 99%

Impaired Pharmacokinetics of Amiodarone under Veno-Venous Extracorporeal Membrane Oxygenation: From Bench to Bedside

et al. 2022

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Background: Adjusting drug therapy under veno-venous extracorporeal membrane oxygenation (VV ECMO) is challenging. Although impaired pharmacokinetics (PK) under VV ECMO have been reported for sedative drugs and antibiotics, data about amiodarone are lacking. We evaluated the pharmacokinetics of amiodarone under VV ECMO both in vitro and in vivo. Methods: In vitro: Amiodarone concentration decays were compared between closed-loop ECMO and control stirring containers over a 24 h period. In vivo: Potassium-induced cardiac arrest in 10 pigs with ARDS, assigned to either control or VV ECMO groups, was treated with 300 mg amiodarone injection under continuous cardiopulmonary resuscitation. Pharmacokinetic parameters Cmax, Tmax AUC and F were determined from both direct amiodarone plasma concentrations observation and non-linear mixed effects modeling estimation. Results: An in vitro study revealed a rapid and significant decrease in amiodarone concentrations in the closed-loop ECMO circuitry whereas it remained stable in control experiment. In vivo study revealed a 32% decrease in the AUC and a significant 42% drop of Cmax in the VV ECMO group as compared to controls. No difference in Tmax was observed. VV ECMO significantly modified both central distribution volume and amiodarone clearance. Monte Carlo simulations predicted that a 600 mg bolus of amiodarone under VV ECMO would achieve the amiodarone bioavailability observed in the control group. Conclusions: This is the first study to report decreased amiodarone bioavailability under VV ECMO. Higher doses of amiodarone should be considered for effective amiodarone exposure under VV ECMO.

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Section: Introductionmentioning

confidence: 99%

Impaired Pharmacokinetics of Amiodarone under Veno-Venous Extracorporeal Membrane Oxygenation: From Bench to Bedside

et al. 2022

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“…Cannulation itself can lead to numerous complications including hemostatic dysfunction, cannula or surgical site bleed, thromboembolic events, clotting in the circuit, and trauma to the heart leading to cardiac tamponade or arrest ( 10 , 11 ). Once cannulated, the patient is at risk for arrhythmias, blood stream or wound infections, and bleeding from ongoing systemic anticoagulation ( 9 , 12 , 13 ). Understandably, there is concern that transport of ECMO patients between facilities could heighten the risk for patient complications, cannulation-related injury, and circuit system malfunction due to influences of transport time, equipment and resource limitations, and vehicle malfunction.…”

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confidence: 99%

Outcomes of Patients Undergoing Interfacility Extracorporeal Membrane Oxygenation Transfer Based on Cannulation Location and Mode of Transport

Wothe

Bergman

Kalland

et al. 2022

Critical Care Explorations

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OBJECTIVES: As the use of extracorporeal membrane oxygenation (ECMO) expands, so has the need for interfacility transfer to ECMO centers. However, the impact of these transfers has not been fully studied. This study evaluates complications and inhospital mortality in adult patients treated with venovenous (V-V) ECMO based on institutional location of cannulation and mode of transport. DESIGN: Retrospective cohort study. SETTING: Large midwestern ECMO center. PATIENTS: Adult patients receiving VV-ECMO. INTERVENTIONS: Need for transfer to ECMO center following VV-ECMO cannulation. MEASUREMENTS AND MAIN RESULTS: The study included 102 adult patients, 57% of which were cannulated at an outside institution prior to transfer. Of these, 60% were transported by ground, and the remainder were transported by air. Risk-adjusted logistic regression did not reveal any significant increase in odds for any complication or inhospital mortality between the groups based on location of cannulation or mode of transport. CONCLUSIONS: This study supports the practice of interfacility ECMO transfer with no difference in outcomes or inhospital mortality based on institutional location of cannulation or mode of transport.

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Atrial Arrhythmias During Venovenous ECMO: A Cry for Help?

Chweich

Naoum

Ortoleva

2022

Journal of Cardiothoracic and Vascular Anesthesia

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New-Onset Atrial Arrhythmias Are Independently Associated With In-Hospital Mortality in Veno-Venous Extracorporeal Membrane Oxygenation

Cited by 3 publications

References 29 publications

Impaired Pharmacokinetics of Amiodarone under Veno-Venous Extracorporeal Membrane Oxygenation: From Bench to Bedside

Impaired Pharmacokinetics of Amiodarone under Veno-Venous Extracorporeal Membrane Oxygenation: From Bench to Bedside

Outcomes of Patients Undergoing Interfacility Extracorporeal Membrane Oxygenation Transfer Based on Cannulation Location and Mode of Transport

Atrial Arrhythmias During Venovenous ECMO: A Cry for Help?

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