Outcomes following venoarterial extracorporeal membrane oxygenation in children with refractory cardiogenic disease

Yang, Liying; Ye, Lifen; Fan, Yuqi; He, Wenjuan; Zong, Qing; Zhao, Wenting; Lin, Ru

doi:10.1007/s00431-019-03352-5

Cited by 8 publications

(10 citation statements)

References 21 publications

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“…Stabilization of hemodynamics and adequate tissue perfusion after VA ECMO could ameliorate hypoxia. Some studies had reported the correlation between higher lactate level obtained at different timepoints and the poor prognosis of patients supported by ECMO [42][43][44]. Our study demonstrated that the cut-off value of 3.0mmol/L at 24 hours after ECMO initiation contributed to risk stratification.…”

Section: Discussionsupporting

confidence: 54%

Clinical Outcome and Risk Factors for Acute Fulminant Myocarditis Supported by Venoarterial Extracorporeal Membrane Oxygenation: an Analysis of Nationwide CSECLS Database in China Mainland

Tang¹,

Jiang

Wu³

et al. 2021

Preprint

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Purpose: To assess the outcomes and risk factors for adult patients with acute fulminant myocarditis supported with venoarterial extracorporeal membrane oxygenation (VA ECMO) in China mainland. Methods: Data were extracted from Chinese Society of ExtraCorporeal Life Support (CSECLS) Registry database. Data from adult patients who were diagnosed with acute myocarditis and needed VA ECMO in the database were retrospectively analyzed. The primary outcome was 90-day mortality after ECMO initiation in patients with acute fulminant myocarditis supported with VA ECMO. Cox proportional hazard regression model was used to examine the risk factors associated with 90-day mortality. Results: Among 221 patients enrolled, 186 (84.2%) patients weaned from ECMO and 159 (71.9%) patients survived to 90 days. The median age was 38 years (IQR 29-49) and males (n=115) accounted for 52.0% of the patients. The median ECMO duration was 134 hours (IQR 96-177hrs). The main adverse events during ECMO course was bleeding (16.3%), followed by infection (15.4%). In the multivariate Cox model, cardiac arrest prior to ECMO initiation (adjusted HR 2.529; 95%CI: 1.341-4.767, p =0.004), lower pH value (adjusted HR 0.016; 95%CI: 0.010-0.059, p <0.001) and higher lactate concentration at 24 hours after ECMO initiation (adjusted HR 1.146; 95%CI: 1.075-1.221, p <0.001) was associated with 90day mortality. Conclusions: In our study, 71.9% patients with acute fulminant myocarditis supported with VA ECMO survived to 90 days. Cardiac arrest prior to ECMO, lower pH and higher lactate concentration at 24 hours after ECMO initiation were correlated with 90-day mortality closely.ClinicalTrials.gov registration number: NCT04158479, Registered 8 November 2019, https://clinicaltrials.gov/ct2/show/NCT04158479?term=hou+xiaotong&draw=2&rank=2.

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Section: Discussionsupporting

confidence: 54%

Clinical Outcome and Risk Factors for Acute Fulminant Myocarditis Supported by Venoarterial Extracorporeal Membrane Oxygenation: an Analysis of Nationwide CSECLS Database in China Mainland

Tang¹,

Jiang

Wu³

et al. 2021

Preprint

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“…We further excluded 42 studies after full‐text evaluation, because they did not meet inclusion criteria. Eventually, 28 studies 11 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 were amenable to meta‐analysis (Figure 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…In our meta‐analysis, applying a random‐effects model, the pooled short‐term mortality (28 studies,1736 patients) was 45.6% (95% CI, 38.7%–52.4%) (Figure 2 ). 11 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 There was no evidence for publication bias because of the funnel plot appearing visually symmetrical (Figure 3 ), and the Egger test suggesting insignificant difference for our primary outcome of interest ( P egger =0.23). The sensitivity analysis performed by excluding the studies with a Joanna Briggs Institute score <8, showed that the pooled short‐term mortality was 46.2% (95% CI, 39.0%–53.4%).…”

Section: Resultsmentioning

confidence: 99%

Short‐Term Mortality Among Pediatric Patients With Heart Diseases Undergoing Veno‐Arterial Extracorporeal Membrane Oxygenation: A Systematic Review and Meta‐Analysis

Zhou,

Wang,

Zhao

et al. 2023

JAHA

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Background Veno‐arterial extracorporeal membrane oxygenation serves as a crucial mechanical circulatory support for pediatric patients with severe heart diseases, but the mortality rate remains high. The objective of this study was to assess the short‐term mortality in these patients. Methods and Results We systematically searched PubMed, Embase, and Cochrane Library for observational studies that evaluated the short‐term mortality of pediatric patients undergoing veno‐arterial extracorporeal membrane oxygenation. To estimate short‐term mortality, we used random‐effects meta‐analysis. Furthermore, we conducted meta‐regression and binomial regression analyses to investigate the risk factors associated with the outcome of interest. We systematically reviewed 28 eligible references encompassing a total of 1736 patients. The pooled analysis demonstrated a short‐term mortality (defined as in‐hospital or 30‐day mortality) of 45.6% (95% CI, 38.7%–52.4%). We found a significant difference ( P <0.001) in mortality rates between acute fulminant myocarditis and congenital heart disease, with acute fulminant myocarditis exhibiting a lower mortality rate. Our findings revealed a negative correlation between older age and weight and short‐term mortality in patients undergoing veno‐arterial extracorporeal membrane oxygenation. Male sex, bleeding, renal damage, and central cannulation were associated with an increased risk of short‐term mortality. Conclusions The short‐term mortality among pediatric patients undergoing veno‐arterial extracorporeal membrane oxygenation for severe heart diseases was 45.6%. Patients with acute fulminant myocarditis exhibited more favorable survival rates compared with those with congenital heart disease. Several risk factors, including male sex, bleeding, renal damage, and central cannulation contributed to an increased risk of short‐term mortality. Conversely, older age and greater weight appeared to be protective factors.

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“…Additionally, inability to obtain negative fluid balance, high serum lactate levels, and high total bilirubin in the first day of ECMO was found to be an independent risk factor for the weaning [ 4 ] . Yang et al [ 9 ] declared that hyperlactatemia and prolonged prothrombin time ( > 6 seconds) were associated with increased mortality in 30 days. In our retrospective study, we revealed that lactate and lactate clearance might be used as predictive factors during ECMO.…”

Section: Discussionmentioning

confidence: 99%

Lactate and Lactate Clearance Are Predictive Factors for Mortality in Patients with Extracorporeal Membrane Oxygenation

Aksoy,

Arslan,

Ugur

et al. 2024

Braz J Cardiovasc Surg

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Outcomes following venoarterial extracorporeal membrane oxygenation in children with refractory cardiogenic disease

Cited by 8 publications

References 21 publications

Clinical Outcome and Risk Factors for Acute Fulminant Myocarditis Supported by Venoarterial Extracorporeal Membrane Oxygenation: an Analysis of Nationwide CSECLS Database in China Mainland

Clinical Outcome and Risk Factors for Acute Fulminant Myocarditis Supported by Venoarterial Extracorporeal Membrane Oxygenation: an Analysis of Nationwide CSECLS Database in China Mainland

Short‐Term Mortality Among Pediatric Patients With Heart Diseases Undergoing Veno‐Arterial Extracorporeal Membrane Oxygenation: A Systematic Review and Meta‐Analysis

Lactate and Lactate Clearance Are Predictive Factors for Mortality in Patients with Extracorporeal Membrane Oxygenation

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