Predicting Survival in Patients Treated With Extracorporeal Membrane Oxygenation After Myocardial Infarction

Pabst, Dirk; Foy, Andrew; Peterson, Brandon; Soleimani, Behzad; Brehm, Christoph

doi:10.1097/ccm.0000000000002995

Cited by 21 publications

(23 citation statements)

References 22 publications

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“…One of the covariates included in the propensity score was the potential for myocardial recovery based upon indications for VA-ECMO. Indeed, outcomes of patients undergoing VA-ECMO greatly differ regarding the reason for ECMO implantation [17][18][19][20][21][22][23][24][25][26]. Forty-two patients who received ECMO less than 48 h were excluded because we considered the probability to receive levosimendan was too low.…”

Section: Discussionmentioning

confidence: 99%

“…Secondary endpoints were mortality at day 28 and at 6 months after VA-ECMO implantation. Based on the available literature [17][18][19][20][21][22][23][24] and on the analysis of patient outcomes in our institutional database [25,26], we classified indications for VA-ECMO into three categories (high, intermediate, or low) according to the potential for myocardial recovery.…”

Section: Study Endpointsmentioning

confidence: 99%

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Can levosimendan reduce ECMO weaning failure in cardiogenic shock?: a cohort study with propensity score analysis

et al. 2020

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Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly used over the last decade in patients with refractory cardiogenic shock. ECMO weaning can, however, be challenging and lead to circulatory failure and death. Recent data suggest a potential benefit of levosimendan for ECMO weaning. We sought to further investigate whether the use of levosimendan could decrease the rate of ECMO weaning failure in adult patients with refractory cardiogenic shock. Methods: We performed an observational single-center cohort study. All patients undergoing VA-ECMO from January 2012 to December 2018 were eligible and divided into two groups: group levosimendan and group control (without levosimendan). The primary endpoint was VA-ECMO weaning failure defined as death during VA-ECMO treatment or within 24 h after VA-ECMO removal. Secondary outcomes were mortality at day 28 and at 6 months. The two groups were compared after propensity score matching. P < 0.05 was considered statistically significant. Results: Two hundred patients were analyzed (levosimendan group: n = 53 and control group: n = 147). No significant difference was found between groups on baseline characteristics except for ECMO duration, which was longer in the levosimendan group (10.6 ± 4.8 vs. 6.5 ± 4.7 days, p < 0.001). Levosimendan administration started 6.6 ± 5.4 days on average following ECMO implantation. After matching of 48 levosimendan patients to 78 control patients, the duration of ECMO was similar in both groups. The rate of weaning failure was 29.1% and 35.4% in levosimendan and control groups, respectively (OR: 0.69, 95%CI: 0.25-1.88). No significant difference was found between groups for all secondary outcomes. Conclusion: Levosimendan did not improve the rate of successful VA-ECMO weaning in patients with refractory cardiogenic shock. Trial registration: ClinicalTrials.gov, NCT04323709.

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Section: Discussionmentioning

confidence: 99%

Section: Study Endpointsmentioning

confidence: 99%

Can levosimendan reduce ECMO weaning failure in cardiogenic shock?: a cohort study with propensity score analysis

et al. 2020

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“…Scoring systems are often used to select appropriate patients for specific therapies [37, 38]. However, for PCS patients who clinicians believe would die without VA-ECMO, decision-making by clinicians often involves many patient and contextual factors and remains difficult despite the use of prediction models.…”

Section: Discussionmentioning

confidence: 99%

Predicting mortality in patients undergoing VA-ECMO after coronary artery bypass grafting: the REMEMBER score

et al. 2019

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BackgroundPrediction scoring systems for coronary artery bypass grafting (CABG) patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO) have not yet been reported. This study was designed to develop a predictive score for in-hospital mortality for cardiogenic shock patients who received VA-ECMO after isolated CABG.MethodsRetrospective cohort study of consecutive CABG patients supported with VA-ECMO (n = 166) at the Beijing Anzhen Hospital between February 2004 and March 2017.ResultsOne hundred and six patients (64%) could be weaned from VA-ECMO, and 74 patients (45%) survived to hospital discharge. On the basis of multivariable logistic regression analyses, the pRedicting mortality in patients undergoing veno-arterial Extracorporeal MEMBrane oxygenation after coronary artEry bypass gRafting (REMEMBER) score was created with six pre-ECMO parameters: older age, left main coronary artery disease, inotropic score > 75, CK-MB > 130 IU/L, serum creatinine > 150 umol/L, and platelet count < 100 × 109/L. Four risk classes, namely class I (REMEMBER score 0–13), class II (14–19), class III (20–25), and class IV (> 25) with their corresponding mortality (13%, 55%, 70%, and 94%, respectively), were identified. The area under the receiver operating characteristic curve 0.85(95% CI 0.79–0.91) for the REMEMBER score was better than those for the SOFA, SAVE, EuroSCORE, and ENCOURAGE scores in this population.ConclusionsThe REMEMBER score might help clinicians at bedside to predict in-hospital mortality for patients receiving VA-ECMO after isolated CABG for refractory cardiogenic shock. Prospective studies are needed to externally validate this scoring system.Electronic supplementary materialThe online version of this article (10.1186/s13054-019-2307-y) contains supplementary material, which is available to authorized users.

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“…6,7 Elevated arterial lactic acid levels are associated with in-hospital and 30-day mortality rates independently from treatment modus. [7][8][9][10][11][12][13][14][15][16] However, focus on the lactate concentration, and its clearance erodes the understanding of the shock state's major physiological underpinnings. 17 Lactate concentration is just a metabolic correlate of the pathophysiological process known as oxygen debt.…”

Section: Introductionmentioning

confidence: 99%

Patterns of oxygen debt repayment in cardiogenic shock patients sustained with extracorporeal life support: a retrospective study

Ganushchak

Kurniawati

Horst

et al. 2021

Preprint

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Cardiogenic shock is the most frequent shock in cardiac intensive care, and cardiac dysfunction and sever hypoxia are often seen in critically ill patients. Inadequate organ and tissue perfusion and hypoxia result in anaerobic metabolism with hyperlactatemia and oxygen debt accumulation. However, the role of accumulated oxygen debt in course of cardiogenic shock and hypoxia is not clearly described. Here we first described the existence of several patterns of oxygen debt repayment in cardiogenic shock patients maintained by extracorporeal life support system. Oxygen debt was computed from the lactate concentration at five time points, covering the first 26 hours of ECLS. The patterns as the basic pathophysiological processes are independent from the cause of primary insult. The groups of patients classified to the specific patterns differed by survival rate from 51.5% to only 4.6%. It is very important that initial class does not predetermine the fate and can change in the course of treatment due to ‘between clusters migration’. We believe that our finding of patterns of oxygen debt repayment in cardiogenic shock patients may offer a new insights for a more rational, goal-directed treatment of such highly morbid conditions as hypoxia and cardiogenic shock.

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Predicting Survival in Patients Treated With Extracorporeal Membrane Oxygenation After Myocardial Infarction

Cited by 21 publications

References 22 publications

Can levosimendan reduce ECMO weaning failure in cardiogenic shock?: a cohort study with propensity score analysis

Can levosimendan reduce ECMO weaning failure in cardiogenic shock?: a cohort study with propensity score analysis

Predicting mortality in patients undergoing VA-ECMO after coronary artery bypass grafting: the REMEMBER score

Patterns of oxygen debt repayment in cardiogenic shock patients sustained with extracorporeal life support: a retrospective study

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