Predictors of in-hospital mortality and midterm outcomes of patients successfully weaned from venoarterial extracorporeal membrane oxygenation

Sertic, F.; Chavez, Lexy; Diagne, Dieynaba; Richards, Thomas J.; Wald, Joyce; Acker, Michael A.; Birati, Edo Y.; Rame, J. Eduardo; Bermúdez, C.

doi:10.1016/j.jtcvs.2019.11.106

Cited by 22 publications

(33 citation statements)

References 25 publications

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“…Studies examining negative predictors of outcome in weaned patients mostly refer to selected VA-ECMO indications. For cardiogenic shock, the following attributes have been identified as independent risk factors of mortality after weaning: advanced age, previous myocardial infarction, diabetes, renal failure with requirement for continuous renal replacement therapy, high serum butyrylcholinesterase, high serum lactate, low mean arterial pressure (MAP), unsuccessful revascularization in the setting of acute myocardial infarction, prolonged VA-ECMO support, hypoxemia at VA-ECMO weaning, low Glasgow Coma Score, and high Sequential Organ Failure Assessment (SOFA) score [20,23,[26][27][28][29]. Additionally, Chommeloux et al recently showed that inability to rapidly restore microcirculation during the first 24 h, which is severely impaired in patients with refractory cardiogenic shock, is associated with death on VA-ECMO [30].…”

Section: Cardiogenic Shockmentioning

confidence: 99%

Update on Weaning from Veno-Arterial Extracorporeal Membrane Oxygenation

Lüsebrink

Stremmel

Stark

et al. 2020

JCM

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Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides temporary cardiac and respiratory support and has emerged as an established salvage intervention for patients with hemodynamic compromise or shock. It is thereby used as a bridge to recovery, bridge to permanent ventricular assist devices, bridge to transplantation, or bridge to decision. However, weaning from VA-ECMO differs between centers, and information about standardized weaning protocols are rare. Given the high mortality of patients undergoing VA-ECMO treatment, it is all the more important to answer the many questions still remaining unresolved in this field Standardized algorithms are recommended to optimize the weaning process and determine whether the VA-ECMO can be safely removed. Successful weaning as a multifactorial process requires sufficient recovery of myocardial and end-organ function. The patient should be considered hemodynamically stable, although left ventricular function often remains impaired during and after weaning. Echocardiographic and invasive hemodynamic monitoring seem to be indispensable when evaluating biventricular recovery and in determining whether the VA-ECMO can be weaned successfully or not, whereas cardiac biomarkers may not be useful in stratifying those who will recover. This review summarizes the strategies of weaning of VA-ECMO and discusses predictors of successful and poor weaning outcome.

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Section: Cardiogenic Shockmentioning

confidence: 99%

Update on Weaning from Veno-Arterial Extracorporeal Membrane Oxygenation

Lüsebrink

Stremmel

Stark

et al. 2020

JCM

View full text Add to dashboard Cite

show abstract

“…It has been described that older age, higher body mass index, coronary artery disease, elevated total bilirubin were promoted for patients receiving ECMO (17,18). Moreover, myocardial infarction, diabetes, prolonged ECMO support, and pulmonary dysfunction were also reported strongly predicted in-hospital mortality after ECMO weaning (19). In our research, we found high levels of age, coronary heart disease, multiple organ failure, bleeding complications, anemia, DBIL, LDH, APTT, and ECMO duration time are strongly associated with worse in-hospital survival of ECMO treated patients, and these clinical markers could as independent predictors for patient in-hospital mortality, hence it would further support previous ndings.…”

Section: Discussionmentioning

confidence: 97%

Fresh frozen plasma transfusion is a potential predictor of mortality in patients undergoing extracorporeal membrane oxygenation

Luo

et al. 2022

Preprint

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Background The patients of extracorporeal membrane oxygenation (ECMO) supported were usually developed bleeding complications and required substantial transfusions, but the risks and predictors of transfusion requirements during ECMO support remain uncertain. This study aims to interpret the risk factors of ECMO patients' in-hospital mortality and investigate the predictors of blood transfusion in ECMO patients.Methods 113 ECMO patients’ clinical parameters were collected in the cohorts. The logistic regression and least absolute shrinkage and selection operator (LASSO) binomial regression analysis were employed to identify the risk factors of ECMO patients' in-hospital mortality. Machine learning approaches were performed to confirm the variable importance. The backward stepwise multiple linear regression analyses were used to examine the predictive values of candidate importance variables. Results Eleven variables including age, coronary heart disease (CHD), multiple organ failure, bleeding complications, anemia, fresh frozen plasma (FFP) transfusion, platelet (PLT) transfusion, direct bilirubin (DBIL), lactate dehydrogenase (LDH), activated partial thromboplastin time (APTT), and ECMO duration were identified could as independent predictors for patients’ mortality. Age, FFP transfusion and ECMO duration were the top three important indexes among eleven variables in the selection of feature importance, and with the risk contribution values were 1.03 (95% CI, 1.01-1.06; p = 0.014), 1.07 (95% CI, 1.01-1.14; p = 0.026) and 1.05 (95% CI, 1.00-1.09; p = 0.043), respectively. FFP transfusion over 2.5 mL/kg/d, age over 48 years old more likely dead in ECMO patients. Furthermore, APTT (R=0. 32, p<0.001), PLT counts (R=-0.40, p<0.001) and uric acid (UA) (R=0.39, p<0.001) were associated with the FFP transfusion, which could as an independent factor for predicting FFP transfusion, with the estimate values were 0.06 (95% CI, 0.02-0.11; p = 0.009), -0.03 (95% CI, -0.05--0.01; p = 0.007) and 0.01 (95% CI, 0.00-0.02; p = 0.003), respectively.Conclusion FFP transfusion was markedly associated with in-hospital mortality among patients receiving ECMO, and APTT, PLT counts and UA were the influence factors for FFP transfusion. It is suggesting that better monitoring of the above three indicators may reduce utilization of FFP, thus improving ECMO patients’ outcomes.

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“…Over the recent decades since the widespread utilization of V-A ECMO, multiple weaning strategies exist, of which decremental pump ow reduction and arteriovenous bridging recirculation technique are the mainstream approaches [2][3][4][5][6][7][8][9][10] . Nevertheless, variations in practice exist among institutions, and there are no consensus guidelines to standardize the weaning algorithms.…”

Section: Discussionmentioning

confidence: 99%

“…To the best of knowledge, decremental ow reduction and arteriovenous bridging recirculation remain the commonest adopted strategies to trial a patient off V-A ECMO [2][3][4][5][6][7][8][9][10] . Nevertheless, limitations of these strategies include variability in circuit arrangement between institutions, and risk of thromboembolic events during clamping of the circuit 11,12 .…”

Section: Introductionmentioning

confidence: 99%

Pump-controlled retrograde trial off for weaning from adult veno-arterial extracorporeal membrane oxygenation – a retrospective observation cohort

Lau

Chan

Lai

et al. 2022

Preprint

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BackgroundThe optimal strategy of weaning veno-arterial (V-A) extracorporeal membrane oxygenation (ECMO) remains poorly described. Pump-controlled retrograde trial off (PCRTO) involves serial decremental pump revolutions until a retrograde flow from the arterial to venous ECMO cannula is achieved. It has been reported as a feasible weaning strategy in the pediatric population, but its application in adults has not been widely reported.MethodsThis was a retrospective observational study including all adult patients who underwent PCRTO during weaning from V-A ECMO at a tertiary ECMO center between January 2019 and July 2021. Hemodynamic characteristics during PCRTO and clinical outcomes were reported. The clinical and echocardiographic parameters of successful and unsuccessful PCRTO runs were compared.Results A total of 57 runs of PCRTO in 36 patients were analyzed – 45 (78.9%) of the trials were successful. The median blood flow rate during PCRTO was 0.6 L/min, and the median duration of PCRTO was 240 minutes in the successful group compared with 35 minutes in the unsuccessful group. Patients who tolerated the trial had higher systolic blood pressure (105 vs 96 mmHg, p=0.042) and mean arterial pressure (78 vs 63 mmHg, p=0.008) at the end of PCRTO. The left ventricular outflow tract velocity-time integral measured during PCRTO was greater in the successful group (17.5 vs 12.9 cm, p=0.021).Of the 35 patients who had at least one session of successful PCRTO, 31 (88.6%) ultimately underwent ECMO decannulation. In adjusted analysis, baseline alanine aminotransferase (OR 8.16, 95% CI 1.31-50.9, p=0.025) and serum creatinine (OR 7.15, 95% CI 1.04-49.2, p=0.046) were significantly associated with increased probability of successful PCRTO.ConclusionsPCRTO is a feasible strategy for trialing off V-A ECMO with a low risk of adverse events and high rate of predicting eventual successful ECMO decannulation. Laboratory parameters that reflect the degree and recovery of end-organ ischemic injury were useful for predicting a successful PCRTO. The application of PCRTO should be studied in multi-centered studies.

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Predictors of in-hospital mortality and midterm outcomes of patients successfully weaned from venoarterial extracorporeal membrane oxygenation

Cited by 22 publications

References 25 publications

Update on Weaning from Veno-Arterial Extracorporeal Membrane Oxygenation

Update on Weaning from Veno-Arterial Extracorporeal Membrane Oxygenation

Fresh frozen plasma transfusion is a potential predictor of mortality in patients undergoing extracorporeal membrane oxygenation

Pump-controlled retrograde trial off for weaning from adult veno-arterial extracorporeal membrane oxygenation – a retrospective observation cohort

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