Predictors of survival in adults undergoing extracorporeal membrane oxygenation with severe infections

Cheng, Aristine; Sun, Hsin‐Yun; Tsai, Mao‐Song; Ko, Wen‐Je; Tsai, Pi‐Ru; Hu, Fu‐Chang; Chen, Yee‐Chun; Chang, Shan‐Chwen

doi:10.1016/j.jtcvs.2016.08.038

Cited by 47 publications

(47 citation statements)

References 36 publications

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“…Although RCS represents the majority of patients on VA‐ECMO , the majority of studies have focused on postcardiotomy patients . Remaining studies have evaluated nonsurgical subgroups or a combination of nonsurgical and surgical populations , which complicates interpretation as the two latter cohorts have different pathophysiological mechanisms. Independent pre‐VA‐ECMO outcome predictors in an unselected nonsurgical population with RCS have only scarcely been identified as studies have mainly included variables from both before and after initiation of VA‐ECMO in the analysis , or have not reported rates of missing data or having substantially incomplete data .…”

mentioning

confidence: 99%

VA‐ECMO Support in Nonsurgical Patients With Refractory Cardiogenic Shock: Pre‐Implant Outcome Predictors

et al. 2018

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Refractory cardiogenic shock (RCS) is associated with a high mortality. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used as acute cardiopulmonary support but selection of VA-ECMO candidates remains challenging. There are limited data on which pre-VA-ECMO variables that predict outcome. The aim of this study was to identify pre-VA-ECMO predictors of 90-day mortality. We retrospectively analyzed 76 consecutive patients (median age 52; interquartile range [IQR]: 37-60) supported with VA-ECMO due to RCS. The association between pre-implant variables and all-cause mortality at 90 days was analyzed with multivariable logistic regression. Main etiologies of RCS were acute myocardial infarction 51% and other AHF etiologies 49%. Cardiopulmonary resuscitation was performed in 54% of patients before initiation of VA-ECMO. Median duration of VA-ECMO was 5 days (IQR: 2-11). The 90-day overall mortality was 49% and in-hospital

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confidence: 99%

VA‐ECMO Support in Nonsurgical Patients With Refractory Cardiogenic Shock: Pre‐Implant Outcome Predictors

et al. 2018

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“…Although there is a paucity of data supporting the use of ECMO in this spectrum of pathologic conditions, several recent reports have suggested that ECMO can become a valuable therapeutic option for patients with refractory cardiovascular dysfunction, especially when introduced promptly after developing septic shock. A recent retrospective analysis of 151 adult patients with sepsis receiving ECMO claimed that worse outcomes were significantly associated with longer door-to-ECMO times, because delayed rescue leads to irreversible multiorgan failure [6]. Moreover, another study showed that the development of shock beyond 30.5 hours before ECMO initiation was associated with 0% survival.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of out-of-hospital cardiopulmonary arrest due to streptococcal toxic shock syndrome – effectiveness of extracorporeal membrane oxygenation and the rapid antigen group A streptococcus test: a case report

Mizuguchi¹,

Taniguchi²,

Takahashi³

2018

J Med Case Reports

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BackgroundStreptococcal toxic shock syndrome caused by Streptococcus pyogenes, a group A streptococcus, infection is a rare condition that rapidly progresses to multiple organ failure, shock, and death. It is thus important to promptly establish a diagnosis, provide hemodynamic support, and initiate appropriate antibiotics therapy.Case presentationA 70-year-old Asian man presented with ventricular fibrillation. Extracorporeal membrane oxygenation was initiated 20 minutes after admission after unsuccessful conventional cardiopulmonary resuscitation including five attempts of electrical cardioversion. On the sixth attempt, a sinus rhythm was obtained. A physical examination revealed a large abscess in his right gluteal region, and computed tomography showed a large low-density area in the right gluteus maximus. Blood examination revealed elevated levels of inflammatory markers, hepatic enzymes, creatinine, and creatinine kinase. Transthoracic echocardiography demonstrated diffuse hypokinesis with an ejection fraction of 25%. A subsequent coronary angiography revealed normal findings. Therefore, we diagnosed our patient as having septic shock and conducted surgical drainage. A rapid antigen group A streptococcus test yielded positive results, which necessitated treatment comprising benzylpenicillin and clindamycin. He was successfully weaned from extracorporeal membrane oxygenation and continuous hemodiafiltration 4 days later and ventilation 9 days later; he was later transferred to another hospital to receive a skin graft.ConclusionsOur case report is the first to demonstrate the successful treatment of cardiac arrest caused by streptococcal toxic shock syndrome via extracorporeal membrane oxygenation and prompt initiation of antibiotic therapy. The rapid antigen group A streptococcus test may be an effective approach to promptly diagnose streptococcal toxic shock syndrome caused by group A streptococcus infection.

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“…3 Here we report on a 67-year-old male patient with refractory septic shock who was successfully supported by VA-ECMO. Historically, sepsis was considered a contraindication to ECMO because of concerns that bacteria would seed the ECMO circuit, leading to intractable bacteremia and death.…”

Section: Introductionmentioning

confidence: 96%

“…Although this assumption has been refuted by recent reports, 2 the use of this technology for adult patients with septic shock remains controversial, especially in elderly patients. 3 Here we report on a 67-year-old male patient with refractory septic shock who was successfully supported by VA-ECMO.…”

Section: Introductionmentioning

confidence: 96%

Successful support by veno‐arterial extracorporeal membrane oxygenation for severe septic shock caused by Aeromonas hydrophila

Ishida

Miyazaki

Hikone

et al. 2019

Acute Medicine & Surgery

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Background Septic shock is a subset of sepsis accompanied by profound circulatory and cellular metabolism abnormalities. Although veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) can provide temporary cardiac support to improve organ perfusion, hemodynamic support by VA‐ECMO for adult patients with septic shock is still controversial. Case presentation A 67‐year‐old man was transferred to our hospital with generalized weakness. He suffered septic shock refractory to vasopressors and inotropes, and his cardiac function deteriorated rapidly. Because of concern for sudden cardiac arrest, he was placed on VA‐ECMO 9 h after his arrival. Blood culture was positive for Aeromonas hydrophila. He was weaned off VA‐ECMO on day 7 and was discharged without any sequelae on day 30. Conclusion Veno‐arterial extracorporeal membrane oxygenation is a viable treatment option for adult patients with refractory septic shock accompanied by cardiac dysfunction. Further research is warranted to identify the candidates for support by VA‐ECMO in a timely fashion.

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Predictors of survival in adults undergoing extracorporeal membrane oxygenation with severe infections

Abstract: Better outcomes were associated with door-to ECMO times of 96 hours or less, for Gram-positive rather than Gram-negative sepsis, and for pneumonia rather than primary bloodstream infections.

Cited by 47 publications

References 36 publications

VA‐ECMO Support in Nonsurgical Patients With Refractory Cardiogenic Shock: Pre‐Implant Outcome Predictors

VA‐ECMO Support in Nonsurgical Patients With Refractory Cardiogenic Shock: Pre‐Implant Outcome Predictors

Successful treatment of out-of-hospital cardiopulmonary arrest due to streptococcal toxic shock syndrome – effectiveness of extracorporeal membrane oxygenation and the rapid antigen group A streptococcus test: a case report

Successful support by veno‐arterial extracorporeal membrane oxygenation for severe septic shock caused by Aeromonas hydrophila

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