Pulmonary vascular dysfunction in refractory acute respiratory distress syndrome before veno‐venous extracorporeal membrane oxygenation

Lazzeri, Chiara; Cianchi, Giovanni; Bonizzoli, Manuela; Batacchi, Stefano; Terenzi, Paolo; Bernardo, Pasquale; Valente, Serafina; Gensini, Gian Franco; Peris, Adriano

doi:10.1111/aas.12643

Cited by 38 publications

(62 citation statements)

References 30 publications

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“…Clinical and biochemical data right before ECMO start were collected for all patients and the sequential organ failure assessment (SOFA) and the simplified acute physiology score (SAPS II) score were calculated . Moreover, according to our clinical standard operating procedure an echocardiographic exam was performed just before ECMO start. In‐hospital mortality was recorded.…”

Section: Methodsmentioning

confidence: 99%

“…Echocardiography is performed routinely before ECMO implantation by the cardiologist who is part of Mobile and in‐house ECMO Team. The cardiologist's main task is to evaluate cardiac function in the pre‐ECMO phase and guides the correct positioning of ECMO cannulas by transesophageal/transthoracic ultrasonography …”

Section: Methodsmentioning

confidence: 99%

“…Indeed, according to our protocol the echocardiographic examination is transthoracic (TTE), transesophageal (TEE) or both, according to the best acoustic window. The LV ejection fraction (LVEF) is estimated by eyeball examination on short‐axis views .…”

Section: Methodsmentioning

confidence: 99%

“…The LV ejection fraction (LVEF) is estimated by eyeball examination on short‐axis views . LV systolic dysfunction was defined as LV ejection fraction < 45% . The right ventricle size is assessed by the RV end‐diastolic area (EDA) (four‐chamber view) and the ratio between EDAs of the right and left ventricles is calculated (RVEDA/LVEDA).…”

Section: Methodsmentioning

confidence: 99%

“…Systolic pulmonary artery pressure (sPAP)is obtained using the simplified Bernouilli's equation with central venous pressure measured through central venous catheters …”

Section: Methodsmentioning

confidence: 99%

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A novel risk score for severe ARDS patients undergoing ECMO after retrieval from peripheral hospitals

Lazzeri

Cianchi

Mauri

et al. 2017

Acta Anaesthesiol Scand

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Background: Extracorporeal Membrane Oxygenation in severe ARDS unresponsive to conventional protective ventilation is associated with elevated costs, resource and complications, and appropriate risk stratification of candidate patients could be useful to recognize those more likely to benefit from ECMO. We aimed to derive a new outcome prediction score for patients retrieved by our ECMO team from peripheral centers, including systematic echocardiographic evaluation before ECMO start. Methods: Sixty-nine consecutive patients with refractory ARDS requiring ECMO transferred from peripheral centers to our ICU (a tertiary ECMO referral center), from 1 October 2009 to 31 December 2015, were assessed. Results: All patients were transported on ECMO (distance, median 77, range 4-456 km) The mortality rate was 41% (28/69). Our new risk score included age ≥ 42 years, BMI < 31 kg/m 2 , RV dilatation, and pH < 7.35. The proposed cut off (Youden's index method) of nine had a sensitivity of 96% and a specificity of 30% (AUC-ROC: 0.85, 95% CI: 0.76-0.94, P < 0.001). When assessing the discriminatory ability of our risk score in the population of local patients, survivors had a mean value of 15.4 AE 8.6, whereas non-survivors showed a mean value of 20.1 AE 7.4 (P < 0.001). Conclusions: Our new risk score shows good discriminatory ability both in patients retrieved from peripheral centers and in those implanted at our center. This score includes variables easily available at bedside, and, for the first time, a pathophysiologic element, RV dilatation.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…Systolic pulmonary artery pressure (sPAP)is obtained using the simplified Bernouilli's equation with central venous pressure measured through central venous catheters …”

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

A novel risk score for severe ARDS patients undergoing ECMO after retrieval from peripheral hospitals

Lazzeri

Cianchi

Mauri

et al. 2017

Acta Anaesthesiol Scand

Self Cite

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The use of echocardiographic indices in defining and assessing right ventricular systolic function in critical care research

et al. 2018

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Body mass index and echocardiography in refractory ARDS treated with veno-venous extracorporeal membrane oxygenation

et al. 2016

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The aims of the present investigation, performed in 118 consecutive patients with refractory ARDS treated with veno-venous extracorporeal membrane oxygenation (VV-ECMO), were as follows: (a) to assess ICU mortality in overweight, obese and morbid obese patients in respect to normal weight; (b) to evaluate echocardiographic findings according to BMI subgroups. Echocardiography was performed before VV-ECMO implantation. Forty-five patients (38.1%) showed normal BMI, 37 patients (31.4%) were overweight and the remaining were obese (21.2%), or morbid obese (9.3%). Morbid obese showed the lowest ICU mortality rate (p = 0.003). No differences were detectable among BMI subgroups in echocardiographic findings apart from the fact that obese patients showed the lowest incidence of LV dysfunction (p = 0.015). At stepwise regression analysis the following variables were independent predictor of ICU mortality (when adjusted for age): RV dilatation (OR 4.361, 95 % CI 1.809-10.512, p < 0.001), BMI (OR 0.884, 95% CI 0.821-0.951, p < 0.001). In other terms, the presence of RV dilatation is an independent predictor of ICU mortality. In refractory ARDS treated with VV-ECMO, BMI > 30 kg/m is common (accounting for one-third of the entire population) but it is not associated with a worse outcome, so that it cannot be considered per se a contraindication to ECMO implantation. The incidence of RV dilatation and failure, which are known to negatively affect prognosis in ARDS patients, were comparable among BMI subgroups.

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Pulmonary vascular dysfunction in refractory acute respiratory distress syndrome before veno‐venous extracorporeal membrane oxygenation

Cited by 38 publications

References 30 publications

A novel risk score for severe ARDS patients undergoing ECMO after retrieval from peripheral hospitals

A novel risk score for severe ARDS patients undergoing ECMO after retrieval from peripheral hospitals

The use of echocardiographic indices in defining and assessing right ventricular systolic function in critical care research

Body mass index and echocardiography in refractory ARDS treated with veno-venous extracorporeal membrane oxygenation

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