Pulse pressure as a prognostic marker in patients receiving extracorporeal life support

Park, Byoung-Won; Seo, Dae-Chul; Moon, Inki; Chung, Jung Kee; Bang, Duk-Won; Hyon, Min-Su; Kim, Sung-Koo; Chang, Won-Ho; Youm, Wook

doi:10.1016/j.resuscitation.2013.04.009

Cited by 39 publications

(29 citation statements)

References 15 publications

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“…Among clinical parameters, neither age, sex, co-morbidities, or severity at the time of VA ECMO implantation were identified as predictors of successful weaning. Pulse pressure appeared to be the only clinical factor associated with weaning success (13,15,21). In our study assessing 51 patients, among the 38 patients undergoing a decrease of ECMO flow, mean pulse pressure was higher in the successfully weaned group 52±12 vs. 39±15 mmHg (5) in others.…”

Section: Clinical Predictors: Pulsed Pressurementioning

confidence: 57%

Weaning from veno-arterial extra-corporeal membrane oxygenation: which strategy to use?

Ortuno¹,

Delmas²,

Diehl³

et al. 2019

Ann. Cardiothorac. Surg

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Refractory cardiogenic shock patients may be rescued by veno-arterial extracorporeal membrane oxygenation (VA ECMO). After a few days of mechanical assistance, the device can sometimes be successfully removed if the patient has partially or fully recovered from the condition that required the use of ECMO. The percentage of patients with refractory cardiogenic shock who are successfully weaned from ECMO varies from 31% to 76%. Weaning does not mean survival, because 20% to 65% of patients weaned from VA ECMO support do not survive to hospital discharge. The high death rate after successful weaning shows that many questions remain unresolved in this field. In this review, we will discuss the various factors influencing survival and a successful weaning from VA ECMO, in addition to weaning approaches proposed in the literature. Based on this information, we will propose a strategy to optimize the weaning process.

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Section: Clinical Predictors: Pulsed Pressurementioning

confidence: 57%

Weaning from veno-arterial extra-corporeal membrane oxygenation: which strategy to use?

Ortuno¹,

Delmas²,

Diehl³

et al. 2019

Ann. Cardiothorac. Surg

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“…Aissaoui et al were the first to describe pulse pressure as an important clinical factor associated with weaning success [7] as did Pappalardo et al and Park et al in their observational studies [6,39]. The latter identified higher mean pulse pressure during the initial 6 h after VA-ECMO implementation as an independent predictor of successful weaning and survival [39].…”

Section: Pulsementioning

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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“…The difference in outcome between IHCA and OHCA results more from the duration of cardiac arrest than from the location of cardiac arrest itself (Tables 1-3) [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57]. The difference in outcome between IHCA and OHCA results more from the duration of cardiac arrest than from the location of cardiac arrest itself (Tables 1-3) [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57].…”

Section: Extracorporeal Membrane Oxygenation For Out-of-hospital Cardmentioning

confidence: 99%

Extracorporeal cardiopulmonary resuscitation

Fagnoul

Combes

Backer

2014

Current Opinion in Critical Care

127

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This review highlights that ECPR is feasible for both IHCA and OHCA. In the recent series, the outcome of ECPR in IHCA is satisfactory, with survival rates good with neurologic outcome reaching the 40-50% range. All series converge in highlighting that time from cardiac arrest to ECMO flow is a critical determinant of outcome, with survival rates of 50% when initiated within 30 min of IHCA, 30% between 30 and 60 min, and 18% after 60 min. Results of ECPR in OHCA are more challenging. Recent series suggest that good outcome can be obtained in 15-20% of the patients, provided that time from arrest to ECMO is shorter than 60 min. Duration of cardiac arrest seems to be more important than location of cardiac arrest. ECPR thus seems to be a valuable option in selected cases.

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Pulse pressure as a prognostic marker in patients receiving extracorporeal life support

Cited by 39 publications

References 15 publications

Weaning from veno-arterial extra-corporeal membrane oxygenation: which strategy to use?

Weaning from veno-arterial extra-corporeal membrane oxygenation: which strategy to use?

Update on Weaning from Veno-Arterial Extracorporeal Membrane Oxygenation

Extracorporeal cardiopulmonary resuscitation

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