The Outcome of Patients Requiring Multiple Extracorporeal Membrane Oxygenation: How Many Runs of ECMO is Reasonable?

Chou, Hong‐Nong; Chang, Te I.; Wang, Chih‐Hsien; Chou, Nai-Kuan; Chi, Nai‐Hsin; Huang, Su‐Cheng; Wu, I-Hui; Chan, Chih-Yang; LeeMei, Ponge; Wang, Ya-Chen; Chen, Yih-Sharng

doi:10.5301/ijao.5000511

Cited by 9 publications

(17 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There is a relative paucity of data with regards to adult patients requiring repeat support. The largest published population of patients with repeat ECMO support documented a 33.3% overall survival rate for two runs in a series of 86 patients . In our series, the majority of REPs were patients requiring VA ECMO after cardiogenic shock, which often has a poorer prognosis than VV ECMO, with an overall survival of 41%…”

Section: Discussionmentioning

confidence: 63%

“…The largest published population of patients with repeat ECMO support documented a 33.3% overall survival rate for two runs in a series of 86 patients. 5 In our series, the majority of REPs were patients requiring VA ECMO after cardiogenic shock, which often has a poorer prognosis than VV ECMO, with an overall survival of 41%. 6 The etiology for the need for repeat ECMO support plays a significant role in prognosis and outcomes.…”

Section: Resultsmentioning

confidence: 68%

“…There has been a paucity of data published on repeat ECMO in adult patients. Survival rates have been as low as 30.2% in patients requiring repeat ECMO . This study reviews our experience with six patients that required repeat ECMO support and compares their outcomes with patients requiring only a single period of ECMO support.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Outcomes in patients requiring repeat extracorporeal membrane oxygenation

Brady

Kwapnoski²,

Lyden

et al. 2018

J Card Surg

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 63%

Section: Resultsmentioning

confidence: 68%

See 1 more Smart Citation

Outcomes in patients requiring repeat extracorporeal membrane oxygenation

Brady

Kwapnoski²,

Lyden

et al. 2018

J Card Surg

View full text Add to dashboard Cite

show abstract

“…45 In another study, the need for hemodialysis in MRE patients has been shown to be a risk factor for mortality. 46 There is much discussion throughout the related literature about lactate levels and lactate clearance time. Elevated lactate levels are caused by hypoperfusion and thus indicate the severity of LCOS before ECMO.…”

Section: Discussionmentioning

confidence: 99%

“…45 In another study, the need for hemodialysis in MRE patients has been shown to be a risk factor for mortality. 46…”

Section: Discussionmentioning

confidence: 99%

Use of extracorporeal membrane oxygenation in postcardiotomy pediatric patients: parameters affecting survival

et al. 2020

View full text Add to dashboard Cite

Aim: We aimed to investigate the risk factors affecting survival after extracorporeal membrane oxygenation use in pediatric postcardiotomy patients. Methods: One hundred thirty-three consecutive patients who underwent surgery for congenital heart disease who needed extracorporeal membrane oxygenation support were retrospectively analyzed. Results: In all, 3,082 patients were operated, of which 140 patients (4.54% of the total number of operations) needed extracorporeal membrane oxygenation. Eighty (60.1%) patients were successfully weaned and 51 (38.3%) patients were discharged. Of the 50 patients discharged during the mean follow-up period of 34.8 (0-192.4) months, 6 (12%) patients died. The extracorporeal membrane oxygenation support was instituted in 29 (21.8%) patients for extracorporeal membrane oxygenation cardiopulmonary resuscitation, in 44 (33.1%) patients due to the inability to be separated from cardiopulmonary bypass, in 19 (14.3%) patients due to respiratory failure, and in 41 patients due to low cardiac output syndrome. Eighty patients (60.2%) were successfully weaned from extracorporeal membrane oxygenation support. The remaining 53 (39.8%) patients died on extracorporeal membrane oxygenation. Mortality was observed in 29 (21.8%) of the 80 patients in the successful weaning group, while the remaining 51 (38.3%) patients were discharged from the hospital. Multivariate analysis showed that double-ventricular physiology increased the rate of successful weaning (odds ratio: 3.4, 95% confidence interval lower: 1.5 and upper: 8, p = 0.004) and prolonged extracorporeal membrane oxygenation durations were a risk factor in successful weaning (odds ratio: 0.9, 95% confidence interval lower: 0.8 and upper: 0.9, p = 0.007). The parameters affecting mortality were the presence of syndrome (odds ratio: 3.8, 95% confidence interval lower: 1.0 and upper: 14.9, p = 0.05), single-ventricular physiology (odds ratio: 5.3, 95% confidence interval lower: 1.8 and upper: 15.3, p = 0.002), and the need for a second extracorporeal membrane oxygenation (odds ratio: 12.9, 95% confidence interval lower: 1.6 and upper: 104.2, p = 0.02). While 1-year survival was 15.2% and 3-year survival was 12.1% in patients with single-ventricular physiology, the respective survival rates were 43.9% and 40.8%. Conclusion: Parameters affecting mortality after extracorporeal membrane oxygenation support in pediatric postcardiotomy patient group were the presence of a syndrome, multiple runs of extracorporeal membrane oxygenation, and single-ventricular physiology. Timing of extracorporeal membrane oxygenation initiation, appropriate patient selection, appropriate reintervention or reoperation for patients with correctable pathology, the use of an appropriate cannulation strategy in single-ventricle patients, management of shunt flow, and appropriate interventions to reduce the incidence of complications play key roles in improving survival.

show abstract