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

Fux, Thomas; Holm, Maja; Corbascio, Matthias; Lund, Lars H.; Linden, Jan van der

doi:10.1111/aor.13331

Cited by 21 publications

(24 citation statements)

References 43 publications

(75 reference statements)

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“…While there were several variables on univariate analysis suggestive of 30‐day survival in our study such as BMI, serum creatinine, platelet count, and SYNTAX score, the only measured multivariable predictor was lower initial serum creatinine. This is intuitive, as serum creatinine as a surrogate of renal function is ubiquitous in mortality prediction tools developed for critically ill, cardiac, and PCI‐amenable patients, although a recent analysis did not show statistical significance for creatinine in VA‐ECMO patients with CS . Accordingly, 38.7% of patients required renal replacement therapy.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of extracorporeal membrane oxygenation support in the cardiac catheterization laboratory

Parr

Sharma

Arora

et al. 2019

Cathet Cardio Intervent

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Objectives The aims of this single‐center retrospective study were to characterize and determine predictors of 30‐day survival in a cohort of patients requiring venoarterial extracorporeal membrane oxygenation (VA‐ECMO) supported cardiopulmonary resuscitation (E‐CPR) in the cardiac catheterization laboratory (CCL) for cardiac arrest (CA) or refractory cardiogenic shock (CS). Background While safety in the CCL has improved, periprocedural mortality from CA remains high. The application of VA‐ECMO is an emerging form of resuscitation with a paucity of data evaluating its use in the CCL for CA or CS. Methods All consecutive patients aged 18 years or older presenting to a single CCL from October 2010 to May 2018 who required E‐CPR for CA or refractory CS were included. The primary outcome of our study was overall survival 30 days from VA‐ECMO initiation. Secondary outcomes included 1‐year survival, hospital length of stay, and ECMO related complications. Results Sixty‐two patients with a mean age of 60 ± 9 years, 63% male, were included. VA‐ECMO was initiated for CA in 39 patients (63%) and for CS in 23 patients (37%). The median ECMO duration was 48 hr. Overall 30‐day survival was 47% (CA group 44% vs. CS group 52%; p = .414). One‐year survival was 44%. Initial serum creatinine (OR 1.18 per 10 μmol/L increase; p = .016; AUC = 0.65) was the only multivariate predictor of 30‐day mortality. Conclusions The use of VA‐ECMO in the CCL is feasible, demonstrating 47% 30‐day survival, largely persistent to 1 year, in a cohort that otherwise has extremely high mortality.

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Section: Discussionmentioning

confidence: 99%

Outcomes of extracorporeal membrane oxygenation support in the cardiac catheterization laboratory

Parr

Sharma

Arora

et al. 2019

Cathet Cardio Intervent

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“…23 Serum lactate levels are widely used as a marker of altered tissue perfusion in critically ill patients or those with acute decompensated HF. [24][25][26][27] Both elevated lactate levels and lactate clearance during ECMO therapy in cardiogenic shock are predictive markers for mortality. 4,25 LA venting allows for the unloading of the LVD and increases the chances of myocardial recovery.…”

Section: Discussionmentioning

confidence: 99%

“…Lactate is a metabolic product of anaerobic glycolysis reflecting inadequate oxygen delivery to the peripheral tissue, thus, suggesting abnormal cellular oxygen metabolism 23 . Serum lactate levels are widely used as a marker of altered tissue perfusion in critically ill patients or those with acute decompensated HF 24‐27 . Both elevated lactate levels and lactate clearance during ECMO therapy in cardiogenic shock are predictive markers for mortality 4,25 .…”

Section: Discussionmentioning

confidence: 99%

Outcomes of left ventricular unloading with a transseptal cannula during extracorporeal membrane oxygenation in adults

et al. 2020

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We evaluated the benefit of left ventricular (LV) unloading using a percutaneous transseptal left atrial (LA) drain catheter via femoral vein incorporated into the ECMO venous circuit. This single-center retrospective observational study analyzed clinical outcomes of the LA venting group (N = 62) who underwent percutaneous transseptal LA drain placement comparing with the conventionally treated control group (N = 62) with an arterial pulse pressure below 10 mm Hg for at least 24 hours from December 2012 to August 2018. The ECMO weaning rate (61.3% vs. 38.7%, P = .012) and cardiac transplantation rate (29.0% vs. 11.3%, P = .014) were higher in the LA venting group than in the control group. Inhospital mortality was not significantly different (56.5% vs. 69.4%, P = .191). Pulmonary congestion mostly improved after LA decompression (61.3%, P = .003). A serum lactate level at 24 hours after LA venting of more than 2.2 mmol/L was associated with poor outcomes. LA venting via transseptal cannula reduced pulmonary venous congestion and achieved higher rates of successful ECMO weaning and cardiac transplantation. Placement of a transseptal venous drain cannula should be considered in patients with uncontrolled pulmonary edema secondary to severe LV loading undergoing VA-ECMO.

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“…Thomas Fux et al of the Karolinska Institute, Stockholm, Sweden reported on preimplant predictors for the use of venoarterial extracorporeal membrane oxygenation (VA‐ECMO) in refractory cardiogenic support (RCS). They retrospectively analyzed 76 consecutive patients supported with VA‐ECMO due to RCS.…”

Section: Cardiopulmonary Support and Membrane Oxygenationmentioning

confidence: 99%

Artificial Organs 2019: A year in review

Malchesky¹

2020

Artificial Organs

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In this Editor’s Review, articles published in 2019 are organized by category and summarized. These provide a brief reflection of the research and progress in artificial organs intended to advance and better human life while providing insight for continued application of these technologies and methods. Artificial Organs continues in the original mission of its founders “to foster communications in the field of artificial organs on an international level.” Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. Peer‐reviewed Special Issues this year included contributions from the 14th International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion edited by Dr Akif Undar, and the 26th Congress of the International Society for Mechanical Circulatory Support edited by Dr Minoru Ono and Dr Francesco Moscato. Additionally, important editorials highlighted the need for sustainability in hemodialysis, challenges and opportunities in mechanical circulatory support, progress in artificial pancreas development, historical perspectives on ventilators and dialysis, tissue engineering for cardiac support, and regional updates from India and China. Our Pioneer Series continues to highlight the many researchers who created this field of study. This year we debuted a new series entitled “Recent Progress in Artificial Organs” prepared by Vakhtang Tchantchaleishvili and Elizabeth Maynes of Thomas Jefferson University, Philadelphia, PA, USA. This series highlights recent advances and new developments in the field. We take this time also to express our gratitude to our authors for contributing their work to this journal. We offer our very special thanks to our reviewers who give so generously of their time and expertise to review, critique, and especially provide meaningful suggestions to the author’s work. Without our dedicated expert reviewers, the quality expected from such a journal would not be possible. We also express our special thanks to our Publisher, John Wiley & Sons, for their expert attention and support in the production Artificial Organs. We look forward to reporting further advances in the coming years.

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

Cited by 21 publications

References 43 publications

Outcomes of extracorporeal membrane oxygenation support in the cardiac catheterization laboratory

Outcomes of extracorporeal membrane oxygenation support in the cardiac catheterization laboratory

Outcomes of left ventricular unloading with a transseptal cannula during extracorporeal membrane oxygenation in adults

Artificial Organs 2019: A year in review

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