Venoarterial extracorporeal membrane oxygenation to rescue sepsis-induced cardiogenic shock: a retrospective, multicentre, international cohort study

Bréchot, Nicolas; Hajage, David; Kimmoun, Antoine; Demiselle, Julien; Agerstrand, Cara; Montero, Santiago; Schmidt, Matthieu; Luyt, Charles‐Édouard; Lebreton, Guillaume; Hékimian, Guillaume; Flécher, Erwan; Zogheib, Élie; Lévy, Bruno; Slutsky, Arthur S.; Brodie, Daniel; Asfar, Pierre; Combes, Alain

doi:10.1016/s0140-6736(20)30733-9

Cited by 135 publications

(129 citation statements)

References 36 publications

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“…However, there is no universal guideline or consensus published in the literature to determine cardiovascular dysfunction in cases of septic shock. Usually, determination of severity of cardiovascular dysfunction is done using the following four parameters-low cardiac index, left ventricular dysfunction, lactatemia, and high inotropic/vasopressor requirement [6,7]. Criteria vary across the institutes.…”

Section: Discussionmentioning

confidence: 99%

“…Septic shock is predominantly distributive and therefore definition of cardiovascular dysfunction in such situation is debatable. Some [6] consider a cardiac index less than 3 L/min/m 2 (considering high output failure physiology), while others [7] consider cardiac index less than 2 L/min/m 2 as a cutoff level for cardiovascular dysfunction in septic shock. There are also different inotrope/ vasopressor scores available to determine the severity of shock [6,7], but those scores are based on institute-specific inotrope/pressor usage and may not include all the inotropes/ vasopressors available in the market.…”

Section: Discussionmentioning

confidence: 99%

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Determination of cardiovascular dysfunction before initiation of extracorporeal membrane oxygenation in septic shock

Rijst

Mangukia

Muhammad

et al. 2021

Indian J Thorac Cardiovasc Surg

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Extracorporeal membrane oxygenation (ECMO) is being increasingly used in patients having sepsis-induced cardiovascular dysfunction. We report successful use of venovenous ECMO in septic shock secondary to pneumonia in the presence of severe left ventricular dysfunction. We also discuss the quantitative evaluation of cardiovascular dysfunction, which provides important input in choosing the type of ECMO in septic shock.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Determination of cardiovascular dysfunction before initiation of extracorporeal membrane oxygenation in septic shock

Rijst

Mangukia

Muhammad

et al. 2021

Indian J Thorac Cardiovasc Surg

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“…Bréchot and colleagues published a multicenter retrospective cohort study investigating the use of venoarterial (VA) ECMO in patients suffering from sepsis-induced cardiogenic shock. 64 Transient myocardial dysfunction is common in patients with sepsis, 65 and more severe myocardial dysfunction is associated with significant increases in mortality. 66 Data were collected from patients with left ventricular ejection fraction 35% or less or cardiac index 3 L/min per m 2 or less; and serum lactate at least 4 mmol/L or inotrope score at least 75 µg/kg per min.…”

Section: Mechanical Circulatory Support: Honing Indications and Understanding Outcomesmentioning

confidence: 99%

Year in Review 2020: Noteworthy Literature in Cardiothoracic Anesthesiology

Clendenen

Ahlgren

Robitaille

et al. 2021

Semin Cardiothorac Vasc Anesth

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The year 2020 was marred by the emergence of a deadly pandemic that disrupted every aspect of life. Despite the disruption, notable research accomplishments in the practice of cardiothoracic anesthesiology occurred in 2020 with an emphasis on optimizing care, improving outcomes, and expanding what is possible for patients undergoing cardiac surgery. This year’s edition of Noteworthy Literature Review will focus on specific themes in cardiac anesthesiology that include preoperative anemia, predictors of acute kidney injury following cardiac surgery, pain management modalities, anticoagulation strategies after transcatheter aortic valve replacement, mechanical circulatory support, and future directions in research.

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“…While VA‐ECMO does not per se affect pulmonary thrombus resolution, it may offer an appropriate hemodynamic and respiratory support in unstable patients or cardiac arrest victims and a precious time window to ensure pulmonary reperfusion therapies or spontaneous thrombolysis. Conversely, VA‐ECMO itself may be associated with a number of drawbacks, related to blood‐circuit interaction, coagulation derangements, and large‐bore cannulae of the circuit, including cerebrovascular events, bleeding, hemolysis, vessel injury, and septic complications 6‐8 …”

Section: Introductionmentioning

confidence: 99%

Use of extracorporeal membrane oxygenation in high‐risk acute pulmonary embolism: A systematic review and meta‐analysis

et al. 2021

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Extracorporeal membrane oxygenation (ECMO) represents a therapeutic option for cardiopulmonary support in patients with high‐risk pulmonary embolism (PE); however, no definite consensus exists on ECMO use in high‐risk PE. Hence, we aim to provide insights into its real‐world use pooling together all available published experiences. We performed a systematic review and pooled analysis of all published studies (up to April 17, 2020) investigating ECMO support in high‐risk PE. All studies including at least four patients were collectively analyzed. Study outcomes were early all‐cause death (primary endpoint) and relevant in‐hospital adverse events. A total of 21 studies were included in the pooled analysis (n = 635 patients). In this population (mean age 47.8 ± 17.3 years, 44.5% females), ECMO was indicated for cardiac arrest in 62.3% and immediate ECMO support was pursued in 61.9% of patients. Adjunctive reperfusion therapies were implemented in 57.0% of patients. Pooled estimate rate of early all‐cause mortality was 41.1% (95% CI 27.7%‐54.5%). The most common in‐hospital adverse event was major bleeding, with an estimated rate of 28.6% (95%CI 21.0%‐36.3%). At meta‐regression analyses, no significant impact of multiple covariates on the primary endpoint was found. In this systematic review of patients who received ECMO for high‐risk PE, pooled all‐cause mortality was 41.1%. Principal indication for ECMO was cardiac arrest, cannulation was chiefly performed at presentation, and major bleeding was the most common complication.

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Venoarterial extracorporeal membrane oxygenation to rescue sepsis-induced cardiogenic shock: a retrospective, multicentre, international cohort study

Cited by 135 publications

References 36 publications

Determination of cardiovascular dysfunction before initiation of extracorporeal membrane oxygenation in septic shock

Determination of cardiovascular dysfunction before initiation of extracorporeal membrane oxygenation in septic shock

Year in Review 2020: Noteworthy Literature in Cardiothoracic Anesthesiology

Use of extracorporeal membrane oxygenation in high‐risk acute pulmonary embolism: A systematic review and meta‐analysis

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