Support time-dependent outcome analysis for veno-venous extracorporeal membrane oxygenation

Abstract Background Extracorporeal membrane oxygenation (ECMO) support may be considered to reduce mortality but survival and clinical outcomes are uncertain after Stanford type A Aortic dissection (TAAD). We analyzed the data of TAAD patients with postoperative ECMO support in our institution to investigate clinical outcomes. Methods In this retrospective cohort study, all clinical data of TAAD patients with postoperative ECMO support from January 2013 to October 2019 in our institution were harvested. Cases with redo or incomplete records were excluded. Results 22 cases were enrolled, 18 male and 4 female. The mean age was52.85±10.91 years. 20 patients underwent VA-ECMO treatment and 2 patients received VV-ECMO support. The support time was92.54±78.71 hours. 9 patients were successfully weaned from ECMO. 30-day in-hospital survival rate was 27.27 % (6/22). The follow-up duration is from 5 to 74 months. The median follow-up time is 35 months. Only four patients were still alive at the end of the follow-up period. Conclusions The mortality of TAAD patients with postoperativesevere circulatory and respiratory dysfunctions is high. ECMO would be considered as a valuable contribution to save lives. But more experience needs to be accumulated to improve clinical outcome.

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Venovenous extracorporeal membrane oxygenation for ARDS: outcome analysis of a Croatian referral center for respiratory ECMO

Wiener klinische Wochenschrift ◽

10.1007/s00508-016-1109-3 ◽

2016 ◽

Vol 129 (13-14) ◽

pp. 497-502

Author(s):

Marko Kutleša ◽

Anđa Novokmet ◽

Renata Josipović Mraović ◽

Bruno Baršić

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Outcome Analysis ◽

Referral Center ◽

Membrane Oxygenation ◽

Venovenous Extracorporeal Membrane Oxygenation

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Outcome analysis of neonates with congenital diaphragmatic hernia treated with venovenous vs venoarterial extracorporeal membrane oxygenation

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2009.01.017 ◽

2009 ◽

Vol 44 (9) ◽

pp. 1691-1701 ◽

Cited By ~ 61

Author(s):

Yigit S. Guner ◽

Robinder G. Khemani ◽

Faisal G. Qureshi ◽

Choo Phei Wee ◽

Mary T. Austin ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Outcome Analysis ◽

Membrane Oxygenation ◽

Venoarterial Extracorporeal Membrane Oxygenation

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Eighteen years of paediatric extracorporeal membrane oxygenation and ventricular assist devices: insight regarding late outcomes

Cardiology in the Young ◽

10.1017/s1047951118001282 ◽

2018 ◽

Vol 28 (11) ◽

pp. 1316-1322

Author(s):

Shawn M. Shah ◽

David W. Kays ◽

Sharon R. Ghazarian ◽

Tom R. Karl ◽

Plato Alexander ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Ventricular Assist Device ◽

Left Heart ◽

Hypoplastic Left Heart ◽

Assist Device ◽

Ventricular Assist ◽

Membrane Oxygenation ◽

Kaplan Meier ◽

Left Heart Syndrome ◽

Support Time

AbstractBackgroundWe reviewed all patients who were supported with extracorporeal membrane oxygenation and/or ventricular assist device at our institution in order to describe diagnostic characteristics and assess mortality.MethodsA retrospective cohort study was performed including all patients supported with extracorporeal membrane oxygenation and/or ventricular assist device from our first case (8 October, 1998) through 25 July, 2016. The primary outcome of interest was mortality, which was modelled by the Kaplan–Meier method.ResultsA total of 223 patients underwent 241 extracorporeal membrane oxygenation runs. Median support time was 4.0 days, ranging from 0.04 to 55.8 days, with a mean of 6.4±7.0 days. Mean (±SD) age at initiation was 727.4 days (±146.9 days). Indications for extracorporeal membrane oxygenation were stratified by primary indication: cardiac extracorporeal membrane oxygenation (n=175; 72.6%) or respiratory extracorporeal membrane oxygenation (n=66; 27.4%). The most frequent diagnosis for cardiac extracorporeal membrane oxygenation patients was hypoplastic left heart syndrome or hypoplastic left heart syndrome-related malformation (n=55 patients with HLHS who underwent 64 extracorporeal membrane oxygenation runs). For respiratory extracorporeal membrane oxygenation, the most frequent diagnosis was congenital diaphragmatic hernia (n=22). A total of 24 patients underwent 26 ventricular assist device runs. Median support time was 7 days, ranging from 0 to 75 days, with a mean of 15.3±18.8 days. Mean age at initiation of ventricular assist device was 2530.8±660.2 days (6.93±1.81 years). Cardiomyopathy/myocarditis was the most frequent indication for ventricular assist device placement (n=14; 53.8%). Survival to discharge was 42.2% for extracorporeal membrane oxygenation patients and 54.2% for ventricular assist device patients. Kaplan–Meier 1-year survival was as follows: all patients, 41.0%; extracorporeal membrane oxygenation patients, 41.0%; and ventricular assist device patients, 43.2%. Kaplan–Meier 5-year survival was as follows: all patients, 39.7%; extracorporeal membrane oxygenation patients, 39.7%; and ventricular assist device patients, 43.2%.ConclusionsThis single-institutional 18-year review documents the differential probability of survival for various sub-groups of patients who require support with extracorporeal membrane oxygenation or ventricular assist device. The indication for mechanical circulatory support, underlying diagnosis, age, and setting in which cannulation occurs may affect survival after extracorporeal membrane oxygenation and ventricular assist device. The Kaplan–Meier analyses in this study demonstrate that patients who survive to hospital discharge have an excellent chance of longer-term survival.

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The use of extracorporeal membrane oxygenation in the setting of postinfarction mechanical complications: outcome analysis of the Extracorporeal Life Support Organization Registry

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa108 ◽

2020 ◽

Vol 31 (3) ◽

pp. 369-374 ◽

Cited By ~ 1

Author(s):

Matteo Matteucci ◽

Dario Fina ◽

Federica Jiritano ◽

Paolo Meani ◽

Giuseppe Maria Raffa ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Life Support ◽

Extracorporeal Life Support ◽

Outcome Analysis ◽

Ventricular Septal Rupture ◽

Old Patients ◽

Patient Cohort ◽

Membrane Oxygenation ◽

Mechanical Complications ◽

Va Ecmo

Abstract OBJECTIVES Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been recently considered and used for patients with post-acute myocardial infarction mechanical complications (post-AMI MC); however, information in this respect is scarce. The purpose of this study was to evaluate the in-hospital outcomes of patients with post-AMI MC submitted to VA-ECMO, and enrolled in the Extracorporeal Life Support Organizations (ELSO)’s data Registry. METHODS This was a retrospective review of the ELSO Registry to identify adult (>18 years old) patients with post-AMI MC who underwent VA-ECMO support between 2007 and 2018. The primary end point of this study was in-hospital survival. ECMO complications were also evaluated. RESULTS The patient cohort available for this study included 158 patients. The median age was 62.4 years (range 20–80). The most common post-AMI MC was ventricular septal rupture (n = 102; 64.5%), followed by papillary muscle rupture (n = 42; 26.6%) and ventricular free-wall rupture (n = 14; 8.9%). Approximately a quarter of patients (n = 41; 25.9%) had cardiac arrest before VA-ECMO institution. The median duration of VA-ECMO was 5.9 days (range 1 h–40.3 days). ECMO complications occurred in 119 patients (75.3%). Overall, survival to hospital discharge for the entire patient cohort was 37.3%. Patients who had ventricular septal rupture as primary diagnosis had higher in-hospital mortality (n = 66; 64.7%). CONCLUSIONS In patients with post-AMI MC, VA-ECMO provides haemodynamic stabilizations and carries a potential to reverse otherwise lethal course. ECMO complications, however, remain an important limitation. Further investigations are required to better evaluate the efficacy and safety of ECMO in this context.

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