Study conclude that in patients in whom VA-ECMO treatment is deemed necessary a combination of VA-ECMO and SE may be a better option than VA-ECMO combined with thrombolysis to treat PE: We disagree about the next prospective study to be realized!

Background. Serious heart failure may be treated with extracorporeal membrane oxygenation (ECMO) when other treatment fails. The aim of the present study was to analyse preoperative risk factors of early mortality in patients treated with veno-arterial (VA)-ECMO. Methods. We studied a total of 18 possible risk factors in 80 patients with severe cardiac insufficiency treated with VA-ECMO. All consecutive cases treated at our institution between Sept.1990 and May 2006 were included. Univariate analysis and multiple logistic regression analysis were performed on 16 risk factors. The endpoint was early mortality (any death within 30 days of ECMO treatment). Results. Thirty patients (37.5%) died within 30 days. Age, gender, cause of cardiac failure, pre-ECMO treatment (ventilator, NO, IABP) did not significantly influence early mortality. A higher SvO2 was associated with survival and remained significant in the multivariate analysis. Conclusion. Treatment with VA-ECMO in patients with severe cardiac failure may save lives. It is, however, difficult to predict outcome. In this study, only SvO2 values prior to ECMO were positively associated with survival. Perfusion (2007) 22, 225—229.

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Isoflurane sedation in patients undergoing VA-ECMO treatment for cardiogenic shock – an observational propensity-matched study

European Heart Journal ◽

10.1093/ehjci/ehaa946.1839 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C Scherer ◽

D Kupka ◽

T Stocker ◽

D Joskowiak ◽

H Scheuplein ◽

...

Keyword(s):

Cardiogenic Shock ◽

Gas Flow ◽

Systolic Arterial Pressure ◽

Bleeding Complications ◽

Sedative Drug ◽

Isoflurane Group ◽

Va Ecmo ◽

Sedation Group ◽

Matched Study ◽

Ecmo Treatment

Abstract Introduction The feasibility and hemodynamic effects of isoflurane sedation in cardiogenic shock in the presence of extracorporeal membrane oxygenation (VA-ECMO) treatment is currently unknown. Methods Thirty-two cardiogenic shock patients with VA-ECMO treatment under sedation with volatile isoflurane on a cardiac intensive care unit have been enrolled in this retrospective single-center study and were matched by propensity score in a 1:1 ratio with intravenously (IV) sedated patients. Results Administration of isoflurane was associated with lower IV sedative drug use during VA-ECMO treatment (86% vs. 32%, p=0.01). Mean systolic arterial pressure was similar (94.3±12.6 mmHg versus 92.9±10.5 mmHg, p=0.65), but mean heart rate was significantly higher in the conventional sedation group, when compared to the isoflurane group (85.2±20.5 / min vs. 74.7±15.0 /min; p=0.02). Catecholamine doses, VA-ECMO blood and gas flow, ventilation time (304±143 h vs. 398±272 h, p=0.16), bleeding complications BARC3a or higher (59.3% vs. 65.3%, p=0.76) and 30-day mortality (59.2% vs. 63.4%, p=0.80) were similar in both groups. Conclusions Volatile sedation with isoflurane is feasible in patients with cardiogenic shock and VA-ECMO treatment and was not associated with higher catecholamine dosage or ECMO flow rate compared to IV sedation. Mortality and bleeding Funding Acknowledgement Type of funding source: None

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Renal Recovery in Critically Ill Adult Patients Treated With Veno-Venous or Veno-Arterial Extra Corporeal Membrane Oxygenation: A Retrospective Cohort Analysis

The Journal of Critical Care Medicine ◽

10.2478/jccm-2021-0006 ◽

2020 ◽

Vol 7 (2) ◽

pp. 104-112

Author(s):

Braghadheeswar Thyagarajan ◽

Mariana Murea ◽

Deanna N. Jones ◽

Amit K. Saha ◽

Gregory B. Russell ◽

...

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Retrospective Cohort ◽

Kidney Injury ◽

Complete Recovery ◽

Renal Recovery ◽

Partial Recovery ◽

Va Ecmo ◽

Ecmo Treatment ◽

Vv Ecmo

Abstract Introduction Patients on extracorporeal membrane oxygenator (ECMO) therapy are critically ill and often develop acute kidney injury (AKI) during hospitalisation. Little is known about the association of exposure to and the effect of the type of ECMO and extent of renal recovery after AKI development. Aim of the study In patients who developed AKI, renal recovery was characterised as complete, partial or dialysis-dependent at the time of hospital discharge in both the Veno-Arterial (VA) and Veno-Venous (VV) ECMO treatment groups. Material and methods The study consisted of a single-centre retrospective cohort that includes all adult patients (n=125) who received ECMO treatment at a tertiary academic medical centre between 2015 to 2019. Data on demographics, type of ECMO circuit, comorbidities, exposure to nephrotoxic factors and receipt of renal replacement therapy (RRT) were collected as a part of the analysis. Acute Kidney Injury Network (AKIN) criteria were used for the diagnosis and classification of AKI. Group differences were assessed using Fisher’s exact tests for categorical data and independent t-tests for continuous outcomes. Results Sixty-four patients received VA ECMO, and 58 received VV ECMO. AKI developed in 58(91%) in the VA ECMO group and 51 (88%) in the VV ECMO group (p=0.77). RRT was prescribed in significantly higher numbers in the VV group 38 (75%) compared to the VA group 27 (47%) (p=0.0035). At the time of discharge, AKI recovery rate in the VA group consisted of 15 (26%) complete recovery and 5 (9%) partial recovery; 1 (2%) remained dialysis-dependent. In the VV group, 22 (43%) had complete recovery (p=0.07), 3(6%) had partial recovery (p=0.72), and 1 (2%) was dialysis-dependent (p>0.99). In-hospital mortality was 64% in the VA group and 49% in the VV group (p=0.13). Conclusions Renal outcomes in critically ill patients who develop AKI are not associated with the type of ECMO used. This serves as preliminary data for future studies in the area.

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Isoflurane sedation in patients undergoing VA-ECMO treatment for cardiogenic shock

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.151 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

C Scherer ◽

D Kupka ◽

E Luesebrink ◽

S Massberg ◽

M Orban

Keyword(s):

Cardiogenic Shock ◽

Gas Flow ◽

Systolic Arterial Pressure ◽

University Hospital ◽

Bleeding Complications ◽

Sedative Drug ◽

Isoflurane Group ◽

Va Ecmo ◽

Sedation Group ◽

Ecmo Treatment

Abstract Funding Acknowledgements Type of funding sources: None. Objectives (Background): The feasibility and hemodynamic effects of isoflurane sedation in cardiogenic shock in the presence of extracorporeal membrane oxygenation (VA-ECMO) treatment is currently unknown. Design Retrospective single-center study Patients/subjects: Cardiogenic shock patients with VA-ECMO treatment under sedation with volatile isoflurane between November 2018 and October 2019 have been enrolled in this study and were matched by propensity score in a 1:1 ratio with intravenously (IV) sedated patients treated between January 2013 and November 2018 from the cardiogenic shock registry of our university hospital. Measurements and Main Results: Isoflurane sedation was used in 32 patients with cardiogenic shock and VA-ECMO treatment. The mean age of conventionally sedated patients was 58.4 ± 13.8 years and 56.3 ± 11.5 years for patients with isoflurane sedation (p = 0.51). Administration of isoflurane was associated with lower IV sedative drug use during VA-ECMO treatment (86% vs. 32%, p = 0.01). Mean systolic arterial pressure was similar (94.3 ± 12.6 mmHg versus 92.9 ± 10.5 mmHg, p = 0.65), but mean heart rate was significantly higher in the conventional sedation group, when compared to the isoflurane group (85.2 ± 20.5 /min vs. 74.7 ± 15.0 /min; p = 0.02). Catecholamine doses, VA-ECMO blood and gas flow, ventilation time (304 ± 143 h vs. 398 ± 272 h,p = 0.16), bleeding complications BARC3a or higher (59.3% vs. 65.3%, p = 0.76) and 30 day-mortality (59.2% vs. 63.4%, p = 0.80) were similar in both groups. The overall sedation costs per patient were significantly lower in the conventional group, when compared to the isoflurane group (537 ± 624 € vs. 1280 ± 837 €, p < 0.001). Conclusions Volatile sedation with isoflurane is feasible – albeit at higher costs - in patients with cardiogenic shock and VA-ECMO treatment and was not associated with higher catecholamine dosage or ECMO flow rate compared to IV sedation.

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Advanced Age as a Predictor of Survival and Weaning in Venoarterial Extracorporeal Oxygenation: A Retrospective Observational Study

BioMed Research International ◽

10.1155/2017/3505784 ◽

2017 ◽

Vol 2017 ◽

pp. 1-14 ◽

Cited By ~ 2

Author(s):

WooSurng Lee ◽

YoHan Kim ◽

HyunHee Choi ◽

HyoungSoo Kim ◽

SunHee Lee ◽

...

Keyword(s):

Risk Factor ◽

Statistical Significance ◽

Survival Rates ◽

Age Groups ◽

Multivariate Logistic Regression Analysis ◽

Advanced Age ◽

Lower Survival Rate ◽

Successful Weaning ◽

Va Ecmo ◽

Ecmo Treatment

Background. In most reports on ECMO treatment, advanced age is classified as a contraindication to VA ECMO. We attempted to investigate whether advanced age would be a main risk factor deciding VA ECMO application and performing VA ECMO support. We determined whether advanced age should be regarded as an absolute or relative contraindication to VA ECMO and could affect weaning and survival rates of VA ECMO patients.Methods.VA ECMO was performed on 135 adult patients with primary cardiogenic shock between January 2010 and December 2014. Successful weaning was defined as weaning from ECMO followed by survival for more than 48 hours.Results. Among the 135 patients, 35 survived and were discharged uneventfully, and the remaining 100 did not survive. There were significant differences in survival between age groups, and older age showed a lower survival rate with statistical significance (P= .01). By multivariate logistic regression analysis, age was not significantly associated with in-hospital mortality (P= .83) and was not significantly associated with VA ECMO weaning (P= .11).Conclusions.Advanced age is an undeniable risk factor for VA ECMO; however, patients of advanced age should not be excluded from the chance of recovery after VA ECMO treatment.

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Survival to Hospital Discharge Rate and Factors Affecting Survival Rate of Adult Patients Under Venoarterial Extracorporeal Membrane Oxygenation (VA ECMO) Treatment in King Chulalongkorn Memorial Hospital

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.07.11929 ◽

2021 ◽

Vol 104 (7) ◽

pp. 1073-1081

Keyword(s):

Survival Rate ◽

Mortality Rate ◽

Extracorporeal Membrane Oxygenation ◽

Cardiogenic Shock ◽

Factors Affecting ◽

Membrane Oxygenation ◽

Venoarterial Extracorporeal Membrane Oxygenation ◽

Va Ecmo ◽

Ecmo Treatment ◽

Significant Factors

Background: Nowadays, venoarterial extracorporeal membrane oxygenation (VA ECMO) is more acceptable to patients with refractory cardiogenic shock. The number of patients receiving VA ECMO treatment is increasing. However, mortality rate of patients cannulating VA ECMO is still high. Furthermore, VA ECMO treatment is expensive, requiring lots of resources and having lots of limitations. As a result, choosing patient wisely for cannulated VA ECMO is important. This is especially true for treatment in developing countries. Objective: To find the survival rate of patients receiving VA ECMO treatment and factors that affected survival rate. Materials and Methods: The present study was a retrospective study using the electronic medical database. Patients with cannulated VA ECMO between 2012 and 2019 were included in the study. Analyses were based on univariate and multivariate logistic regression to find factors associated with survival. Results: The authors found that out of 81 patients included in the present study, there were 20 survivors, representing a survival rate of 24.69%. Based on Univariate Analysis, factors measured at baseline that affected the survival rate were higher Glasgow Coma Scale, lower arterial blood gas carbon dioxide (ABG PaCO₂), lower blood level of lactate before cannulating VA ECMO, lower APACHE II, lower SOFA scores, and predicted mortality rate by SOFA score. Using multivariate regression, the ABG PaCO₂ and blood lactate level were significant factors that can predict survival rate (odd ratio 0.91, 95% CI 0.85 to 0.98 and 0.90, 95% CI 0.81 to 0.99, respectively). Conclusion: The present study found the survival rate of patients cannulating VA ECMO was 24.69%. The lower value of ABG PaCO₂ and lactate are significant factors that lead to higher survival rate. These findings lead to recommendations that, for an effective VA ECMO treatment, patients should not be at a severe sickness state, whose ABG PaCO₂ and lactate level should be at low levels. Keywords: Venoarterial extracorporeal membrane oxygenation (VA ECMO); Cardiogenic shock; In hospital survival rate; Factors affecting survival rate

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