scholarly journals Mid-term survival of patients with chronic kidney disease after extracorporeal membrane oxygenation

2020 ◽  
Vol 31 (5) ◽  
pp. 595-602
Author(s):  
Yueh-An Lu ◽  
Shao-Wei Chen ◽  
Cheng-Chia Lee ◽  
Victor Chien-Chia Wu ◽  
Pei-Chun Fan ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Mortality Rate ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Subgroup Analysis ◽  
Mortality Rates ◽  
Term Survival ◽  
Membrane Oxygenation ◽  
Ecmo Treatment

Abstract OBJECTIVES Chronic kidney disease (CKD) impairs the elimination of fluids, electrolytes and metabolic wastes, which can affect the outcomes of extracorporeal membrane oxygenation (ECMO) treatment. This study aimed to elucidate the impact of CKD on in-hospital mortality and mid-term survival of adult patients who received ECMO treatment. METHODS Patients who received first-time ECMO treatment between 1 January 2003 and 31 December 2013 were included. Those with CKD were identified and matched to patients without CKD using a 1:2 ratio and were followed for 3 years. The study outcomes included in-hospital outcomes and the 3-year mortality rate. A subgroup analysis was conducted by comparing the dialytic patients with the non-dialytic CKD patients. RESULTS The study comprised 1008 CKD patients and 2016 non-CKD patients after propensity score matching. The CKD patients had higher in-hospital mortality rates [69.5% vs 62.2%; adjusted odds ratio 1.41; 95% confidence interval (CI) 1.15–1.72] than the non-CKD patients. The 3-year mortality rate was 80.4% in the CKD group and 68% in the non-CKD group (adjusted hazard ratio 1.17; 95% CI 1.06–1.28). The subgroup analysis showed that the 3-year mortality rates were 84.5% and 78.4% in the dialytic and non-dialytic patients, respectively. No difference in the 3-year mortality rate was noted between the 2 CKD subgroups (P = 0.111). CONCLUSIONS CKD was associated with increased risks of in-hospital and mid-term mortalities in patients who received ECMO treatment. Furthermore, no difference in survival was observed between the patients with end-stage renal disease and non-dialytic CKD patients.

scholarly journals Features of Patients Receiving Extracorporeal Membrane Oxygenation Relative to Cardiogenic Shock Onset: A Single-Centre Experience

Medicina ◽  
2021 ◽  
Vol 57 (9) ◽  
pp. 886
Author(s):  
Dong-Geum Shin ◽  
Sang-Deock Shin ◽  
Donghoon Han ◽  
Min-Kyung Kang ◽  
Seung-Hun Lee ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Mortality Rate ◽  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Subgroup Analysis ◽  
Shock Group ◽  
Shock Onset ◽  
Membrane Oxygenation ◽  
Admission Group

Background and Objectives: Extracorporeal membrane oxygenation (ECMO) can be helpful in patients with cardiogenic shock associated with myocardial infarction, and its early use can improve the patient survival rate. In this study, we report a mortality rate-difference analysis that examined the time and location of shock occurrence. Materials and Methods: We enrolled patients who underwent ECMO due to cardiogenic shock related to myocardial infarction and assigned them to either a pre- or post-admission shock group. The primary outcome was the 1-month mortality rate; a subgroup analysis was conducted to assess the effect of bailout ECMO. Results: Of the 113 patients enrolled, 67 (38 with pre-admission shock, 29 with post-admission shock) were analysed. Asystole was more frequently detected in the pre-admission shock group than in the post-admission group. In both groups, the commonest culprit lesion location was in the left anterior descending artery. Cardiopulmonary resuscitation was performed significantly more frequently and earlier in the pre-admission group. The 1-month mortality rate was significantly lower in the pre-admission group than in the post-admission group. Male sex and ECMO duration (≥6 days) were factors significantly related to the reduced mortality rate in the pre-admission group. In the subgroup analysis, the mortality rate was lower in patients receiving bailout ECMO than in those not receiving it; the difference was not statistically significant. Conclusions: ECMO application resulted in lower short-term mortality rate among patients with out-of-hospital cardiogenic shock onset than with in-hospital shock onset; early cardiopulmonary resuscitation and ECMO might be helpful in select patients.

scholarly journals Clinical outcomes of patients receiving prolonged extracorporeal membrane oxygenation for respiratory support

2019 ◽  
Vol 13 ◽  
pp. 175346661984894 ◽  
Author(s):  
Soo Jin Na ◽  
Jae-Seung Jung ◽  
Sang-Bum Hong ◽  
Woo Hyun Cho ◽  
Sang-Min Lee ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Mortality Rate ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Ecmo Support ◽  
Respiratory Support ◽  
Short Term ◽  
Membrane Oxygenation

Background: There are limited data regarding prolonged extracorporeal membrane oxygenation (ECMO) support, despite increase in ECMO use and duration in patients with respiratory failure. The objective of this study was to investigate the outcomes of severe acute respiratory failure patients supported with prolonged ECMO for more than 28 days. Methods: Between January 2012 and December 2015, all consecutive adult patients with severe acute respiratory failure who underwent ECMO for respiratory support at 16 tertiary or university-affiliated hospitals in South Korea were enrolled retrospectively. The patients were divided into two groups: short-term group defined as ECMO for ⩽28 days and long-term group defined as ECMO for more than 28 days. In-hospital and 6-month mortalities were compared between the two groups. Results: A total of 487 patients received ECMO support for acute respiratory failure during the study period, and the median support duration was 8 days (4–20 days). Of these patients, 411 (84.4%) received ECMO support for ⩽28 days (short-term group), and 76 (15.6%) received support for more than 28 days (long-term group). The proportion of acute exacerbation of interstitial lung disease as a cause of respiratory failure was higher in the long-term group than in the short-term group (22.4% versus 7.5%, p < 0.001), and the duration of mechanical ventilation before ECMO was longer (4 days versus 1 day, p < 0.001). The hospital mortality rate (60.8% versus 69.7%, p = 0.141) and the 6-month mortality rate (66.2% versus 74.0%, p = 0.196) were not different between the two groups. ECMO support longer than 28 days was not associated with hospital mortality in univariable and multivariable analyses. Conclusions: Short- and long-term survival rates among patients receiving ECMO support for more than 28 days for severe acute respiratory failure were not worse than those among patients receiving ECMO for 28 days or less.

Trends in extracorporeal membrane oxygenation treatment from 2005 to 2018 in South Korea

Perfusion ◽  
2021 ◽  
pp. 026765912110181
Author(s):  
Hyoung-Won Cho ◽  
In-Ae Song ◽  
Tak Kyu Oh
Keyword(s):  
Respiratory Failure ◽  
South Korea ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Population Based ◽  
Case Volume ◽  
Health Records ◽  
Membrane Oxygenation ◽  
Treatment Indications ◽  
Ecmo Treatment

Introduction: This study aimed to investigate trends in extracorporeal membrane oxygenation (ECMO) treatment during 2005–2018 and examine factors associated with in-hospital mortality. Methods: We conducted a population-based cohort study based on health records obtained from the National Health Insurance Service database in South Korea. All adult patients (⩾18 years old) who received ECMO treatment in the intensive care unit after hospitalization from 2005 to 2018 were enrolled. Results: We analyzed data for 21,129 adult ECMO patients from 128 hospitals. The prevalence of ECMO treatment gradually and continuously increased from 4 per 100,000 individuals (95% confidence interval [CI]: 3–4) in 2005 to 67.4 per 100,000 individuals (95% CI: 65–68) in 2018. There was a significant increase in ECMO treatment for acute respiratory distress syndrome (ARDS) or respiratory failure (from 2.5% during 2005–2008 to 14.5% during 2016–2018). The overall in-hospital and 30-day mortality rates of the patients were 48.4% and 53.5%, respectively. The in-hospital mortality rate was highest among patients with shock (62.1%) and lowest among ECMO patients with liver failure (21.6%). On multivariable logistic regression, a higher hospital case volume was associated with improvement in in-hospital mortality (p < 0.001). Conclusions: In South Korea, the prevalence of ECMO treatment has increased gradually and continuously between 2005 and 2018. There was a significant increase in the prevalence of ECMO treatment for ARDS or respiratory failure. Our results support that ECMO treatment indications have been expanding, and ECMO will become vital for treating critically ill patients in the future.

scholarly journals Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome: Propensity Score Matching

Membranes ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 393
Author(s):  
Li-Chung Chiu ◽  
Li-Pang Chuang ◽  
Shaw-Woei Leu ◽  
Yu-Jr Lin ◽  
Chee-Jen Chang ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Mortality Rate ◽  
Propensity Score ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Propensity Score Matching ◽  
Distress Syndrome ◽  
Membrane Oxygenation

The high mortality rate of patients with severe acute respiratory distress syndrome (ARDS) warrants aggressive clinical intervention. Extracorporeal membrane oxygenation (ECMO) is a salvage therapy for life-threatening hypoxemia. Randomized controlled trials of ECMO for severe ARDS comprise a number of ethical and methodological issues. Therefore, indications and optimal timing for implementation of ECMO, and predictive risk factors for outcomes have not been adequately investigated. We performed propensity score matching to match ECMO-supported and non-ECMO-supported patients at 48 h after ARDS onset for comparisons based on clinical outcomes and hospital mortality. A total of 280 severe ARDS patients were included, and propensity score matching of 87 matched pairs revealed that the 90-d hospital mortality rate was 56.3% in the ECMO group and 74.7% in the non-ECMO group (p = 0.028). Subgroup analysis revealed that greater severity of ARDS, higher airway pressure, or a higher Sequential Organ Failure Assessment score tended to benefit from ECMO treatment in terms of survival. Multivariate logistic regression revealed that hospital mortality was significantly lower among patients who received ECMO than among those who did not. Our findings suggested that early initiation of ECMO (within 48 h) may increase the likelihood of survival for patients with severe ARDS.

scholarly journals Income Levels and Mortality Rates in Patients with Chronic Kidney Disease in South Korea: a Population-Based Cohort Study Using National Health Insurance Data

2020 ◽  
Author(s):  
Young Choi
Keyword(s):  
Chronic Kidney Disease ◽  
Health Insurance ◽  
Kidney Disease ◽  
Mortality Rate ◽  
National Health Insurance ◽  
National Health ◽  
Mortality Rates ◽  
Dialysis Patients ◽  
Income Levels ◽  
Low Incomes

Background: To examine the association between income levels and mortality rates in patients with chronic kidney disease. Methods: We analyzed data obtained from 3,172 patients with chronic kidney disease obtained from the Korean National Health Insurance claims database (2003&ndash;2009). Each patient was monitored until December 2010 or until death, whichever came first. Individual income was estimated from the national health insurance premium. Information on mortality was obtained from the Korean National Statistical Office. Cox proportional hazard models were used to compare mortality rates between different income groups after adjusting for possible confounding risk factors. Results: A low income was significantly associated with a high mortality rate after adjusting for covariates (adjusted HR 1.298 [1.082&ndash;1.556]). In addition, dialysis patients who had low incomes were more likely to have higher mortality rates compared to those in dialysis patients who had high incomes (adjusted HR 1.528 [1.122&ndash;2.082]). Conclusion: The findings of this study indicate that chronic kidney disease patients with low incomes have the highest mortality risk. Promotion of targeted policies and priority health services for patients with low incomes may help reduce the mortality rate in this vulnerable group.

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

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

scholarly journals Mortality analysis of COVID-19 infection in chronic kidney disease, haemodialysis and renal transplant patients compared with patients without kidney disease: a nationwide analysis from Turkey

2020 ◽  
Vol 35 (12) ◽  
pp. 2083-2095
Author(s):  
Savas Ozturk ◽  
Kenan Turgutalp ◽  
Mustafa Arici ◽  
Ali Riza Odabas ◽  
Mehmet Riza Altiparmak ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Hospital Mortality ◽  
Admission Rate ◽  
Mortality Rates ◽  
Small Sample ◽  
Control Group ◽  
Icu Admission ◽  
Increased Risk ◽  
Comorbidity Burden

Abstract Background Chronic kidney disease (CKD) and immunosuppression, such as in renal transplantation (RT), stand as one of the established potential risk factors for severe coronavirus disease 2019 (COVID-19). Case morbidity and mortality rates for any type of infection have always been much higher in CKD, haemodialysis (HD) and RT patients than in the general population. A large study comparing COVID-19 outcome in moderate to advanced CKD (Stages 3–5), HD and RT patients with a control group of patients is still lacking. Methods We conducted a multicentre, retrospective, observational study, involving hospitalized adult patients with COVID-19 from 47 centres in Turkey. Patients with CKD Stages 3–5, chronic HD and RT were compared with patients who had COVID-19 but no kidney disease. Demographics, comorbidities, medications, laboratory tests, COVID-19 treatments and outcome [in-hospital mortality and combined in-hospital outcome mortality or admission to the intensive care unit (ICU)] were compared. Results A total of 1210 patients were included [median age, 61 (quartile 1–quartile 3 48–71) years, female 551 (45.5%)] composed of four groups: control (n = 450), HD (n = 390), RT (n = 81) and CKD (n = 289). The ICU admission rate was 266/1210 (22.0%). A total of 172/1210 (14.2%) patients died. The ICU admission and in-hospital mortality rates in the CKD group [114/289 (39.4%); 95% confidence interval (CI) 33.9–45.2; and 82/289 (28.4%); 95% CI 23.9–34.5)] were significantly higher than the other groups: HD = 99/390 (25.4%; 95% CI 21.3–29.9; P &lt; 0.001) and 63/390 (16.2%; 95% CI 13.0–20.4; P &lt; 0.001); RT = 17/81 (21.0%; 95% CI 13.2–30.8; P = 0.002) and 9/81 (11.1%; 95% CI 5.7–19.5; P = 0.001); and control = 36/450 (8.0%; 95% CI 5.8–10.8; P &lt; 0.001) and 18/450 (4%; 95% CI 2.5–6.2; P &lt; 0.001). Adjusted mortality and adjusted combined outcomes in CKD group and HD groups were significantly higher than the control group [hazard ratio (HR) (95% CI) CKD: 2.88 (1.52–5.44); P = 0.001; 2.44 (1.35–4.40); P = 0.003; HD: 2.32 (1.21–4.46); P = 0.011; 2.25 (1.23–4.12); P = 0.008), respectively], but these were not significantly different in the RT from in the control group [HR (95% CI) 1.89 (0.76–4.72); P = 0.169; 1.87 (0.81–4.28); P = 0.138, respectively]. Conclusions Hospitalized COVID-19 patients with CKDs, including Stages 3–5 CKD, HD and RT, have significantly higher mortality than patients without kidney disease. Stages 3–5 CKD patients have an in-hospital mortality rate as much as HD patients, which may be in part because of similar age and comorbidity burden. We were unable to assess if RT patients were or were not at increased risk for in-hospital mortality because of the relatively small sample size of the RT patients in this study.

scholarly journals Extracorporeal Membrane Oxygenation in Patients with Burns, Hero or Futile Medical Care? A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Yu-Jen Chiu ◽  
Yu-Chen Huang ◽  
Tai-Wei Chen ◽  
Yih-An King ◽  
Hsu Ma
Keyword(s):  
Systematic Review ◽  
Extracorporeal Membrane Oxygenation ◽  
Meta Analysis ◽  
Mortality Rates ◽  
Cochrane Library ◽  
Burn Patients ◽  
Group V ◽  
Risk Of Death ◽  
Membrane Oxygenation ◽  
Ecmo Treatment

Abstract Background Severely burned patients, particularly when compounded with inhalation injuries, are at high risk for cardiopulmonary failure. Recently, promising studies have stimulated interest in using extracorporeal membrane oxygenation (ECMO) as a potential therapy for burn patients with refractory cardiac and/or respiratory failure. Several observational studies have been reported, but the findings in these vary. Methods In this study, we conducted a systematic review and meta-analysis using standardized mortality ratios (SMRs) to elucidate the benefits associated with the use of ECMO in patients with burn and/or inhalation injuries. A literature search using PubMed, EMBASE, MEDLINE, and the Cochrane Library were performed from inception to October 20, 2020. Clinical outcomes in the selected studies were compared. Results 22 studies were included in the final review and analysis. 13 studies with a total of 75 patients were included in SMR quantitative analysis. The overall pooled mortality rate of burn patients receiving ECMO was 48%. The meta-analysis found that the observed mortality was significantly higher than the predicted mortality in patients receiving ECMO, with a pooled SMR of 2.07 (95% CI: 1.04–4.14). However, in the subgroup of burn patients with inhalation injuries, all patients receiving V-V ECMO had lower mortality rates compared to their predicted mortality rates, with a pooled SMR of 0.95 (95% CI: 0.52–1.73). Other subgroup analyses, including an adult group, pediatric group, V-V setting group, and a V-A setting group reported no benefits from ECMO; however, these results were not statistically significant. Interestingly, the pooled SMR values decreased as the selected patients’ revised Baux scores increased (R=-0.92), indicating that the potential benefits from the ECMO treatment increased as the severity of patients with burns increased, especially when the patients’ revised Baux scores exceeded 90. Conclusions Our meta-analysis revealed that burn patients receiving ECMO treatment were at a higher risk of death. However, select patients, including those with inhalation injuries and those with the revised Baux scores over 90, would benefit from ECMO treatment. We suggest that burn patients with inhalation injuries or with revised Baux scores exceeding 90 should be considered for ECMO treatment and early transfer to an ECMO centre.

Machine-learning algorithm as a prognostic tool in non-obstructive acute-on-chronic kidney disease in the cat

2021 ◽  
pp. 1098612X2110012
Author(s):  
Jade Renard ◽  
Mathieu R Faucher ◽  
Anaïs Combes ◽  
Didier Concordet ◽  
Brice S Reynolds
Keyword(s):  
Machine Learning ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Decision Tree ◽  
Diagnostic Performance ◽  
Clinical Signs ◽  
Learning System ◽  
Clinical Severity ◽  
Medium Term ◽  
Term Survival

Objectives The aim of this study was to develop an algorithm capable of predicting short- and medium-term survival in cases of intrinsic acute-on-chronic kidney disease (ACKD) in cats. Methods The medical record database was searched to identify cats hospitalised for acute clinical signs and azotaemia of at least 48 h duration and diagnosed to have underlying chronic kidney disease based on ultrasonographic renal abnormalities or previously documented azotaemia. Cases with postrenal azotaemia, exposure to nephrotoxicants, feline infectious peritonitis or neoplasia were excluded. Clinical variables were combined in a clinical severity score (CSS). Clinicopathological and ultrasonographic variables were also collected. The following variables were tested as inputs in a machine learning system: age, body weight (BW), CSS, identification of small kidneys or nephroliths by ultrasonography, serum creatinine at 48 h (Crea48), spontaneous feeding at 48 h (SpF48) and aetiology. Outputs were outcomes at 7, 30, 90 and 180 days. The machine-learning system was trained to develop decision tree algorithms capable of predicting outputs from inputs. Finally, the diagnostic performance of the algorithms was calculated. Results Crea48 was the best predictor of survival at 7 days (threshold 1043 µmol/l, sensitivity 0.96, specificity 0.53), 30 days (threshold 566 µmol/l, sensitivity 0.70, specificity 0.89) and 90 days (threshold 566 µmol/l, sensitivity 0.76, specificity 0.80), with fewer cats still alive when their Crea48 was above these thresholds. A short decision tree, including age and Crea48, predicted the 180-day outcome best. When Crea48 was excluded from the analysis, the generated decision trees included CSS, age, BW, SpF48 and identification of small kidneys with an overall diagnostic performance similar to that using Crea48. Conclusions and relevance Crea48 helps predict short- and medium-term survival in cats with ACKD. Secondary variables that helped predict outcomes were age, CSS, BW, SpF48 and identification of small kidneys.

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