SAVE score with lactate modification predicts in-hospital mortality in patients with ongoing cardiac arrest during VA-ECMO cannulation

The International Journal of Artificial Organs ◽

10.1177/03913988211021878 ◽

2021 ◽

pp. 039139882110218

Author(s):

Lee Ann Santore ◽

James W Schurr ◽

Mohammad Noubani ◽

Andrew Rabenstein ◽

Kathleen Dhundale ◽

...

Keyword(s):

Cardiac Arrest ◽

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Significant Variable ◽

Membrane Oxygenation ◽

Va Ecmo

The survival after veno-arterial extracorporeal membrane oxygenation score and its lactate modification predict in-hospital mortality in patients based on pre-extracorporeal membrane oxygenation variables. Cardiac arrest history is a significant variable in these scores; however, patients with ongoing cardiac arrest during cannulation were excluded from these models. The goal of this study is to validate the survival after veno-arterial extracorporeal membrane oxygenation score with a lactate modification among patients with ongoing cardiac arrest. In our study, the survival after veno-arterial extracorporeal membrane oxygenation score predicted mortality in all patients, but did so with higher discrimination among ongoing cardiac arrest patients with a lactate modification.

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Predictors of mortality in patients with VA-extracorporeal membrane oxygenation

European Heart Journal ◽

10.1093/ehjci/ehaa946.1237 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J Kang ◽

H.S Lee ◽

S.M Han ◽

H.J Cho

Keyword(s):

Heart Failure ◽

Cardiac Arrest ◽

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Acute Heart Failure ◽

Baseline Characteristic ◽

Coronary Syndrome ◽

Membrane Oxygenation ◽

History Of ◽

Va Ecmo

Abstract Background Venoarterial extracorporeal membrane oxygenation (VA-ECMO) support is a lifesaving tool used in the treatment of cardiogenic shock, acute heart failure, or extracorporeal cardiopulmonary resuscitation (CPR). We report on a single center experience with ECMO and aim to identify the prognostic markers for in-hospital mortality and death at 72 hours after ECMO. Methods Between 2011 and 2019 we evaluated 131 patients, who received ECMO. Collected data was analyzed to identify baseline characteristic, outcomes including clinical variables predictive of poor outcome. Results The mean age was 62.5 years, 67.2% were male patients, with prior CPR in 61.8%. The annual number of VA-ECMO procedures steadily increased, whereas in-hospital mortality is decreasing. Within the total cohort, the indication for VA-ECMO was cardiac arrest in 19.1%, acute coronary syndrome in 41.2%, acute heart failure in 23.7%, and myocarditis in 10.7%. Overall in-hospital mortality was 58.8%. Multivariate logistic regression model revealed presence of malignancy, history of revascularization, duration of cardiac arrest, and low BMI as independent predictors for mortality in 72 hours after ECMO (table). On the other hand, predictors of in-hospital mortality were prior congestive heart failure, male, and history of malignancy. The C-statistic for discriminating mortality in 72 hours after ECMO with the duration of cardiac arrest was 0.67 (figure). Conclusions Although the use of ECMO as a last line in the treatment of critical patients measures constitutes an important improvement in their care; with 41.2% overall survival; patient selection and timing of ECMO initiation remains challenging. The importance of consideration for ECMO use earlier in course of illness rather than later. Funding Acknowledgement Type of funding source: None

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Risk factors of acute renal injury and in-hospital mortality in adult patients with postcardiotomy cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation: utility of MELD-XI score

Perfusion ◽

10.1177/02676591211006619 ◽

2021 ◽

pp. 026765912110066

Author(s):

Xiaochen Ding ◽

Haixiu Xie ◽

Feng Yang ◽

Liangshan Wang ◽

Xiaotong Hou

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Cardiogenic Shock ◽

Sofa Score ◽

Adult Patients ◽

Left Ventricular Ejection ◽

Survival Group ◽

Membrane Oxygenation ◽

Va Ecmo ◽

Postcardiotomy Cardiogenic Shock

Background: The suitability of model for end-stage liver disease excluding international normalized ratio (MELD-XI) score to predict the incidence of acute kidney injury (AKI) and in-hospital mortality in adult patients with postcardiotomy cardiogenic shock (PCS) requiring venoarterial extracorporeal membrane oxygenation (VA ECMO) remains uncertain. This study was performed to explore whether the MELD-XI score has the association with the incidence of AKI and in-hospital mortality in these patients. Methods: Adult patients with PCS requiring VA ECMO from January 2012 to December 2017 were enrolled and first classified into AKI group ( n = 151) versus no-AKI group ( n = 132), then classified into survival group ( n = 143) versus no-survival group ( n = 140). Multivariate logistic regressions were performed to identify factors independently associated with AKI and mortality. Baseline data were defined as the first measurement available. Results: Of 283 patients, the incidence of AKI was 53.36%. The in-hospital mortality rates were 63.58% and 33.33% in patients with and without AKI (p < 0.0001). Baseline MELD-XI score, baseline serum total bilirubin (T-Bil), baseline blood urea nitrogen (BUN), baseline left ventricular ejection fraction (LVEF), sequential organ failure assessment (SOFA) score, and lactate level at ECMO initiation were shown to be associated with the AKI. Vasoactive-inotropic score (VIS) and SOFA score at ECMO initiation as well as renal failure requiring renal replacement therapy (RRT) were shown to be associated with in-hospital mortality. Conclusions: The baseline MELD-XI score, baseline BUN, baseline T-Bil, baseline LVEF, SOFA score and lactate at the initiation of ECMO were associated with AKI. AKI, SOFA score, and VIS at the initiation of ECMO were associated with in-hospital mortality, whereas MELD-XI score was not found to be associated with in-hospital mortality. A specific MELD-XI score as a threshold, as well as its sensitivity and specificity, needs to be confirmed in further studies.

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Outcomes of severe systemic rheumatic disease patients requiring extracorporeal membrane oxygenation

Annals of Intensive Care ◽

10.1186/s13613-021-00819-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Pierre Bay ◽

Guillaume Lebreton ◽

Alexis Mathian ◽

Pierre Demondion ◽

Cyrielle Desnos ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Critically Ill ◽

Left Ventricular ◽

Arterial Lactate ◽

Saps Ii ◽

Membrane Oxygenation ◽

Saps Ii Score ◽

Va Ecmo ◽

Vv Ecmo

Abstract Background Systemic rheumatic diseases (SRDs) are a group of inflammatory disorders that can require intensive care unit (ICU) admission because of multiorgan involvement with end-organ failure(s). Critically ill SRD patients requiring extracorporeal membrane oxygenation (ECMO) were studied to gain insight into their characteristics and outcomes. Methods This French monocenter, retrospective study included all SRD patients requiring venovenous (VV)- or venoarterial (VA)-ECMO admitted to a 26-bed ECMO-dedicated ICU from January 2006 to February 2020. The primary endpoint was in-hospital mortality. Results Ninety patients (male/female ratio: 0.5; mean age at admission: 41.6 ± 15.2 years) admitted to the ICU received VA/VV-ECMO, respectively, for an SRD-related flare (n = 69, n = 38/31) or infection (n = 21, n = 10/11). SRD was diagnosed in-ICU for 31 (34.4%) patients. In-ICU and in-hospital mortality rates were 48.9 and 51.1%, respectively. Nine patients were bridged to cardiac (n = 5) or lung transplantation (n = 4), or left ventricular assist device (n = 2). The Cox multivariable model retained the following independent predictors of in-hospital mortality: in-ICU SRD diagnosis, day-0 Simplified Acute Physiology Score (SAPS) II score ≥ 70 and arterial lactate ≥ 7.5 mmol/L for VA-ECMO–treated patients; diagnosis other than vasculitis, day-0 SAPS II score ≥ 70, ventilator-associated pneumonia and arterial lactate ≥ 7.5 mmol/L for VV-ECMO–treated patients. Conclusions ECMO support is a relevant rescue technique for critically ill SRD patients, with 49% survival at hospital discharge. Vasculitis was independently associated with favorable outcomes of VV-ECMO–treated patients. Further studies are needed to specify the role of ECMO for SRD patients.

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Prognostic Significance of Arterial Lactate Levels at Weaning from Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation

Journal of Clinical Medicine ◽

10.3390/jcm8122218 ◽

2019 ◽

Vol 8 (12) ◽

pp. 2218 ◽

Cited By ~ 2

Author(s):

Fausto Biancari ◽

Antonio Fiore ◽

Kristján Jónsson ◽

Giuseppe Gatti ◽

Svante Zipfel ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Prognostic Significance ◽

Optimal Timing ◽

Prognostic Impact ◽

Arterial Lactate ◽

Membrane Oxygenation ◽

Venoarterial Extracorporeal Membrane Oxygenation ◽

Lactate Levels ◽

Va Ecmo

Background: The outcome after weaning from postcardiotomy venoarterial extracorporeal membrane oxygenation (VA-ECMO) is poor. In this study, we investigated the prognostic impact of arterial lactate levels at the time of weaning from postcardiotomy VA. Methods: This analysis included 338 patients from the multicenter PC-ECMO registry with available data on arterial lactate levels at weaning from VA-ECMO. Results: Arterial lactate levels at weaning from VA-ECMO (adjusted OR 1.426, 95%CI 1.157–1.758) was an independent predictor of hospital mortality, and its best cutoff values was 1.6 mmol/L (<1.6 mmol/L, 26.2% vs. ≥ 1.6 mmol/L, 45.0%; adjusted OR 2.489, 95%CI 1.374–4.505). When 261 patients with arterial lactate at VA-ECMO weaning ≤2.0 mmol/L were analyzed, a cutoff of arterial lactate of 1.4 mmol/L for prediction of hospital mortality was identified (<1.4 mmol/L, 24.2% vs. ≥1.4 mmol/L, 38.5%, p = 0.014). Among 87 propensity score-matched pairs, hospital mortality was significantly higher in patients with arterial lactate ≥1.4 mmol/L (39.1% vs. 23.0%, p = 0.029) compared to those with lower arterial lactate. Conclusions: Increased arterial lactate levels at the time of weaning from postcardiotomy VA-ECMO increases significantly the risk of hospital mortality. Arterial lactate may be useful in guiding optimal timing of VA-ECMO weaning.

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Cardiac Arrest Prior to Initiation of Veno-Venous Extracorporeal Membrane Oxygenation Is Not Associated with Increased In-Hospital Mortality

ASAIO Journal ◽

10.1097/mat.0000000000001135 ◽

2020 ◽

Vol 66 (6) ◽

pp. e79-e81

Author(s):

Kevin M. Jones ◽

Laura DiChiacchio ◽

Kristopher B. Deatrick ◽

Katelyn Dolly ◽

Jeffrey Rea ◽

...

Keyword(s):

Cardiac Arrest ◽

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Membrane Oxygenation

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Outcomes of Venoarterial Extracorporeal Membrane Oxygenation for Cardiac Arrest in Adult Patients in the United States

Journal of the American Heart Association ◽

10.1161/jaha.121.021406 ◽

2021 ◽

Author(s):

George Gill ◽

Jignesh K. Patel ◽

Diego Casali ◽

Georgina Rowe ◽

Hongdao Meng ◽

...

Keyword(s):

Cardiac Arrest ◽

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Coronary Intervention ◽

The United States ◽

Mortality Factors ◽

Factors Associated ◽

Predictors Of Mortality ◽

Membrane Oxygenation ◽

Nationally Representative

Background Factors associated with poor prognosis following receipt of extracorporeal membrane oxygenation (ECMO) in adults with cardiac arrest remain unclear. We aimed to identify predictors of mortality in adults with cardiac arrest receiving ECMO in a nationally representative sample. Methods and Results The US Healthcare Cost and Utilization Project's National Inpatient Sample was used to identify 782 adults hospitalized with cardiac arrest who received ECMO between 2006 and 2014. The primary outcome of interest was all‐cause in‐hospital mortality. Factors associated with mortality were analyzed using multivariable logistic regression. The overall in‐hospital mortality rate was 60.4% (n=472). Patients who died were older and more often men, of non‐White race, and with lower household income than those surviving to discharge. In the risk‐adjusted analysis, independent predictors of mortality included older age, male sex, lower annual income, absence of ventricular arrhythmia, absence of percutaneous coronary intervention, and presence of therapeutic hypothermia. Conclusions Demographic and therapeutic factors are independently associated with mortality in patients with cardiac arrest receiving ECMO. Identification of which patients with cardiac arrest may receive the utmost benefit from ECMO may aid with decision‐making regarding its implementation. Larger‐scale studies are warranted to assess the appropriate candidates for ECMO in cardiac arrest.

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Prognostic factors in children with acute fulminant myocarditis receiving venoarterial extracorporeal membrane oxygenation

World Journal of Pediatric Surgery ◽

10.1136/wjps-2021-000271 ◽

2022 ◽

Vol 5 (1) ◽

pp. e000271

Author(s):

Mingwei Sun ◽

Qing Zong ◽

Li Fen Ye ◽

Yong Fan ◽

Lijun Yang ◽

...

Keyword(s):

Prognostic Factors ◽

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Fulminant Myocarditis ◽

Multivariable Logistic Regression Analysis ◽

Laboratory Findings ◽

Membrane Oxygenation ◽

Venoarterial Extracorporeal Membrane Oxygenation ◽

Survivor Group ◽

Va Ecmo

BackgroundPediatric acute fulminant myocarditis (AFM) is a very dangerous disease that may lead to acute heart failure or even sudden death. Previous reports have identified some prognostic factors in adult AFM; however, there is no such research on children with AFM on venoarterial extracorporeal membrane oxygenation (VA-ECMO). This study aimed to find relevant prognostic factors for predicting adverse clinical outcomes.MethodsA retrospective analysis was performed in an affiliated university children’s hospital with consecutive patients receiving VA-ECMO for AFM from July 2010 to November 2020. These children were classified into a survivor group (n=33) and a non-survivor group (n=8). Patient demographics, clinical events, laboratory findings, and electrocardiographic and echocardiographic parameters were analyzed.ResultsPeak serum creatinine (SCr) and peak creatine kinase isoenzyme MB during ECMO had joint predictive value for in-hospital mortality (p=0.011, AUC=0.962). Based on multivariable logistic regression analysis, peak SCr level during ECMO support was an independent predictor of in-hospital mortality (OR=1.035, 95% CI 1.006 to 1.064, p=0.017, AUC=0.936, with optimal cut-off value of 78 μmol/L).ConclusionTissue hypoperfusion and consequent end-organ damage ultimately hampered the outcomes. The need for left atrial decompression indicated a sicker patient on ECMO and introduced additional risk for complications. Earlier and more cautious deployment would likely be associated with decreased risk of complications and mortality.

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Effect of Acute Limb Ischemia on the Mortality of Patients with Extracorporeal Membrane Oxygenation Established by Femoral Vein-Arterial Catheterization and Analysis of Related Risk Factors

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2021/3471764 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Xiang Li ◽

Guang Chen ◽

Sheng Zhang ◽

Xinting Zheng ◽

Wenjun Zhao ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Arrest ◽

Risk Factor ◽

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Cardiopulmonary Failure ◽

Va Ecmo ◽

Associated Risk Factors

Extracorporeal membrane oxygenation (ECMO) is a common treatment for cardiopulmonary failure. Although it can effectively reduce the mortality of patients with cardiopulmonary failure, it still has a high mortality rate, such as acute limb ischemia (ALI), stroke, liver and kidney failure, and other related complications and related causes of death. This study aims to explore the impact of ALI on the mortality of VA-ECMO patients in hospital and 6 months after discharge and analyze the occurrence of ALI and related factors that affect the mortality of VA-ECMO in hospital and 6 months after discharge. The results showed that the smoking history was an independent risk factor for ALI, and age, diabetes, cardiac arrest, first time of ECMO, and hyperbilirubinemia were associated risk factors for in-hospital mortality. Cardiac arrest and ALI were associated risk factors for mortality at 6 months after discharge. Although ALI is not significantly associated with VA-ECMO in-hospital mortality, it is a risk factor for mortality at 6 months after discharge, and medical personnel should therefore strive to reduce and avoid ALI.

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