Acute mesenteric ischaemia in refractory shock on veno-arterial extracorporeal membrane oxygenation

Background: Acute mesenteric ischaemia is a severe complication in critically ill patients, but has never been evaluated in patients on veno-arterial extracorporeal membrane oxygenation (V-A ECMO). This study was designed to determine the prevalence of mesenteric ischaemia in patients supported by V-A ECMO and to evaluate its risk factors, as well as to appreciate therapeutic modalities and outcome. Methods: In a retrospective single centre study (January 2013 to January 2017), all consecutive adult patients who underwent V-A ECMO were included, with exclusion of those dying in the first 24 hours. Diagnosis of mesenteric ischaemia was performed using digestive endoscopy, computed tomography scan or first-line laparotomy. Results: One hundred and fifty V-A ECMOs were implanted (65 for post-cardiotomy shock, 85 for acute cardiogenic shock, including 39 patients after refractory cardiac arrest). Overall, median age was 58 (48–69) years and mortality 56%. Acute mesenteric ischaemia was suspected in 38 patients, with a delay of four (2–7) days after ECMO implantation, and confirmed in 14 patients, that is, a prevalence of 9%. Exploratory laparotomy was performed in six out of 14 patients, the others being too unstable to undergo surgery. All patients with mesenteric ischaemia died. Independent risk factors for developing mesenteric ischaemia were renal replacement therapy (odds ratio (OR) 4.5, 95% confidence interval (CI) 1.3–15.7, p=0.02) and onset of a second shock within the first five days (OR 7.8, 95% CI 1.5–41.3, p=0.02). Conversely, early initiation of enteral nutrition was negatively associated with mesenteric ischaemia (OR 0.15, 95% CI 0.03–0.69, p=0.02). Conclusions: Acute mesenteric ischaemia is a relatively frequent but dramatic complication among patients on V-A ECMO.

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Risk factors and prognosis of nosocomial pneumonia in patients undergoing extracorporeal membrane oxygenation: a retrospective study

Journal of International Medical Research ◽

10.1177/0300060520964701 ◽

2020 ◽

Vol 48 (10) ◽

pp. 030006052096470

Author(s):

Jianrong Wang ◽

Jinyu Huang ◽

Wei Hu ◽

Xueying Cai ◽

Weihang Hu ◽

...

Keyword(s):

Risk Factors ◽

Extracorporeal Membrane Oxygenation ◽

Nosocomial Pneumonia ◽

Discharge Rate ◽

Multivariable Analysis ◽

Ventilator Support ◽

Membrane Oxygenation ◽

Independent Risk Factors ◽

Medical University ◽

Vv Ecmo

Objective We aimed to examine the risk factors and prognosis of nosocomial pneumonia (NP) during extracorporeal membrane oxygenation (ECMO). Methods We retrospectively analyzed data of patients who received ECMO at the Affiliated Hangzhou Hospital of Nanjing Medical University between January 2013 and August 2019. The primary outcome was the survival-to-discharge rate. Results Sixty-nine patients who received ECMO were enrolled, median age 42 years and 26 (37.7%) women; 14 (20.3%) patients developed NP. The NP incidence was 24.7/1000 ECMO days. Patients with NP had a higher proportion receiving veno-venous (VV) ECMO (50% vs. 7.3%); longer ECMO support duration (276 vs. 140 hours), longer ventilator support duration before ECMO weaning (14.5 vs. 6 days), lower ECMO weaning success rate (50.0% vs. 81.8%), and lower survival-to-discharge rate (28.6% vs. 72.7%) than patients without NP. Multivariable analysis showed independent risk factors that predicted NP during ECMO were ventilator support duration before ECMO weaning (odds ratio [OR] = 1.288; 95% confidence interval [CI]: 1.111–1.494) and VV ECMO mode (OR = 10.970; 95% CI: 1.758–68.467). Conclusion NP during ECMO was associated with ventilator support duration before ECMO weaning and VV ECMO mode. Clinicians should shorten the respiratory support duration for patients undergoing ECMO to prevent NP.

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Infections Acquired by Adults Who Receive Extracorporeal Membrane Oxygenation Risk Factors and Outcome

Infection Control and Hospital Epidemiology ◽

10.1086/668439 ◽

2013 ◽

Vol 34 (1) ◽

pp. 24-30 ◽

Cited By ~ 70

Author(s):

Cecile Aubron ◽

Allen C. Cheng ◽

David Pilcher ◽

Tim Leong ◽

Geoff Magrin ◽

...

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Extracorporeal Membrane Oxygenation ◽

Unit Length ◽

Severity Of Illness ◽

Infectious Complications ◽

Hospital Length ◽

Interquartile Range ◽

Hospital Length Of Stay ◽

Membrane Oxygenation

Objectives.To analyze infectious complications that occur in patients who receive extracorporeal membrane oxygenation (ECMO), associated risk factors, and consequences on patient outcome.Design.Retrospective observational survey from 2005 through 2011.Participants and Setting.Patients who required ECMO in an Australian referral center.Methods.Cases of bloodstream infection (BSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (YAP) that occurred in patients who received ECMO were analyzed.Results.A total of 146 ECMO procedures were performed for more than 48 hours in 139 patients, and 36 patients had a total of 46 infections (30.1 infectious episodes per 1,000 days of ECMO). They included 24 cases of BSI, 6 of them secondary to VAP; 23 cases of VAP; and 5 cases of CAUTI. The most frequent pathogens were Enterobacteriaceae (found in 16 of 46 cases), and Candida was the most common cause of BSI (in 9 of 24 cases). The Sequential Organ Failure Assessment score before ECMO initiation and the number of days of support were independenuy associated with a risk of BSI, with odds ratios of 1.23 (95% confidence interval [CI], 1.03-1.47; P = .019) and 1.08(95% CI, 1.03-1.19]; P = .006), respectively. Infected patients did not have a significantly higher mortality compared with uninfected patients (41.7% vs 32%; P = .315), but intensive care unit length of stay (16 days [interquartile range, 8-26 days] vs 11 days [IQR, 4-19 days]; P = .012) and hospital length of stay (33.5 days [interquartile range, 15.5-55.5] vs 24 days [interquartile range, 9-42 days]; P = .029) were longer.Conclusion.The probability of infection increased with the duration of support and the severity of illness before initiation of ECMO. Infections affected length of stay but did not have an impact on mortality.

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Use of extracorporeal membrane oxygenation in postpartum patients with refractory shock or respiratory failure

Scientific Reports ◽

10.1038/s41598-020-80423-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ryoung-Eun Ko ◽

Chi Ryang Chung ◽

Jeong Hoon Yang ◽

Kyeongman Jeon ◽

Gee Young Suh ◽

...

Keyword(s):

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Major Bleeding ◽

Discharge Rate ◽

Median Number ◽

Survival Outcomes ◽

Refractory Shock ◽

Membrane Oxygenation ◽

Study Population ◽

Level Of Experience

AbstractAlthough extracorporeal membrane oxygenation (ECMO) is increasingly utilized, only a limited level of experience has been reported in postpartum cardiopulmonary failure. Ten critically ill postpartum patients who received ECMO were included between January 2010 and December 2018 in this retrospective observational study. The main indication for ECMO support was peripartum cardiomyopathy (n = 5), followed by postpartum hemorrhage (n = 2). Nine patients initially received veno-arterial ECMO, and one patient received veno-venous ECMO. Major bleeding occurred in six patients. The median number of units of red blood cells (RBC) transfused during ECMO was 14.5 units (interquartile range 6.8–37.8 units), and most RBC transfusions occurred on the first day of ECMO. The survival-to-discharge rate was 80%. Compared to the survival outcomes in female patients of similar age who received ECMO, the survival outcomes were significantly better in the study population (56% versus 80%, P = 0.0004). Despite the high risk of major bleeding, ECMO for patients with postpartum cardiac or respiratory failure showed excellent survival outcomes. ECMO is feasible in these patients and can be carried out with good outcomes in an experienced centre.

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Biventricular Unloading with Impella and Venoarterial Extracorporeal Membrane Oxygenation in Severe Refractory Cardiogenic Shock: Implications from the Combined Use of the Devices and Prognostic Risk Factors of Survival

Journal of Clinical Medicine ◽

10.3390/jcm10040747 ◽

2021 ◽

Vol 10 (4) ◽

pp. 747

Author(s):

Georgios Chatzis ◽

Styliani Syntila ◽

Birgit Markus ◽

Holger Ahrens ◽

Nikolaos Patsalis ◽

...

Keyword(s):

Risk Factors ◽

Extracorporeal Membrane Oxygenation ◽

Cardiogenic Shock ◽

Risk Scores ◽

Circulatory Support ◽

Membrane Oxygenation ◽

Venoarterial Extracorporeal Membrane Oxygenation ◽

Refractory Cardiogenic Shock ◽

Lactate Levels ◽

Va Ecmo

Since mechanical circulatory support (MCS) devices have become integral component in the therapy of refractory cardiogenic shock (RCS), we identified 67 patients in biventricular support with Impella and venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) for RCS between February 2013 and December 2019 and evaluated the risk factors of mortality in this setting. Mean age was 61.07 ± 10.7 and 54 (80.6%) patients were male. Main cause of RCS was acute myocardial infarction (AMI) (74.6%), while 44 (65.7%) were resuscitated prior to admission. The mean Simplified Acute Physiology Score II (SAPS II) and Sequential Organ Failure Assessment Score (SOFA) score on admission was 73.54 ± 16.03 and 12.25 ± 2.71, respectively, corresponding to an expected mortality of higher than 80%. Vasopressor doses and lactate levels were significantly decreased within 72 h on biventricular support (p < 0.05 for both). Overall, 17 (25.4%) patients were discharged to cardiac rehabilitation and 5 patients (7.5%) were bridged successfully to ventricular assist device implantation, leading to a total of 32.8% survival on hospital discharge. The 6-month survival was 31.3%. Lactate > 6 mmol/L, vasoactive score > 100 and pH < 7.26 on initiation of biventricular support, as well as Charlson comorbity index > 3 and prior resuscitation were independent predictors of survival. In conclusion, biventricular support with Impella and VA-ECMO in patients with RCS is feasible and efficient leading to a better survival than predicted through traditional risk scores, mainly via significant hemodynamic improvement and reduction in lactate levels.

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Venoarterial extracorporeal membrane oxygenation for postcardiotomy shock: Risk factors for mortality

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2018.05.061 ◽

2018 ◽

Vol 156 (5) ◽

pp. 1894-1902.e3 ◽

Cited By ~ 26

Author(s):

Thomas Fux ◽

Manne Holm ◽

Matthias Corbascio ◽

Lars H. Lund ◽

Jan van der Linden

Keyword(s):

Risk Factors ◽

Extracorporeal Membrane Oxygenation ◽

Membrane Oxygenation ◽

Venoarterial Extracorporeal Membrane Oxygenation ◽

Postcardiotomy Shock

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Extracorporeal membrane oxygenation outcomes in children with hemophagocytic lymphohistiocytosis

Perfusion ◽

10.1177/0267659116667804 ◽

2016 ◽

Vol 32 (2) ◽

pp. 151-156 ◽

Cited By ~ 3

Author(s):

Katherine Cashen ◽

Roland L Chu ◽

Justin Klein ◽

Peter T Rycus ◽

John M Costello

Keyword(s):

Risk Factors ◽

Extracorporeal Membrane Oxygenation ◽

Cardiac Failure ◽

Hemophagocytic Lymphohistiocytosis ◽

Pediatric Patients ◽

Life Support ◽

Extracorporeal Life Support ◽

Hemorrhagic Complication ◽

Membrane Oxygenation ◽

Va Ecmo

Introduction: Pediatric patients with hemophagocytic lymphohistiocytosis (HLH) may develop refractory respiratory or cardiac failure that warrants consideration for extracorporeal membrane oxygenation (ECMO) support. The purposes of this study were to describe the use and outcomes of ECMO in pediatric HLH patients, to identify risk factors for hospital mortality and to compare their ECMO use and outcomes to the ECMO population as a whole. Methods: Pediatric patients (⩽ 18 years) with a diagnosis of HLH in the Extracorporeal Life Support Organization (ELSO) Registry were included. Results: Between 1983 and 2014, data for 30 children with HLH were available in the ELSO registry and all were included in this study. All cases occurred in the last decade. Of the 30 HLH patients, 24 (80%) had a respiratory indication for ECMO and six (20%) had a cardiac indication (of which 4 were E-CPR and 2 cardiac failure). Of the 24 respiratory ECMO patients, 63% were placed on VA ECMO. Compared with all pediatric patients in the ELSO registry during the study period (n=17,007), HLH patients had worse hospital survival (non-HLH 59% vs HLH 30%, p=0.001). In pediatric HLH patients, no pre-ECMO risk factors for mortality were identified. The development of a hemorrhagic complication on ECMO was associated with decreased mortality (p=0.01). Comparing HLH patients with respiratory failure to patients with other immune compromised conditions, the overall survival rate is similar (HLH 38% vs. non-HLH immune compromised 31%, p=0.64). Conclusions: HLH is an uncommon indication for ECMO and these patients have increased mortality compared to the overall pediatric ECMO population. These data should be factored into decision-making when considering ECMO for pediatric HLH patients.

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The Extracorporeal Membrane Oxygenation Debate

PEDIATRICS ◽

10.1542/peds.85.3.380 ◽

1990 ◽

Vol 85 (3) ◽

pp. 380-381

Author(s):

BILLIE LOU SHORT

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Controlled Trial ◽

Therapeutic Modalities ◽

Membrane Oxygenation ◽

Boston Study

To the Editor.— I would like to thank Dr Dworetz and associates1 for their concern for the use of retrospective criteria in determining ECMO (extracorporeal membrane oxygenation) entry criteria, a concern that is common to all of us. It should be pointed out that a controlled trial comparing ECMO to hyperventilation was completed at Boston Children's Hospital2 showing an improved survival with extracorporeal membrane oxygenation. Even though the criteria of the Boston study were tested prospectively, a year after that study, we must deal with how to change the criteria to reflect new therapeutic modalities.

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