scholarly journals Veno-Arterial Extracorporeal Membrane Oxygenation in Adults with Septic Shock

2022 ◽  
Vol 9 (01) ◽  
pp. 5879-5890
Author(s):  
Katherine Jacoby ◽  
Ramiro Saavedra ◽  
Matthew Spanier ◽  
Joshua Huelster ◽  
Alex Campbell ◽  
...  
Keyword(s):  
Septic Shock ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Discharge ◽  
Sofa Score ◽  
Left Ventricular Ejection ◽  
Membrane Oxygenation ◽  
Distributive Shock ◽  
Refractory Septic Shock ◽  
Va Ecmo ◽  
Shock Profile

Survivors and non-survivors were compared for 20 adults supported with veno-arterial extracorporeal membrane oxygenation (VA ECMO) for refractory septic shock from 2012-2018. The primary outcome was hospital survival. Secondary outcomes were ECMO associated complications and survival to decannulation. Median age was 53.5 (IQR 42.0-61.3). At ≤ 24 hours prior to cannulation, median SOFA score was 17.5 (IQR 15 - 19) and 17 patients (85%) had new cardiac dysfunction. Median left ventricular ejection fraction (LVEF) was 20% (IQR 10-38). Thirteen patients had a mixed (cardiogenic and distributive) or cardiogenic shock profile (65%), 7 had a distributive shock profile (35%), and 17 (85%) survived to decannulation. Fourteen (70%) survived to hospital discharge and median cerebral performance category score was 1 (IQR 1-2). No differences were found in age, comorbid conditions, time from shock onset to cannulation, peak flow rate on ECMO, ECMO complications, shock profile, LVEF, or vasoactive-inotrope score (VIS). More patients in the distributive shock profile experienced limb ischemia complications (n=3, 42.9%) compared to the cardiogenic and mixed shock profiles (n=1, 7.7%). Survivors to hospital discharge had a lower SOFA score. VA ECMO support may be a beneficial therapy for refractory septic shock and could be considered in select adult patients.

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 ◽  
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.

scholarly journals Venoarterial extracorporeal membrane oxygenation as mechanical circulatory support in adult septic shock: a systematic review and meta-analysis with individual participant data meta-regression analysis

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Ryan Ruiyang Ling ◽  
Kollengode Ramanathan ◽  
Wynne Hsing Poon ◽  
Chuen Seng Tan ◽  
Nicolas Brechot ◽  
...  
Keyword(s):  
Septic Shock ◽  
Extracorporeal Membrane Oxygenation ◽  
Mechanical Circulatory Support ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Adult Patients ◽  
Circulatory Support ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Refractory Septic Shock ◽  
Va Ecmo

Abstract Background While recommended by international societal guidelines in the paediatric population, the use of venoarterial extracorporeal membrane oxygenation (VA ECMO) as mechanical circulatory support for refractory septic shock in adults is controversial. We aimed to characterise the outcomes of adults with septic shock requiring VA ECMO, and identify factors associated with survival. Methods We searched Pubmed, Embase, Scopus and Cochrane databases from inception until 1st June 2021, and included all relevant publications reporting on > 5 adult patients requiring VA ECMO for septic shock. Study quality and certainty in evidence were assessed using the appropriate Joanna Briggs Institute checklist, and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach, respectively. The primary outcome was survival to hospital discharge, and secondary outcomes included intensive care unit length of stay, duration of ECMO support, complications while on ECMO, and sources of sepsis. Random-effects meta-analysis (DerSimonian and Laird) were conducted. Data synthesis We included 14 observational studies with 468 patients in the meta-analysis. Pooled survival was 36.4% (95% confidence interval [CI]: 23.6%–50.1%). Survival among patients with left ventricular ejection fraction (LVEF) < 20% (62.0%, 95%-CI: 51.6%–72.0%) was significantly higher than those with LVEF > 35% (32.1%, 95%-CI: 8.69%–60.7%, p = 0.05). Survival reported in studies from Asia (19.5%, 95%-CI: 13.0%–26.8%) was notably lower than those from Europe (61.0%, 95%-CI: 48.4%–73.0%) and North America (45.5%, 95%-CI: 16.7%–75.8%). GRADE assessment indicated high certainty of evidence for pooled survival. Conclusions When treated with VA ECMO, the majority of patients with septic shock and severe sepsis-induced myocardial depression survive. However, VA ECMO has poor outcomes in adults with septic shock without severe left ventricular depression. VA ECMO may be a viable treatment option in carefully selected adult patients with refractory septic shock.

scholarly journals Extracorporeal membrane oxygenation for refractory septic shock in adults

2014 ◽  
Vol 47 (2) ◽  
pp. e68-e74 ◽  
Author(s):  
Taek Kyu Park ◽  
Jeong Hoon Yang ◽  
Kyeongman Jeon ◽  
Seung-Hyuk Choi ◽  
Jin-Ho Choi ◽  
...  
Keyword(s):  
Septic Shock ◽  
Extracorporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Refractory Septic Shock

scholarly journals P0605 / #959: USE OF EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT DURING STAPHYLOCOCCUS AUREUS REFRACTORY SEPTIC SHOCK: A CASE REPORT FOR MECHANICAL SUPPORT

2021 ◽  
Vol 22 (Supplement 1 3S) ◽  
pp. 297-297
Author(s):  
J. Rodriguez Coronado ◽  
J. Saldivar Martinez ◽  
R. Gomez Gutierrez ◽  
G. Quezada Valenzuela ◽  
M. Contreras Cepeda ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Septic Shock ◽  
Case Report ◽  
Extracorporeal Membrane Oxygenation ◽  
Mechanical Support ◽  
Membrane Oxygenation ◽  
Refractory Septic Shock

Streptococcus pyogenes purpura fulminans and septic shock: A case highlighting the ethical considerations of high-risk extracorporeal membrane oxygenation

2020 ◽  
Vol 43 (7) ◽  
pp. 500-502
Author(s):  
Taylor Wheaton ◽  
Ogechukwu Menkiti ◽  
Amit Misra
Keyword(s):  
Septic Shock ◽  
High Risk ◽  
Extracorporeal Membrane Oxygenation ◽  
Streptococcus Pyogenes ◽  
Purpura Fulminans ◽  
Ethical Challenges ◽  
Membrane Oxygenation ◽  
Risk Patients ◽  
Refractory Septic Shock ◽  
Poor Outcomes

Separately, refractory septic shock and purpura fulminans have very poor outcomes. The ethics involved in offering extracorporeal membrane oxygenation to very high-risk patients is complex. We report a novel case of refractory shock requiring veno-arterial extracorporeal membrane oxygenation and continuous renal replacement therapy due to Streptococcus pyogenes bacteremia with purpura fulminans to highlight the ethical challenges in offering extracorporeal membrane oxygenation to a patient with such a poor likelihood of survival.

scholarly journals Veno-Arterial Extracorporeal Membrane Oxygenation for Septic Cardiomyopathy due to Legionella Pneumonia after Influenza Virus Infection

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Motohiro Asaki ◽  
Takamitsu Masuda ◽  
Yasuo Miki
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Septic Cardiomyopathy ◽  
Altered Level ◽  
Ventricular Ejection Fraction ◽  
Membrane Oxygenation ◽  
Circulatory Insufficiency ◽  
Va Ecmo

A 57-year-old man presented to the emergency department with fever and progressive altered level of consciousness of 5 days’ duration. Three days before admission, influenza A was diagnosed at a clinic. On admission, his vital signs were unstable. Pneumonia was diagnosed through chest computed tomography, and urinary Legionella antigen test was positive. A diagnosis of septic shock due to Legionella and influenza pneumonia was made, and critical care management was initiated, including mechanical ventilation and vasopressors. However, tachycardia did not improve, left ventricular ejection fraction was 20%, and circulatory insufficiency progressed. Therefore, considering the involvement of septic cardiomyopathy and cardiogenic shock, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was initiated for circulation assistance on day 3 since admission. Tachycardia and myocardial dysfunction improved by day 8, and VA-ECMO was withdrawn. Subsequently, nutrition management and rehabilitation were performed, and the patient was transferred to a recovery hospital on day 108. VA-ECMO may be beneficial when concomitant with circulatory assistance in uncontrollable cases of septic cardiomyopathy using catecholamines and β-blockers. It may be necessary to adopt VA-ECMO at an appropriate time before the patient progresses to cardiopulmonary arrest.

Extracorporeal Membrane Oxygenation for Refractory Septic Shock in Children

PEDIATRICS ◽  
1994 ◽  
Vol 93 (5) ◽  
pp. 726-729
Author(s):  
John Beca ◽  
Warwick Butt
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Extracorporeal Membrane Oxygenation ◽  
Demographic Data ◽  
Pediatric Intensive Care ◽  
Organ System ◽  
Severe Respiratory Failure ◽  
Prism Score ◽  
Membrane Oxygenation ◽  
Refractory Septic Shock

Objective. To review demographic data and outcome of children who received extracorporeal membrane oxygenation (ECMO) for refractory septic shock. Method. Review of medical charts of nine children receiving ECMO for culture-proven refractory septic shock treated in a multidisciplinary pediatric intensive care unit. Results. Median age was 12 years and median weight was 45 kg. Median inotrope requirements (µg/kg per minute) before ECMO were dopamine, 15; dobutamine, 12.5; epinephrine, 4; and norepinephrine, 3.5. Four children received two inotropes concurrently, and five received three or more. All nine patients had severe respiratory failure; eight had evidence of other organ system dysfunction, with six having five or more organ system dysfunctions. Median PRISM score was 27. Median duration of ECMO was 137 hours. Within 24 hours of starting ECMO, 7 of 9 children had all inotropes stopped. Four patients died and five survived, all of whom are leading normal lives. Conclusion. In this small group of children with probably fatal septic shock, ECMO was successfully supported the circulation and 5 of the 9 children survived. We suggest that septic shock should not be considered a contra-indication to ECMO.

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