scholarly journals Clinical prognosis analysis of extracorporeal membrane oxygenation in patients with heart transplantation

2019 ◽  
Author(s):  
Xiaozu Liao ◽  
Zhou Cheng ◽  
Liqiang Wang ◽  
Binfei Li ◽  
Weizhao Huang ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Membrane Oxygenation ◽  
Heart Transplantation ◽  
Independent Risk Factor ◽  
Life Support ◽  
Univariate Analysis ◽  
Clinical Prognosis ◽  
Ischemia Time ◽  
Membrane Oxygenation

Abstract Purpose Extracorporeal membrane oxygenation (ECMO) is the primary indication for transplanted right heart failure in transition and postoperative period for heart transplantation patients. This study explored risk factors affecting the clinical prognosis of ECMO through analyzing the clinical data of heart transplantation patients with such condition. Methods Data on 28 heart transplantation patients with ECMO obtained from January 2012 to January 2018 in the People’s Hospital of Zhongshan City were retrospectively analyzed. Results A total of 25 patients (20 male and 5 female) were included in this study. Heart transplantation among patients was performed mainly due to cardiomyopathy (77.8%). Eighteen patients survived and were discharged 18 (72%). Four patients were treated with cardiopulmonary resuscitation before ECMO, and three patients died in the hospital. No differences existed among the surviving and death group donors (N-terminal pro b-type natriuretic peptide（NT-proBNP）, creatine kinase-muscle/brain（CK-MB）, warm ischemia time of donated heart, cold ischemia time of donated heart, total ischemia time of donated heart, and donator type). Univariate analysis showed that body mass index(BMI), length of stay in intensive care unit(ICU), and cardiopulmonary resuscitation are relevant prognosis factors in applying ECMO for patients with heart transplantation. Multi-factor logistic regression results show that cardiopulmonary resuscitation before ECMO (OR: 49.45, 95% CI[1.37, 1781.6]; P=0.033) is an independent risk factor influencing prognosis. Conclusion ECMO is an important life support method for patients with heart transplantation before and after the operation. Patients with obesity, poor preoperative cardiac function, and considerable red blood cell transfusions during surgery may influence the prognosis of patients. Extracardiac compression before ECMO of patients is an independent risk factor for their prognosis.

High Hemoglobin Is an Independent Risk Factor for the Development of Hemolysis During Pediatric Extracorporeal Life Support

2017 ◽  
Vol 34 (3) ◽  
pp. 259-264 ◽  
Author(s):  
Christopher L. Jenks ◽  
Ayesha Zia ◽  
Ramgopal Venkataraman ◽  
Lakshmi Raman
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Extracorporeal Membrane Oxygenation ◽  
Centrifugal Pump ◽  
Independent Risk Factor ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Single Center ◽  
Membrane Oxygenation ◽  
Increased Risk

Objective: To evaluate risk factors for hemolysis in pediatric extracorporeal life support. Design: Retrospective, single-center study. Setting: Pediatric intensive care unit. Patients: Two hundred thirty-six children who received extracorporeal membrane oxygenation. Interventions: None. Measurements and Main Results: Risk factors for hemolysis were retrospectively analyzed from a single center in a total of 236 neonatal and pediatric patients who received extracorporeal membrane oxygenation support (ECMO). There was no difference in the incidence of hemolysis between centrifugal (127 patients) and roller head (109 patients) pump type or between venoarterial and venovenous ECMO. High hemoglobin (Hb) was found to be an independent risk factor for hemolysis in both pump types. The Hb level >12 g/dL was significant in the roller group and the Hb level >13 g/dL was significant in the centrifugal group for the development of hemolysis for the cumulative ECMO run. The presence of high Hb levels on any given day increased the risk of hemolysis for that day of the ECMO run regardless of ECMO pump type. Higher revolutions per minute (RPMs) and higher inlet pressures on any given day increased the risk for the development of hemolysis in the centrifugal pump. Lower inlet venous pressures and RPMs were not associated with hemolysis in the roller group. Conclusions: An Hb level greater than 13 g/dL was associated with an increased risk of hemolysis, and a high Hb on a given day was associated with a significantly higher risk of hemolysis on the same day. Higher RPMs and lower inlet venous pressures were associated with an increased risk of hemolysis in the centrifugal pump only.

Extracorporeal Membrane Oxygenation for Pediatric Cardiac Arrest

2015 ◽  
Vol 35 (1) ◽  
pp. 60-69 ◽  
Author(s):  
Jennie Ryan
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Membrane Oxygenation ◽  
Life Support ◽  
Survival Rates ◽  
Underlying Disease ◽  
The Body ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Membrane Oxygenation ◽  
The Impact

Extracorporeal cardiopulmonary resuscitation (ECPR) remains a promising treatment for pediatric patients in cardiac arrest unresponsive to traditional cardiopulmonary resuscitation. With venoarterial extracorporeal support, blood is drained from the right atrium, oxygenated through the extracorporeal circuit, and transfused back to the body, bypassing the heart and lungs. The use of artificial oxygenation and perfusion thus provides the body a period of hemodynamic stability, while allowing resolution of underlying disease processes. Survival rates for ECPR patients are higher than those for traditional cardiopulmonary resuscitation (CPR), although neurological outcomes require further investigation. The impact of duration of CPR and length of treatment with extracorporeal membrane oxygenation vary in published reports. Furthermore, current guidelines for the initiation and use of ECPR are limited and may lead to confusion about appropriate use of this support. Many ethical concerns arise with this advanced form of life support. More often than not, the dilemma is not whether to withhold ECPR, but rather when to withdraw it. Although clinicians must decide if ECPR is appropriate and when further intervention is futile, the ultimate burden of choice is left to the patient’s caregivers. Offering support and guidance to the patient’s family as well as the patient is essential.

Abstract 2553: Effect of Pre-Transplant Extracorporeal Membrane Oxygenation on Pediatric Heart Transplantation Outcomes: An Analysis of the United Network for Organ Sharing Database

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Nishant D Patel ◽  
Eric S Weiss ◽  
Lois U Nwakanma ◽  
Janet Scheel ◽  
Duke E Cameron ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Heart Transplantation ◽  
Heart Transplant ◽  
Propensity Scores ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Membrane Oxygenation ◽  
Kaplan Meier ◽  
Before And After ◽  
United Network

Introduction : Extracorporeal membrane oxygenation (ECMO) has been used as salvage therapy in children with intractable heart failure as a bridge to transplantation, but outcomes have not been examined in a large pediatric transplant database. Methods : All pediatric (<18 years of age) primary heart transplant recipients reported to the United Network for Organ Sharing database from 1999 –2007 were reviewed and segregated according to need for pre-transplant ECMO. Survival was estimated by Kaplan-Meier method before and after propensity match analysis. Propensity-adjusted Cox regression modeling was used to identify predictors of mortality. Results : During the study period, 2141 children underwent first time heart transplantation: 154 (7%) were on ECMO. On univariate analysis, children bridged to heart transplant with ECMO had lower weight at operation (15 vs 27 kg; p <0.0001), shorter time on the organ waitlist (31 vs 92 days; p =0.0002), longer post-transplant length of stay (40 vs 24 days; p <0.0001), and higher incidence of stroke (5% vs 2%, p =0.02), reoperation (16% vs 8%; p =0.002), and infection (50% vs 25%; p <0.0001). Kaplan-Meier 5-year survival was inferior for the pre-transplant ECMO group (55% vs 73%) (Figure ), both before and after propensity matching ( p <0.0001). After propensity score adjustment, pre-transplant ECMO was a significant predictor of mortality (HR 2.7; 95% CI 1.8 – 4.1; p <0.001). Conclusion : Patients on ECMO before heart transplant have inferior outcomes, even after adjustment for propensity scores, but still have acceptable 5-year survival. Improvement in survival will likely require refinement in mechanical support technology and practice. Kaplan -Meler Estimates of Morality 1999–2007 Stratified by ECMO

scholarly journals Feasibility of extracorporeal membrane oxygenation cardiopulmonary resuscitation by low volume centers in Belgium

2021 ◽  
Vol 2 (3) ◽  
Author(s):  
Paul B. Massion ◽  
Sabrina Joachim ◽  
Philippe Morimont ◽  
Guy‐Loup Dulière ◽  
Romain Betz ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Low Volume

scholarly journals Anti-Xa activity and hemorrhagic events under extracorporeal membrane oxygenation (ECMO): a multicenter cohort study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Richard Descamps ◽  
Mouhamed D. Moussa ◽  
Emmanuel Besnier ◽  
Marc-Olivier Fischer ◽  
Sébastien Preau ◽  
...  
Keyword(s):  
Cohort Study ◽  
Extracorporeal Membrane Oxygenation ◽  
Univariate Analysis ◽  
Hemorrhagic Complication ◽  
Multicenter Cohort Study ◽  
Membrane Oxygenation ◽  
Multicenter Cohort ◽  
Hemorrhagic Event ◽  
Hemorrhagic Events ◽  
Va Ecmo

Abstract Background Hemorrhagic events remain a major concern in patients under extracorporeal membrane oxygenation (ECMO) support. We tested the association between anticoagulation levels and hemorrhagic events under ECMO using anti-Xa activity monitoring. Methods We performed a retrospective multicenter cohort study in three ECMO centers. All adult patients treated with veno-venous (VV)- or veno-arterial (VA)-ECMO in 6 intensive care units between September 2017 and August 2019 were included. Anti-Xa activities were collected until a hemorrhagic event in the bleeding group and for the duration of ECMO in the non-bleeding group. All dosages were averaged to obtain means of anti-Xa activity for each patient, and patients were compared according to the occurrence or not of bleeding. Results Among 367 patients assessed for eligibility, 121 were included. Thirty-five (29%) presented a hemorrhagic complication. In univariate analysis, anti-Xa activities were significantly higher in the bleeding group than in the non-bleeding group, both for the mean anti-Xa activity (0.38 [0.29–0.67] vs 0.33 [0.22–0.42] IU/mL; p = 0.01) and the maximal anti-Xa activity (0.83 [0.47–1.46] vs 0.66 [0.36–0.91] IU/mL; p = 0.05). In the Cox proportional hazard model, mean anti-Xa activity was associated with bleeding (p = 0.0001). By Kaplan–Meier analysis with the cutoff value at 0.46 IU/mL obtained by ROC curve analysis, the probability of survival under ECMO without bleeding was significantly lower when mean anti-Xa was > 0.46 IU/mL (p = 0.0006). Conclusion In critically ill patients under ECMO, mean anti-Xa activity was an independent risk factor for hemorrhagic complications. Anticoagulation targets could be revised downward in both VV- and VA-ECMO.

Evaluation of a Multimodal Heparin Laboratory Monitoring Protocol in Adult Extracorporeal Membrane Oxygenation Patients

2021 ◽  
pp. 089719002110212
Author(s):  
Kalynn A. Northam ◽  
Bobbie Nguyen ◽  
Sheh-Li Chen ◽  
Edward Sredzienski ◽  
Anthony Charles
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Major Bleeding ◽  
Infusion Rate ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Factor Xa ◽  
Median Number ◽  
Multimodal Approach ◽  
Membrane Oxygenation ◽  
Monitoring Protocol

Background: Anticoagulation monitoring practices vary during extracorporeal membrane oxygenation (ECMO). The Extracorporeal Life Support Organization describes that a multimodal approach is needed to overcome assay limitations and minimize complications. Objective: Compare activated clotting time (ACT) versus multimodal approach (activated partial thromboplastin time (aPTT)/anti-factor Xa) for unfractionated heparin (UFH) monitoring in adult ECMO patients. Methods: We conducted a single-center retrospective pre- (ACT) versus post-implementation (multimodal approach) study. The incidence of major bleeding and thrombosis, blood product and antithrombin III (ATIII) administration, and UFH infusion rates were compared. Results: Incidence of major bleeding (69.2% versus 62.2%, p = 0.345) and thrombosis (23% versus 14.9%, p = 0.369) was similar between groups. Median number of ATIII doses was reduced in the multimodal group (1.0 [IQR 0.0-2.0] versus 0.0 [0.0 -1.0], p = 0.007). The median UFH infusion rate was higher in the ACT group, but not significant (16.9 [IQR 9.6-22.4] versus 13 [IQR 9.6-15.4] units/kg/hr, p = 0.063). Fewer UFH infusion rate changes occurred prior to steady state in the multimodal group (0.9 [IQR 0.3 -1.7] versus 0.1 [IQR 0.0-0.2], p < 0.001). Conclusion: The incidence of major bleeding and thrombosis was similar between groups. Our multimodal monitoring protocol standardized UFH infusion administration and reduced ATIII administration.

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