scholarly journals Use of Extracorporeal Life Support for Heart Transplantation: Key Factors to Improve Outcome

2021 ◽  
Author(s):  
Jun Ho Lee ◽  
Ilkun Park ◽  
Joo Yeon Kim ◽  
Kiick Sung ◽  
Wook Sung Kim ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Sofa Score ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Multivariable Analysis ◽  
Key Factors ◽  
Central Type ◽  
Significant Difference ◽  
Failure Assessment ◽  
Central Cannulation

Abstract Although patients receiving extracorporeal life support (ECLS) as a bridge to transplantation have demonstrated worse outcomes than those without ECLS, we investigated the key factors in the improvement of their posttransplant outcome. From December 2003 to December 2018, 257 adult patients who underwent heart transplantation (HTx) at our institution were included. We identified 100 patients (38.9%) who underwent HTx during ECLS (ECLS group). The primary outcome was 1-year mortality after HTx. The median duration of ECLS was 10.0 days. A central type of ECLS was used in 35.0% of patients in the ECLS group. The 1-year mortality rate was 12.8%, with no significant difference between the ECLS and non-ECLS groups (16.0% versus 10.8%, p = 0.227). Multivariable analysis indicated that the use of ECLS was not a predictor of 1-year mortality (p = 0.140). Independent predictors of 1-year mortality were found to be cardiopulmonary resuscitation before HTx (p = 0.002) and Sequential Organ Failure Assessment (SOFA) score (p < 0.001). A SOFA score greater than 10 was suggested the a cutoff value for 1-year survival. Early ECLS application, sophisticated ECLS and intensive care, and liberal use of central cannulation may be important steps in achieving favorable survival after HTx.

scholarly journals Use of Extracorporeal Life Support for Heart Transplantation: Key Factors to Improve Outcome

2021 ◽  
Vol 10 (12) ◽  
pp. 2542
Author(s):  
Jun Ho Lee ◽  
Nayeon Choi ◽  
Yun Jin Kim ◽  
Kiick Sung ◽  
Wook Sung Kim ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Organ Failure ◽  
Primary Outcome ◽  
Life Support ◽  
Total Bilirubin ◽  
Extracorporeal Life Support ◽  
Total Bilirubin Level ◽  
Key Factors ◽  
Bridge To Transplantation ◽  
Failure Assessment

Although patients receiving extracorporeal life support (ECLS) as a bridge to transplantation have demonstrated worse outcomes than those without ECLS, we investigated the key factors in the improvement of their posttransplant outcome. From December 2003 to December 2018, 257 adult patients who underwent heart transplantation (HTx) at our institution were included. We identified 100 patients (38.9%) who underwent HTx during ECLS (ECLS group). The primary outcome was 30-day mortality after HTx. The median duration of ECLS was 10.0 days. The 30-day mortality rate was 3.9% (9.2% in peripheral ECLS, 2.9% in central ECLS, and 1.9% in non-ECLS). The use of ECLS was not an independent predictor of 30-day and 1-year mortality (p = 0.248 and p = 0.882, respectively). Independent predictors of 30-day mortality were found to be higher ejection fraction (p < 0.001), Sequential Organ Failure Assessment score (p < 0.001), and total bilirubin level (p = 0.005). In a subgroup analysis, cannulation type was not a predictor of 30-day mortality (p = 0.275). Early ECLS application to prevent organ failure and sophisticated management of acute heart failure may be important steps in achieving favorable survival after HTx.

Extracorporeal Membrane Oxygenation after Heart Transplantation: Impact of Type of Cannulation

2020 ◽  
Author(s):  
Arash Mehdiani ◽  
Moritz Benjamin Immohr ◽  
Charlotte Boettger ◽  
Hannan Dalyanoglu ◽  
Daniel Scheiber ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Statistical Significance ◽  
Early Death ◽  
Limb Ischemia ◽  
Bleeding Complications ◽  
Membrane Oxygenator ◽  
Extracorporeal Membrane Oxygenator ◽  
Central Cannulation

Abstract Background Primary graft dysfunction (PGD) is a common cause of early death after heart transplantation (htx). The use of extracorporeal life support (ECLS) after htx has increased during the last years. It is still discussed controversially whether peripheral cannulation is favorable compared to central cannulation. We aimed to compare both cannulation techniques. Methods Ninety patients underwent htx in our department between 2010 and 2017. Twenty-five patients were treated with ECLS due to PGD (10 central extracorporeal membrane oxygenator [cECMO] and 15 peripheral extracorporeal membrane oxygenator [pECMO] cannulation). Pre- and intraoperative parameters were comparable between both groups. Results Thirty-day mortality was comparable between the ECLS-groups (cECMO: 30%; pECMO: 40%, p = 0.691). Survival at 1 year (n = 18) was 40 and 30.8% for cECMO and pECMO, respectively. The incidence of postoperative renal failure, stroke, limb ischemia, and infection was comparable between both groups. We also did not find significant differences in duration of mechanical ventilation, intensive care unit stay, or in-hospital stay. The incidence of bleeding complications was also similar (cECMO: 60%; pECMO: 67%). Potential differences in support duration in pECMO group (10.4 ± 9.3 vs. 5.7 ± 4.7 days, p = 0.110) did not reach statistical significance. Conclusions In patients supported for PGD, peripheral and central cannulation strategies are safe and feasible for prolonged venoarterial ECMO support. There was no increase in bleeding after central implantation. With regard to the potential complications of a pECMO, we think that aortic cannulation with tunneling of the cannula and closure of the chest could be a good option in patients with PGD after htx.

Predictors and Outcome of Extracorporeal Life Support After Pediatric Heart Transplantation

2015 ◽  
Vol 99 (6) ◽  
pp. 2166-2172 ◽  
Author(s):  
Jacob Simmonds ◽  
Troy Dominguez ◽  
Joanna Longman ◽  
Nitin Shastri ◽  
Maura O’Callaghan ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Pediatric Heart Transplantation

Abstract 16064: Mechanical Left Ventricular Venting is Associated With Improved Survival in Adults Undergoing Venoarterial Extracorporeal Life Support: An ELSO Registry Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jose I Nunez ◽  
Brooks Willar ◽  
Kevin Kennedy ◽  
Peter Rycus ◽  
Joseph Tonna ◽  
...  
Keyword(s):  
Adverse Events ◽  
Renal Injury ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Limb Ischemia ◽  
Aortic Disease ◽  
Left Ventricular ◽  
Ventricular Assist ◽  
Clinical Covariates ◽  
Central Cannulation

Introduction: Venoarterial extracorporeal life support (VA-ECLS) imposes increased afterload on the left ventricle (LV), potentially provoking LV distension and impaired ventricular recovery. Prior studies have suggested a survival benefit with LV mechanical venting (MV), but multi-center data are lacking. Methods: We queried the ELSO registry for adults undergoing VA-ECLS and stratified them by the use of MV, including intra-aortic balloon pump and percutaneous ventricular assist device. We excluded patients with pulmonary embolism, heart transplant, congenital and valvular heart disease, aortic disease, and central cannulation. The primary outcome was in-hospital mortality. Secondary outcomes were on-support mortality and major adverse events, including bleeding, hemolysis, ischemic stroke, limb ischemia, and renal injury. We used multivariable logistic regression modeling to adjust for relevant clinical covariates. Results: Among 12734 patients undergoing VA-ECLS, 3353 (26.3%) received MV devices. Patients with MV were older (mean age 56.3 vs 52.7 years), more often male (76.3% vs 68.5%), and more often supported for acute myocardial infarction (43.0% vs 21.7%), p<0.001 for all. Prior to ECLS, patients with MV had lower rates of cardiac arrest (51.7% vs 55.1%) but more commonly needed >2 vasopressors (41.8% vs 27.2%) and had a higher incidence of acute renal (17.1% vs 10.5%), liver (4.4% vs 3.1%), and respiratory failure (20.9% vs 15.9%), p<0.001 for all. Crude on-support (41.6% vs 47.8%, p<0.001) and in-hospital (56.7% vs 59.2%, p=0.01) mortality were lower in the MV group. In multivariable modeling, MV was associated with a significantly lower odds of mortality but higher odds of adverse events including medical and cannula site bleeding, hemolysis, limb ischemia and renal injury (Figure). Conclusions: Among adults supported with peripheral VA-ECLS, LV MV was associated with lower mortality despite a higher rate of important adverse events.

Blood Platelet Activation and Membrane Glycoprotein Changes during Extracorporeal Life Support (Ecls). In Vitro Studies

1995 ◽  
Vol 18 (6) ◽  
pp. 315-321 ◽  
Author(s):  
K. Mellgren ◽  
L.G. Friberg ◽  
T. Hedner ◽  
G. Mellgren ◽  
H. Wadenvik
Keyword(s):  
Centrifugal Pump ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Membrane Receptors ◽  
Receptor Protein ◽  
Roller Pump ◽  
Platelet Surface ◽  
Continuous Increase ◽  
Significant Difference

The aim of this study was to evaluate an in vitro model for investigation of platelet function parameters in an extracorporeal system. Two different perfusion pumps were compared, a roller pump (Polystan) and a centrifugal pump (Biomedicus). A continuous increase in glycoprotein (GP)1b-negative platelets was observed in both circuits. A marked increase of plasma β-thromboglobulin thromboglobulin concentration and a decrease of the intracellular pool of serotonin was observed, indicating a marked release of alpha as well as of dense granules. The plasma concentration of glycocalicin increased in parallel with a reduced platelet surface expression of GP1b, suggesting that the loss of GP1b is caused by proteolysis rather than by a downregulation of this receptor protein. It is concluded that ECLS results in a pronounced platelet degranulation and causes changes of important membrane receptors which might explain some of the bleeding problems observed in patients treated with ECLS. No significant difference was noted between the roller pump and the centrifugal pump. Trial of strategies, e.g. protease inhibitors and nitric oxide to revert this untoward effect of ECLS are highly warranted.

scholarly journals Salvage of severe primary graft dysfunction following heart transplantation using extracorporeal life support

2018 ◽  
Vol 31 (4) ◽  
pp. 482-486
Author(s):  
Katalin Martits-Chalangari ◽  
Omar Hernandez ◽  
Aayla K. Jamil ◽  
Huanying Qin ◽  
Joost Felius ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Primary Graft Dysfunction ◽  
Graft Dysfunction

Extracorporeal life support as a bridge to high-urgency heart transplantation

2011 ◽  
Vol 26 (3) ◽  
pp. 484-488 ◽  
Author(s):  
Emeline Barth ◽  
Michel Durand ◽  
Christophe Heylbroeck ◽  
Marine Rossi-Blancher ◽  
Aude Boignard ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
High Urgency

scholarly journals Change of Hemoglobin Levels in the Early Post-cardiac Arrest Phase Is Associated With Outcome

2021 ◽  
Vol 8 ◽  
Author(s):  
Christoph Schriefl ◽  
Christian Schoergenhofer ◽  
Florian Ettl ◽  
Michael Poppe ◽  
Christian Clodi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Vascular Permeability ◽  
Fluid Balance ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Multivariable Analysis ◽  
Cerebral Performance Category ◽  
Endothelial Activation ◽  
Temperature Management ◽  
Neurologic Function

Background: The post-cardiac arrest (CA) phase is characterized by high fluid requirements, endothelial activation and increased vascular permeability. Erythrocytes are large cells and may not leave circulation despite massive capillary leak. We hypothesized that dynamic changes in hemoglobin concentrations may reflect the degree of vascular permeability and may be associated with neurologic function after CA.Methods: We included patients ≥18 years, who suffered a non-traumatic CA between 2013 and 2018 from the prospective Vienna Clinical Cardiac Arrest Registry. Patients without return of spontaneous circulation (ROSC), with extracorporeal life support, with any form of bleeding, undergoing surgery, receiving transfusions, without targeted temperature management or with incomplete datasets for multivariable analysis were excluded. The primary outcome was neurologic function at day 30 assessed by the Cerebral Performance Category scale. Differences of hemoglobin concentrations at admission and 12 h after ROSC were calculated and associations with neurologic function were investigated by uni- and multivariable logistic regression.Results: Two hundred and seventy-five patients were eligible for analysis of which 143 (52%) had poor neurologic function. For every g/dl increase in hemoglobin from admission to 12 h the odds of poor neurologic function increased by 26% (crude OR 1.26, 1.07–1.49, p = 0.006). The effect remained unchanged after adjustment for fluid balance and traditional prognostication markers (adjusted OR 1.27, 1.05–1.54, p = 0.014).Conclusion: Increasing hemoglobin levels in spite of a positive fluid balance may serve as a surrogate parameter of vascular permeability and are associated with poor neurologic function in the early post-cardiac arrest period.

scholarly journals Is either arterial or venous antithrombin III level linked to outcome in elderly males versus females with severe sepsis?

2014 ◽  
Vol 6 (1) ◽  
pp. 34-39
Author(s):  
Nermien N Adly ◽  
Rania M Abou-Hashema
Keyword(s):  
Severe Sepsis ◽  
Cohort Study ◽  
Sofa Score ◽  
Antithrombin Iii ◽  
Medical Sciences ◽  
Elderly Males ◽  
Significant Difference ◽  
Failure Assessment ◽  
Males And Females ◽  
The Difference

Objectives: We aimed to study arterial and venous ATIII levels, in elderly males and females with severe sepsis, and their impact upon the patients’ outcomes. Patients and Methods: A cohort study was performed in thirty-nine elderly patients with severe sepsis. Arterial and venous ATIII levels were measured. Sequential Organ Failure Assessment (SOFA) score was calculated.  Results: Both arterial and venous ATIII levels were negatively correlated with age in the whole sample (P=0.004 and .05 consecutively) (r = −0.45 and −0.32 consecutively). There was a significant difference between the arterial and venous ATIII levels in males (P=0.04). In males, SOFA score was positively correlated with arterial ATIII and the difference between arterial and venous ATIII levels (P=0.04 and .05 consecutively). Arterial and venous ATIII were the significant predictors of SOFA score, only in males (P <0.001 and 0.003 consecutively). Conclusion: ATIII level decreased with increasing age. In males, both higher arterial and lower venous ATIII levels were significant predictors of worse organ dysfunction. DOI: http://dx.doi.org/10.3126/ajms.v6i1.10795 Asian Journal of Medical Sciences Vol.6(1) 2015 34-39

scholarly journals Prosthetic valve thrombosis during extracorporeal life support for postcardiotomy shock

2020 ◽  
Vol 31 (4) ◽  
pp. 573-575
Author(s):  
Andrew Melehy ◽  
Joseph Sanchez ◽  
Justin A Fried ◽  
Koji Takeda
Keyword(s):  
Prosthetic Valve ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Open Heart Surgery ◽  
Initial Flow ◽  
Prosthetic Valve Thrombosis ◽  
Prosthetic Valves ◽  
Valve Thrombosis ◽  
Postcardiotomy Shock ◽  
Central Cannulation

Abstract Postcardiotomy shock is a complication after open-heart surgery that may be alleviated with extracorporeal life support (ECLS). Postcardiotomy shock patients on ECLS with prosthetic valves are at a high risk of valve thrombosis. We retrospectively reviewed patients supported with ECLS after the development of postcardiotomy shock at our centre, 90 of which had prosthetic valves. Nine patients developed prosthetic valve thrombosis, an incidence of 10%. Patients who developed prosthetic valve thrombosis were more often supported via central cannulation (78% vs 38%, P = 0.034) and had a higher median initial flow (4.4 vs 3.2 l/min, P = 0.018). Central cannulation was associated with valve thrombosis by multivariable logistic regression (odds ratio 7.56; 95% confidence interval 1.12–149.87). Central cannulation with high flow is thought to reduce intracardiac blood flow, thereby increasing the risk of stasis and thrombus formation. Patients with prosthetic valve thrombosis were treated with anticoagulation or surgical intervention and 4 patients (44%) survived to discharge.

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