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.

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.

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

Evaluation of qSOFA as a Predictor of Mortality Among ICU Patients With Positive Clinical Cultures—A Retrospective Cohort Study

2019 ◽  
Vol 35 (11) ◽  
pp. 1278-1284
Author(s):  
Barry Kelly ◽  
Johann Patlak ◽  
Shahzad Shaefi ◽  
Dustin Boone ◽  
Ariel Mueller ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Assessment Score ◽  
Failure Assessment ◽  
Discriminative Value

Objective: To compare the discriminative value of the quick-sequential organ failure assessment score (qSOFA) to SOFA in a critically ill population, in which a microbial pathogen was isolated within 48 hours of admission to intensive care. Design: Retrospective cohort study. Setting: Academic tertiary referral center from July 2008 to June 2017. Patients: Hospitalized patients admitted to intensive care unit. Interventions: None. Measurements and Main Results: The primary outcome was in-hospital mortality for all patients with confirmed positive microbiological cultures within 48 hours of admission to intensive care unit (ICU). Subgroup analysis was performed on patients with pathogenic bacteremia or positive cultures in cerebrospinal fluid. Of the 11 415 patients analyzed with positive microbiology specimens within 48 hours of admission, 2933 (25.7%) had a qSOFA ≥2. Of these, 16.6% reached the primary outcome of in-hospital mortality. Unsurprisingly, the discriminative value of qSOFA on admission was significantly worse than that of SOFA (0.73 vs 0.76; P = .0004), despite observing a significant association between qSOFA category and in-hospital mortality ( P < .0001). In secondary analyses, similar observations were found using qSOFA within 6 and 24 hours of ICU admission. When analysis was focused on patients with pathogenic bacteremia or positive cerebrospinal fluid (CSF) cultures (n = 1646), there was no significant difference between the discriminative value of qSOFA and SOFA (0.75 vs 0.78; P = .17). Conclusions: Quick-sequential organ failure assessment score at admission was not superior to SOFA in predicting in-hospital mortality in patients with positive clinical cultures within 48 hours of admission to ICU. Quick-sequential organ failure assessment score at admission to the ICU was associated with mortality and showed reasonable calibration and discrimination. When the analysis was focused on patients with pathogenic bacteremia or positive CSF cultures, qSOFA performed similarly to SOFA in discriminatory those who will die from sepsis.

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

Successfully treated necrotizing fasciitis using extracorporeal life support combined with hemoadsorption device and continuous renal replacement therapy

2018 ◽  
Vol 41 (3) ◽  
pp. 178-182 ◽  
Author(s):  
Maroua Eid ◽  
Olivier Fouquet ◽  
Cédric Darreau ◽  
Marc Pierrot ◽  
Achille Kouatchet ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Necrotizing Fasciitis ◽  
Replacement Therapy ◽  
Organ Failure ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Blood Parameters ◽  
Multiple Organ ◽  
Superficial Fascia

Introduction: Necrotizing fasciitis represents a life-threatening infectious condition that causes spreading necrotisis of superficial fascia and subcutaneous cellular tissues. We describe the case of a patient diagnosed with septic and toxic shocks leading to multiple organ failure successfully treated with a combination of extracorporeal life support, continuous renal replacement therapy, and a hemoadsorption device. Methods: A 41-year-old patient presented with necrotizing fasciitis and multi-organ failure. Initial extracorporeal life support therapy was implanted, compensating for systolic failure. Due to acute renal failure that persisted in time, continuous renal replacement therapy was added. Despite these treatments and as a last attempt to control the septic condition, a CytoSorb® hemoadsorption device was installed in parallel to the extracorporeal life support circuit and two sessions were run. Results: During the days following CytoSorb® treatment, hemodynamic stabilization was observed, as well as normalization of lactic acidosis and blood parameters. Conclusion: This case describes the successful use of CytoSorb® with continuous renal replacement therapy and extracorporeal life support in a combined way to overcome a critical phase of septic shock in a young adult patient. This combination of treatments turned out to be efficient for this patient in the context of necrotizing fasciitis.

scholarly journals Case Report: Colchicine Toxicokinetic Analysis in a Poisoned Child Requiring Extracorporeal Life Support

2021 ◽  
Vol 9 ◽  
Author(s):  
Maria Pérez Marín ◽  
Sylvain Prod'hom ◽  
Suzanne Francesca de Villiers ◽  
Thomas Ferry ◽  
Vivianne Amiet ◽  
...  
Keyword(s):  
Organ Failure ◽  
Activated Charcoal ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Blood Levels ◽  
Renal Elimination ◽  
Close Monitoring ◽  
Small Contribution ◽  
Multi Organ Failure ◽  
Colchicine Poisoning

Colchicine poisoning is associated with a poor prognosis, especially when leading to shock and multi-organ failure, and management is limited to supportive care, including multiple-dose activated charcoal. At therapeutic concentrations, colchicine elimination occurs mainly through hepatic metabolism and involves an enterohepatic circulation, with a small contribution of renal elimination (10–30%). Colchicine toxicokinetics is however rarely described, especially in children. We present the case of a 4-year-old patient who survived a severe iatrogenic colchicine intoxication with a dose of 0.5 mg/kg. She developed multi-organ failure and shock, but recovered after receiving aggressive resuscitation, including extracorporeal life support. Close monitoring of colchicine blood levels showed a plateau for 6 days, indicating impeded elimination resulting from liver failure. We observed no significant clearance from renal replacement therapy, nor activated charcoal, during this period. Extracorporeal life support may play a supportive role in the management of severe colchicine poisoning. However, extracorporeal techniques do not seem to improve colchicine elimination.

Multiple Organ Failure and Refractory Cardiogenic Shock due to Venlafaxine Intoxication, Successfully Treated with Veno-Arterial Extracorporeal Life Support

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Painvin B ◽  
◽  
Le Balc’h P ◽  
Gicquel T ◽  
Camus C ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Multiple Organ Failure ◽  
Organ Failure ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Multiple Organ ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Prolonged Release ◽  
Refractory Cardiogenic Shock

Venlafaxine has critical side effects from arrhythmias to cardiogenic shock after toxic dose ingestion. We report a case of venlafaxine intoxication with Multiple Organ Failure (MOF) treated with Veno-Arterial Extracorporeal Life Support (VA-ECLS). A 60-year old male with a history of chronic depression ingested 72 tablets of prolonged-release venlafaxine hydrochloride 75 mg (total 5400 mg). Initial EKG showed broadened QRS complexes and Transthoracic Echocardiography (TTE) revealed diffuse ventricular hypokinesia with Left Ventricular Ejection Fraction (LVEF) of 15% for which dobutamine infusion was started. Due to persistent refractory cardiogenic shock and MOF, a Medos® Deltastream® VA-ECLS was surgically implanted in our intensive care unit. On day 1, toxicology analysis found plasma concentrations of venlafaxine 3.2mg/L and its metabolite desmethylvenlafaxine at 0.92 mg/L. At day 6, we performed a weaning trial, enabling ECLS removal. Motion defect of anteroseptal and inferolateral walls was also noticed. EKGs showed a shorten R wave in the anteroseptal territory leading to the potential diagnosis of underlying ischemic cardiomyopathy. The patient was extubated at day-10 and discharged for cardiology unit at day-17. At day-20, cardiac magnetic resonance imaging showed no sign of ischemia and TTE parameters were normalized. This is the first report of refractory cardiogenic shock and MOF due to venlafaxine intoxication treated with VA-ECLS. The main objective of ECLS is to restore cardiac output especially when ventricular failure is refractory to inotropes. Our experience suggests that MOF secondary to refractory cardiogenic shock should quickly prompt the implantation of a VA-ECLS in venlafaxine critical overdose.

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