Outcomes from adult veno-arterial extracorporeal membrane oxygenation in a cardiovascular disease center from 2009 to 2019.
15 Feb 2021-Perfusion (SAGE PublicationsSage UK: London, England)-pp 267659121993365-267659121993365
TL;DR: In this article, a single-center experience of veno-arterial (V-A) ECMO was provided for a single patient with a venoarterial lesion.
Abstract: Introduction:Extracorporeal membrane oxygenation (ECMO) is an imperative short-term cardiopulmonary support device now. We aimed to provide a single-center experience of veno-arterial (V-A) ECMO ma...
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TL;DR: In this article, an update of the epidemiology, outcomes and pathophysiology of acute kidney injury in patients receiving ECMO, highlights technical aspects when combining Renal Replacement Therapy (RRT) with ECMO and identifies future research questions.
Abstract: Acute kidney injury is a common complication in patients receiving extracorporeal membrane oxygenation (ECMO). The underlying mechanisms are multifactorial including the primary disease, effects of invasive mechanical ventilation, ECMO circuit-related factors and critical illness in general. Renal replacement therapy (RRT) is often required to control fluid balance and is associated with worse outcomes. No consensus exists for indication, timing, modality, and how to best to combine RRT and ECMO. This chapter provides an update of the epidemiology, outcomes and pathophysiology of acute kidney injury in patients receiving ECMO, highlights technical aspects when combining RRT with ECMO, and identifies future research questions.
25 citations
TL;DR: In 2019, Fuwai hospital launched a three-month education program for venoarterial (V-A) ECMO, which was composed of didactic courses, water-drill courses, high-fidelity simulation and clinical training as discussed by the authors .
Abstract: Extracorporeal membrane oxygenation (ECMO) is a rescue therapy in patients with cardiopulmonary emergencies (1, 2). Although the use of ECMO is gradually increasing, ECMO is still a very costly and invasive treatment. ECMO education programs may expand the availability of this treatment to meet growing needs (3). Fuwai Hospital is a national center for cardiovascular disease in China, and it has provided ECMO support since 2004 (4, 5). In 2019, Fuwai hospital launched a three-month education program for venoarterial (V-A) ECMO that recruited participants from all over the nation. The program was composed of didactic courses, water-drill courses, high-fidelity simulation, and clinical training. By June 2022, 10 sessions had been held. This study aimed to introduce the three-month education program for V-A ECMO and to evaluate the program by assessing the participants’ feedback.
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TL;DR: The guidelines focused on 4 key domains: (1) AKI definition, (2) prevention and treatment of AKI, (3) contrastinduced AKI (CI-AKI) and (4) dialysis interventions for the treatment ofAKI.
Abstract: tion’, implying that most patients ‘should’ receive a particular action. In contrast, level 2 guidelines are essentially ‘suggestions’ and are deemed to be ‘weak’ or discretionary, recognising that management decisions may vary in different clinical contexts. Each recommendation was further graded from A to D by the quality of evidence underpinning them, with grade A referring to a high quality of evidence whilst grade D recognised a ‘very low’ evidence base. The overall strength and quality of the supporting evidence is summarised in table 1 . The guidelines focused on 4 key domains: (1) AKI definition, (2) prevention and treatment of AKI, (3) contrastinduced AKI (CI-AKI) and (4) dialysis interventions for the treatment of AKI. The full summary of clinical practice statements is available at www.kdigo.org, but a few key recommendation statements will be highlighted here.
6,247 citations
TL;DR: Although ECMO can improve survival of patients with advanced heart disease, there is significant associated morbidity with performance of this intervention.
651 citations
TL;DR: The SAVE-score may be a tool to predict survival for patients receiving ECMO for refractory cardiogenic shock (www.save-score.com) and create the survival after veno-arterial-ECMO (SAVE)-score.
Abstract: Rationale Extracorporeal membrane oxygenation (ECMO) may provide mechanical pulmonary and circulatory support for patients with cardiogenic shock refractory to conventional medical therapy. Prediction of survival in these patients may assist in management of these patients and comparison of results from different centers. Aims To identify pre-ECMO factors which predict survival from refractory cardiogenic shock requiring ECMO and create the survival after veno-arterial-ECMO (SAVE)-score. Methods and results Patients with refractory cardiogenic shock treated with veno-arterial ECMO between January 2003 and December 2013 were extracted from the international Extracorporeal Life Support Organization registry. Multivariable logistic regression was performed using bootstrapping methodology with internal and external validation to identify factors independently associated with in-hospital survival. Of 3846 patients with cardiogenic shock treated with ECMO, 1601 (42%) patients were alive at hospital discharge. Chronic renal failure, longer duration of ventilation prior to ECMO initiation, pre-ECMO organ failures, pre-ECMO cardiac arrest, congenital heart disease, lower pulse pressure, and lower serum bicarbonate (HCO3) were risk factors associated with mortality. Younger age, lower weight, acute myocarditis, heart transplant, refractory ventricular tachycardia or fibrillation, higher diastolic blood pressure, and lower peak inspiratory pressure were protective. The SAVE-score (area under the receiver operating characteristics [ROC] curve [AUROC] 0.68 [95%CI 0.64-0.71]) was created. External validation of the SAVE-score in an Australian population of 161 patients showed excellent discrimination with AUROC = 0.90 (95%CI 0.85-0.95). Conclusions The SAVE-score may be a tool to predict survival for patients receiving ECMO for refractory cardiogenic shock (www.save-score.com).
616 citations
TL;DR: ECMO support can rescue 40% of otherwise fatal cardiogenic shock patients but its initiation under cardiac massage or after renal or hepatic failure carried higher risks of intensive care unit death, while fulminant myocarditis had a better prognosis.
Abstract: Objective:To assess the outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation (ECMO) for refractory cardiogenic shock.Design, Setting, and Patients:Refractory cardiogenic shock is almost always lethal without emergency circulatory support, e.g., ECMO. EC
557 citations
TL;DR: In patients undergoing cardiac surgery who were at moderate‐to‐high risk for death, a restrictive strategy regarding red‐cell transfusion was noninferior to a liberal strategy with respect to the composite outcome of death from any cause, myocardial infarction, stroke, or new‐onset renal failure with dialysis, with less blood transfused.
Abstract: BackgroundThe effect of a restrictive versus liberal red-cell transfusion strategy on clinical outcomes in patients undergoing cardiac surgery remains unclear. MethodsIn this multicenter, open-label, noninferiority trial, we randomly assigned 5243 adults undergoing cardiac surgery who had a European System for Cardiac Operative Risk Evaluation (EuroSCORE) I of 6 or more (on a scale from 0 to 47, with higher scores indicating a higher risk of death after cardiac surgery) to a restrictive red-cell transfusion threshold (transfuse if hemoglobin level was <7.5 g per deciliter, starting from induction of anesthesia) or a liberal red-cell transfusion threshold (transfuse if hemoglobin level was <9.5 g per deciliter in the operating room or intensive care unit [ICU] or was <8.5 g per deciliter in the non-ICU ward). The primary composite outcome was death from any cause, myocardial infarction, stroke, or new-onset renal failure with dialysis by hospital discharge or by day 28, whichever came first. Secondary outc...
496 citations