Article Data

  • Views 419
  • Dowloads 169

Original Research

Open Access Special Issue

Hospital outcomes after emergent peripheral veno-arterial extracorporeal membrane oxygenation in adult patients presenting with cardiogenic shock

  • Mohamed Laimoud1,2
  • Mosleh Alanazi1
  • Rehan Qureshi1

1Adult Cardiac Surgical Intensive Care Unit (CSICU), King Faisal Specialist Hospital & Research Center, 11211 Riyadh, Saudi Arabia

2Critical Care Medicine department, Cairo University, 12613 Cairo, Egypt

DOI: 10.22514/sv.2021.118 Vol.17,Issue 5,September 2021 pp.103-109

Submitted: 02 April 2021 Accepted: 12 May 2021

Published: 08 September 2021

*Corresponding Author(s): Mohamed Laimoud E-mail: m.laimoud@cu.edu.eg mlaimoud@kfshrc.edu.sa

Abstract

Background: Emergent peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been used frequently to support patients with refractory cardiogenic shock with variable rates of complications. We retrospectively analyzed adult patients who received peripheral VA-ECMO support between 2015 and 2019 at our tertiary care hospital.

Results: Sixty five patients with a mean age of 37.9 ± 14.9 years, mostly males (70.8%), were supported with femoral VA-ECMO with a median duration of 8 (IQR: 3–40) days. Hospital mortality occurred in 29 (44.6%) patients. Complications included acute kidney injury (AKI) in 39 (60%), acute cerebral strokes in 13 (20%), gastrointestinal bleeding in 14 (21.5%) and acute limb ischemia in 21 (32.3%) patients. Non-survivors had significantly higher mean Sequential Organ Failure Assessment (SOFA) scores and significantly increased rates of acute kidney injury, renal replacement therapy, ischemic cerebral strokes, cannulation site exploration for bleeding, atrial fibrillation and anticoagulation discontinuation. Multivariable regression analysis revealed significant Odds Ratios (OR), 95% Confidence Intervals (CI) of hospital mortality with: increasing SOFA scores after 48 hours (2.15, 1.441–3.214, p < 0.001), atrial fibrillation (11.351, 1.354–83.222, p = 0.025) and hyperlactatemia (2.74, 1.448–6.719, p = 0.016).

Conclusion: High mortality and frequent morbidities due to emergent peripheral VA-ECMO should be considered before initiation for cardiogenic shock. According to our results, increasing trend of SOFA scores, atrial fibrillation and progressive hyperlactatemia are independent predictors of hospital mortality of peripheral VA-ECMO.


Keywords

Extracorporeal membrane oxygenation; Extracorporeal life support; VA-ECMO; Cardiogenic shock; SOFA score; Lactate; Atrial fibrillation


Cite and Share

Mohamed Laimoud,Mosleh Alanazi,Rehan Qureshi. Hospital outcomes after emergent peripheral veno-arterial extracorporeal membrane oxygenation in adult patients presenting with cardiogenic shock. Signa Vitae. 2021. 17(5);103-109.

References

[1] Eckman PM, Katz JN, El Banayosy A, Bohula EA, Sun B, van Diepen S. Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. Circulation. 2019; 140: 2019–2037.

[2] Chung S, Sheu J, Lin Y, Sun C, Chang L, Chen Y, et al. Outcome of Patients with Profound Cardiogenic Shock after Cardiopulmonary Re-suscitation and Prompt Extracorporeal Membrane Oxygenation Support. Circulation Journal. 2012; 76: 1385–1392.

[3] Beurtheret S, Mordant P, Paoletti X, Marijon E, Celermajer DS, Leger P, et al. Emergency circulatory support in refractory cardiogenic shock patients in remote institutions: a pilot study (the cardiac-RESCUE program). European Heart Journal. 2013; 34: 112–120.

[4] Chang C, Chen H, Caffrey JL, Hsu J, Lin J, Lai M, et al. Survival Analysis after Extracorporeal Membrane Oxygenation in Critically Ill Adults: a Nationwide Cohort Study. Circulation. 2016; 133: 2423–2433.

[5] Laimoud M, Alanazi M. The Validity of SOFA Score to Predict Mortality in Adult Patients with Cardiogenic Shock on Venoarterial Extracorporeal Membrane Oxygenation. Critical Care Research and Practice. 2020; 2020: 1–9.

[6] Abrams D, Combes A, Brodie D. Extracorporeal Membrane Oxygenation in Cardiopulmonary Disease in Adults. Journal of the American College of Cardiology. 2014; 63: 2769–2778.

[7] Schmidt M, Burrell A, Roberts L, Bailey M, Sheldrake J, Rycus PT, et al. Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE)-score. European Heart Journal. 2015; 36: 2246–2256.

[8] Lorusso R, Gelsomino S, Parise O, Mendiratta P, Prodhan P, Rycus P, et al. Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock in Elderly Patients: Trends in Application and Outcome from the Extracorporeal Life Support Organization (ELSO) Registry. The Annals of Thoracic Surgery. 2017; 104: 62–69.

[9] Combes A, Leprince P, Luyt C, Bonnet N, Trouillet J, Léger P, et al. Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Critical Care Medicine. 2008; 36: 1404–1411.

[10] Chen W, Huang K, Yao C, Wu C, Liang S, Li C, et al. The modified SAVE score: predicting survival using urgent veno-arterial extracorporeal membrane oxygenation within 24 hours of arrival at the emergency department. Critical Care. 2016; 20: 336.

[11] Aubin H, Petrov G, Dalyanoglu H, Richter M, Saeed D, Akhyari P, et al. Four-year experience of providing mobile extracorporeal life support to out-of-center patients within a suprainstitutional network-Outcome of 160 consecutively treated patients. Resuscitation. 2017; 121: 151–157.

[12] Wang J, Han J, Jia Y, Zeng W, Hou X, Meng X. Outcome of veno-arterial extracorporeal membrane oxygenation for patients undergoing valvular surgery. PLoS ONE. 2013; 8: e63924.

[13] Laimoud M, Alanazi M. The clinical significance of blood lactate levels in evaluation of adult patients with veno-arterial extracorporeal membrane oxygenation. The Egyptian Heart Journal. 2020; 72: 74.

[14] Rao P, Khalpey Z, Smith R, Burkhoff D, Kociol RD. Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock and Cardiac Arrest. Circulation. Heart Failure. 2018; 11: e004905.

[15] Aiyagari RM, Rocchini AP, Remenapp RT, Graziano JN. Decompression of the left atrium during extracorporeal membrane oxygenation using a transseptal cannula incorporated into the circuit. Critical Care Medicine. 2006; 34: 2603–2606.

[16] Wang L, Yang F, Wang X, Xie H, Fan E, Ogino M, et al. Predicting mortality in patients undergoing VA-ECMO after coronary artery bypass grafting: the REMEMBER score. Critical Care. 2019; 23: 11.

[17] Laimoud M, Ahmed W. Acute neurological complications in adult pa-tients with cardiogenic shock on veno-arterial extracorporeal membrane oxygenation support. The Egyptian Heart Journal. 2020; 72: 26.

[18] Lorusso R, Barili F, Mauro MD, Gelsomino S, Parise O, Rycus PT, et al. In-Hospital Neurologic Complications in Adult Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation: Results from the Extracorporeal Life Support Organization Registry. Critical Care Medicine. 2016; 44: e964–e972.

[19] Cheng R, Hachamovitch R, Kittleson M, Patel J, Arabia F, Moriguchi J, et al. Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta-analysis of 1,866 adult patients. The Annals of Thoracic Surgery. 2014; 97: 610–616.

[20] Tanaka D, Hirose H, Cavarocchi N, Entwistle JWC. The Impact of Vascular Complications on Survival of Patients on Venoarterial Extracorporeal Membrane Oxygenation. The Annals of Thoracic Surgery. 2016; 101: 1729–1734.

[21] Yen C, Kao C, Tsai C, Tsai S. Identifying the Risk Factor and Prevention of Limb Ischemia in Extracorporeal Membrane Oxygenation with Femoral Artery Cannulation. The Heart Surgery Forum. 2018; 21: E018–E022.

[22] Yang F, Hou D, Wang J, Cui Y, Wang X, Xing Z, et al. Vascular com-plications in adult postcardiotomy cardiogenic shock patients receiving venoarterial extracorporeal membrane oxygenation. Annals of Intensive Care. 2018; 8: 72.

[23] Jentzer JC, Bennett C, Wiley BM, Murphree DH, Keegan MT, Gajic O, et al. Predictive Value of the Sequential Organ Failure Assessment Score for Mortality in a Contemporary Cardiac Intensive Care Unit Population. Journal of the American Heart Association. 2018; 7: e008169.

[24] Mustafa AK, Alexander PJ, Joshi DJ, Tabachnick DR, Cross CA, Pappas PS, et al. Extracorporeal Membrane Oxygenation for Patients with COVID-19 in Severe Respiratory Failure. JAMA Surgery. 2020; 155: 990.

[25] Henry BM, Lippi G. Poor survival with extracorporeal membrane oxygenation in acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19): Pooled analysis of early reports. Journal of Critical Care. 2020; 58: 27–28.

[26] Barbaro RP, MacLaren G, Boonstra PS, Iwashyna TJ, Slutsky AS, Fan E, et al. Extracorporeal membrane oxygenation support in COVID-19: An international cohort study of the Extracorporeal Life Support Organization registry. The Lancet. 2020; 396: 1071–1078.

[27] Park JF, Banerjee S, Umar S. In the eye of the storm: the right ventricle in COVID-19. Pulmonary Circulation. 2020; 10: 204589402093666.

[28] Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. COVID-19: consider cytokine storm syndromes and immunosuppres-sion. The Lancet. 2020; 395: 1033–1034.

[29] Chousterman BG, Swirski FK, Weber GF. Cytokine storm and sepsis disease pathogenesis. Seminars in Immunopathology. 2017; 39: 517–528.

[30] von Bahr V, Millar JE, Malfertheiner MV, Ki KK, Passmore MR, Bart-nikowski N, et al. Mesenchymal stem cells may ameliorate inflammation in an ex vivo model of extracorporeal membrane oxygenation. Perfusion. 2019; 34: 15–21.

[31] Millar JE, Fanning JP, McDonald CI, McAuley DF, Fraser JF. The inflammatory response to extracorporeal membrane oxygenation (ECMO): a review of the pathophysiology. Critical Care. 2016; 20: 387.


Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 0.5(2019) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time

Conferences

Top