TY - JOUR
T1 - Patients treated with venoarterial extracorporeal membrane oxygenation have different baseline risk and outcomes dependent on indication and route of cannulation
AU - Kosmopoulos, Marinos
AU - Bartos, Jason A.
AU - Kalra, Rajat
AU - Goslar, Tomaz
AU - Carlson, Claire
AU - Shaffer, Andrew
AU - John, Ranjit
AU - Kelly, Rose
AU - Raveendran, Ganesh
AU - Brunsvold, Melissa
AU - Chipman, Jeffrey
AU - Beilman, Gregory
AU - Yannopoulos, Demetris
N1 - Funding Information:
This work was supported by a grant from the Helmsley Charitable Trust and the Robert Eddy Endowment for Resuscitation Medicine to Dr. Demetris Yannopoulos.
Publisher Copyright:
© 2020 Hellenic Society of Cardiology
PY - 2021/1/1
Y1 - 2021/1/1
N2 - Objectives: To investigate the baseline risk of patients treated with Extracorporeal Cardiopulmonary Membrane Oxygenation (ECMO) in relation to cannulation strategy and indication for ECMO as well as the relation of cannulation strategy with survival and secondary hospitalization outcomes. Methods: Severity of illness and predicted mortality risk were assessed in 317 patients. Central cannulation was used in 52 patients unable to wean off cardiopulmonary bypass after cardiac surgery. Peripheral cannulation was used in 179 patients for extracorporeal cardiopulmonary resuscitation (eCPR) and in 86 patients who received ECMO for refractory cardiogenic shock (RCS). Results: Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were significantly worse (P < 0.01) for peripheral ECMO eCPR (23.2) vs central ECMO (14.6) and vs peripheral ECMO for RCS (18.9). Survival After Venoarterial ECMO (SAVE) scores were significantly worse for peripheral ECMO for eCPR (−7.85) and RCS (−10.38) vs central ECMO (−3.97), and P < 0.01. Peripherally cannulated patients had significantly worse renal function. No significant difference existed for survival to discharge (peripheral ECMO for eCPR, 31%; central ECMO, 44%; peripheral ECMO for refractory cardiac shock, 39.5%; and P = 0.176), although centrally cannulated patients had significantly longer treatment durations compared with peripheral ECMO for eCPR. Conclusions: Peripherally cannulated patients with eCPR had significantly worse APACHE II and SAVE scores compared to peripherally cannulated RCS or patients with central ECMO, despite having similar mortality.
AB - Objectives: To investigate the baseline risk of patients treated with Extracorporeal Cardiopulmonary Membrane Oxygenation (ECMO) in relation to cannulation strategy and indication for ECMO as well as the relation of cannulation strategy with survival and secondary hospitalization outcomes. Methods: Severity of illness and predicted mortality risk were assessed in 317 patients. Central cannulation was used in 52 patients unable to wean off cardiopulmonary bypass after cardiac surgery. Peripheral cannulation was used in 179 patients for extracorporeal cardiopulmonary resuscitation (eCPR) and in 86 patients who received ECMO for refractory cardiogenic shock (RCS). Results: Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were significantly worse (P < 0.01) for peripheral ECMO eCPR (23.2) vs central ECMO (14.6) and vs peripheral ECMO for RCS (18.9). Survival After Venoarterial ECMO (SAVE) scores were significantly worse for peripheral ECMO for eCPR (−7.85) and RCS (−10.38) vs central ECMO (−3.97), and P < 0.01. Peripherally cannulated patients had significantly worse renal function. No significant difference existed for survival to discharge (peripheral ECMO for eCPR, 31%; central ECMO, 44%; peripheral ECMO for refractory cardiac shock, 39.5%; and P = 0.176), although centrally cannulated patients had significantly longer treatment durations compared with peripheral ECMO for eCPR. Conclusions: Peripherally cannulated patients with eCPR had significantly worse APACHE II and SAVE scores compared to peripherally cannulated RCS or patients with central ECMO, despite having similar mortality.
KW - Cardiogenic
KW - Extracorporeal Life Support
KW - Mortality
KW - Resuscitation
KW - Shock
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U2 - 10.1016/j.hjc.2020.04.013
DO - 10.1016/j.hjc.2020.04.013
M3 - Article
C2 - 32387591
AN - SCOPUS:85103323175
SN - 1109-9666
VL - 62
SP - 38
EP - 45
JO - Hellenic Journal of Cardiology
JF - Hellenic Journal of Cardiology
IS - 1
ER -