Predictors of Survival to Discharge After Successful Weaning From Venoarterial Extracorporeal Membrane Oxygenation in Patients With Cardiogenic Shock
Open Access
- 25 November 2020
- journal article
- research article
- Published by Japanese Circulation Society in Circulation Journal
- Vol. 84 (12), 2205-2211
- https://doi.org/10.1253/circj.cj-20-0550
Abstract
Background:This study identified predictors of hospital mortality after successful weaning of patients with cardiogenic shock off venoarterial (VA) extracorporeal membrane oxygenation (ECMO) support. Methods and Results:Adult patients who received peripheral VA ECMO from January 2012 to April 2017 were reviewed retrospectively. After excluding patients who died on ECMO support, predictors for survival to discharge were investigated in patients who were successfully weaned off ECMO. Of 191 patients successfully weaned off ECMO, 143 (74.9%) survived to discharge. The prevalence of a history of stroke and coronary artery disease, as well as ECMO-related complications, including newly developed stroke and sepsis, was a higher in patients who did not survive to discharge than in those who did. On the day of ECMO weaning, Sequential Organ Failure Assessment score and serum lactate were higher in patients who did not survive to discharge, although there was no significant difference in blood pressure and the use of vasoactive drugs between the 2 groups. On multivariable analysis, stroke and sepsis during ECMO support, a lower Glasgow Coma Scale and acute kidney injury requiring continuous renal replacement therapy after weaning were significant predictors for in-hospital mortality. Conclusions:Complications that occurred during ECMO and the presence of extracardiac organ dysfunction after weaning were associated with in-hospital mortality in patients with cardiogenic shock who were successfully weaned off ECMO.Keywords
This publication has 25 references indexed in Scilit:
- Mechanical circulatory support in cardiogenic shockEuropean Heart Journal, 2013
- Factors associated with outcomes of patients on extracorporeal membrane oxygenation support: a 5-year cohort studyCritical Care, 2013
- Nosocomial Infections in Adult Cardiogenic Shock Patients Supported by Venoarterial Extracorporeal Membrane OxygenationClinical Infectious Diseases, 2012
- Extracorporeal Membrane Oxygenation in 108 Patients with Low Cardiac Output – a Single-Center ExperienceThe International Journal of Artificial Organs, 2011
- Infections occurring during extracorporeal membrane oxygenation use in adult patientsThe Journal of Thoracic and Cardiovascular Surgery, 2010
- Extracorporeal membrane oxygenation to support adult patients with cardiac failure: predictive factors of 30-day mortalityInteractive CardioVascular and Thoracic Surgery, 2010
- Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock*Critical Care Medicine, 2008
- Acute decompensated heart failure and the cardiorenal syndromeCritical Care Medicine, 2008
- Nosocomial infections during extracorporeal membrane oxygenationIntensive Care Medicine, 2001
- Clinical experience with 202 adults receiving extracorporeal membrane oxygenation for cardiac failure: Survival at five yearsThe Journal of Thoracic and Cardiovascular Surgery, 2001