Impact of ECMO-Related Complications on In-Hospital Mortality: A Single-Center Retrospective Study

March 26, 2024 No Comments

This study examines the association between complications arising from Extracorporeal Membrane Oxygenation (ECMO) treatment and in-hospital mortality among adult patients. It involves a retrospective analysis of 856 ECMO interventions, revealing that vascular and cerebrovascular complications occurred in 20.2% and 13.6% of cases, respectively. The overall in-hospital mortality rate was 48.7%. Surprisingly, the analysis found no significant correlation between ECMO-related complications and an increased risk of in-hospital death, suggesting that while ECMO complications are prevalent, they do not independently contribute to patient mortality.

Intra-Aortic Balloon Pump in VA-ECMO Patients: Insights from the Chinese Extracorporeal Life Support Registry

March 26, 2024 No Comments

This study from the Chinese Extracorporeal Life Support (CSECLS) registry explored the effectiveness of using an intra-aortic balloon pump (IABP) alongside venoarterial extracorporeal membrane oxygenation (VA-ECMO) in patients undergoing treatment for refractory cardiogenic shock or cardiac arrest. Covering data from over 112 member centers, the study analyzed outcomes of 4,755 patients, comparing those who received VA-ECMO with IABP to those who did not. Findings indicated no significant difference in in-hospital mortality rates between the two groups, though IABP use was associated with higher incidences of continuous renal replacement therapy (CRRT) and limb ischemia. These results suggest that while IABP use does not reduce mortality in VA-ECMO patients, it may lead to increased complications, calling for further research and careful clinical decision-making.

Mortality in Patients with Normal LV Function Requiring Emergency VA-ECMO for Postcardiotomy Cardiogenic Shock

March 22, 2024 No Comments

This retrospective study examines outcomes in patients with normal preoperative left ventricular ejection fraction (LVEF) who required venoarterial extracorporeal membrane oxygenation (VA-ECMO) for postcardiotomy cardiogenic shock (PCCS) related to coronary malperfusion. Among 62,125 cardiac surgeries, 59 patients with normal LVEF needed VA-ECMO due to coronary malperfusion-related PCCS, showing a 30-day mortality rate of 50.8%. Complications were common, and factors like lactate levels >9.9 mmol/l before VA-ECMO, delay in revascularization, and peripheral arterial disease were significant mortality predictors. Early VA-ECMO initiation and revascularization are crucial for survival.

Scrutinizing Mechanical Circulatory Support in Cardiogenic Shock: Have We Jumped the Gun?

March 20, 2024 No Comments

This article examines the efficacy of mechanical circulatory support (MCS) systems, like veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and Impella devices, in treating cardiogenic shock (CS). Despite their increasing use and endorsement in ESC and AHA/ACC guidelines based on observational studies, the article highlights a critical gap: the lack of clear mortality benefit from randomized controlled trials. This gap calls for a reassessment of the current evidence supporting MCS in CS, suggesting that enthusiasm for these technologies might have outpaced their proven clinical value. The article advocates for a careful reflection on the existing evidence to better understand the role of MCS in CS management.

Temporary Extracorporeal Life Support: Single-Center Experience with a New Concept

March 17, 2024 No Comments

This study explores the efficacy of a novel ECMELLA setup combining veno-arterial extracorporeal membrane oxygenation (va-ECMO) with a micro-axial flow pump in treating cardiogenic shock (CS). Analyzing data from 67 patients treated between December 2020 and December 2022, the study found the technique feasible and effective, with a 27% myocardial recovery rate and a 24% transition rate to durable LVADs. Despite a 49% mortality rate on support, the single-artery cannulation approach showed relatively low access-related complications. This single-center experience suggests ECMELLA 2.0/2.1 as a promising therapy for severe CS with a focus on reducing complications related to access sites.

Rates, Outcomes, and Resource Burden of Extracorporeal Membrane Oxygenation Use in Hospitalizations in the United States During the Pandemic

March 16, 2024 No Comments

This study characterizes the burden and outcomes of ECMO use in U.S. hospitalizations during the pandemic, analyzing 17,520 cases from the National Inpatient Sample between 2019 and 2020. It highlights a significant increase in ECMO utilization, with a marked impact on inpatient mortality, length of hospital stay, and healthcare costs. Predominantly affecting patients with circulatory and respiratory diseases, ECMO hospitalizations showed a higher mortality rate (43.1%) compared to non-ECMO cases (2.1%), with an average hospital stay of 26 days and an average cost of US$967,647 per case. Factors like Hispanic descent, higher CCI score, age over 60, and a higher APRDRG risk were associated with increased mortality.

Identifying and Mitigating Risk of Post-Cardiotomy Cardiogenic Shock in Patients with Ischemic and Non-Ischemic Cardiomyopathy

March 14, 2024 No Comments

This study aimed to identify preoperative predictors of post-cardiotomy cardiogenic shock in patients with ischemic and non-ischemic cardiomyopathy, focusing on 238 patients undergoing cardiac surgery. It found that pulmonary artery pulsatility index and pulmonary capillary wedge pressure were key predictors, with the predictors varying between ischemic and non-ischemic conditions. The study highlights the importance of preoperative right heart catheterization in identifying patients at higher risk of cardiogenic shock. Ejection fraction improvements were noted at 12 months post-surgery.

Risk Factors for Neurological Disability Outcomes in Patients Under ECMO Following Cardiac Arrest: An Observational Study

March 12, 2024 No Comments

This observational study focused on identifying factors influencing neurological outcomes and disability in patients receiving extracorporeal membrane oxygenation (ECMO) after cardiac arrest, either in-hospital (IHCA) or out-of-hospital (OHCA). Analyzing data from 48 patients treated between February 2016 and March 2020, the study found that timely intervention—specifically shorter intervals from collapse to CPR and ECMO initiation—was crucial for better neurological outcomes and reduced disability. The findings underscore the importance of rapid response in cardiac arrest situations to improve patient recovery prospects.

Protocol for Venoarterial Extracorporeal Membrane Oxygenation to Reduce Morbidity and Mortality Following Bilateral Lung Transplantation: The ECMOToP Randomised Controlled Trial

March 10, 2024 No Comments

The ECMOToP trial aims to evaluate the effectiveness of two VA-ECMO initiation strategies in patients undergoing bilateral lung transplantation for obstructive or restrictive lung diseases. This multicentre randomised controlled trial contrasts an ‘on-demand’ approach, where VA-ECMO is initiated based on specific hemodynamic and respiratory needs, with a ‘systematic’ strategy of preemptive initiation. The primary endpoint is the number of ventilator-free days at day 28, with secondary endpoints including organ failure occurrence, vital status at day 28, day 90, and year 1, along with adverse events. This research endeavors to establish a more effective protocol for VA-ECMO initiation, potentially improving survival and quality of life for lung transplant recipients.

Using Extracorporeal Membrane Oxygenation in Donations After Cardiac Death or Brain Death: A Single-Center Experience and Long-Term Outcome

March 10, 2024 No Comments

This study explores the impact of using extracorporeal membrane oxygenation (ECMO) in liver transplants from donors after cardiac death (DCD) or brain death (DBD). Conducted as a retrospective study from January 2006 to December 2019 at a single center, it included 90 deceased donor liver transplants. The findings indicate no significant survival rate differences between the DBD and DCD groups with ECMO support. However, the DCD with ECMO group showed significant differences in warm and cold ischemia times and bilirubin levels compared to the DBD group. The study underscores ECMO’s role in enhancing the liver graft pool, contributing to 35.6% of liver transplants, with 5-year survival rates being 78.1% for DBD, 90.9% for DBD with ECMO, and 75.6% for DCD with ECMO groups.

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Impact of ECMO-Related Complications on In-Hospital Mortality: A Single-Center Retrospective Study

Intra-Aortic Balloon Pump in VA-ECMO Patients: Insights from the Chinese Extracorporeal Life Support Registry

Mortality in Patients with Normal LV Function Requiring Emergency VA-ECMO for Postcardiotomy Cardiogenic Shock

Scrutinizing Mechanical Circulatory Support in Cardiogenic Shock: Have We Jumped the Gun?

Temporary Extracorporeal Life Support: Single-Center Experience with a New Concept

Rates, Outcomes, and Resource Burden of Extracorporeal Membrane Oxygenation Use in Hospitalizations in the United States During the Pandemic

Identifying and Mitigating Risk of Post-Cardiotomy Cardiogenic Shock in Patients with Ischemic and Non-Ischemic Cardiomyopathy

Risk Factors for Neurological Disability Outcomes in Patients Under ECMO Following Cardiac Arrest: An Observational Study

Protocol for Venoarterial Extracorporeal Membrane Oxygenation to Reduce Morbidity and Mortality Following Bilateral Lung Transplantation: The ECMOToP Randomised Controlled Trial

Using Extracorporeal Membrane Oxygenation in Donations After Cardiac Death or Brain Death: A Single-Center Experience and Long-Term Outcome

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