Fabio Rigamonti1, Fabrizio Montecucco2, Filippo Boroli3, Florian Rey4, Baris Gencer4, Mustafa Cikirikcioglu5, Stéphane Reverdin4, Federico Carbone6, Stephane Noble4, Marco Roffi4, Carlo Banfi5, Raphael Giraud3. 1. Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1205 Geneva, Switzerland. Electronic address: Fabio.rigamonti@hcuge.ch. 2. Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; IRCCS AOU San Martino-IST Genova, 10 Largo Rosanna Benzi, 16132 Genoa, Italy. 3. Intensive Care Unit, Departement of Anesthesiology and Intensive Care Specialities, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1205 Geneva, Switzerland. 4. Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1205 Geneva, Switzerland. 5. Division of Cardiovascular Surgery, Department of Surgery, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1205 Geneva, Switzerland. 6. Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy.
Abstract
BACKGROUND: Parameters allowing for outcome discrimination of extracorporeal membrane oxygenation (ECMO) therapy in acute coronary syndromes (ACS) complicated by refractory cardiogenic shock (CS) and/or cardio-respiratory arrest (CA) remain elusive. We aimed at evaluating the potential prognostic roles of blood and procedural parameters associated with 30-day mortality following ECMO. METHODS AND RESULTS: A group of 29 patients with ACS complicated by CS and/or CA, who underwent ECMO at a single center, was retrospectively analyzed. Eighteen patients (62%) died at 30-day follow up. "Survivors" and "non-survivors" had similar demographics, clinical and biochemical characteristics at admission, except for blood lactate peak in the first 24h that was increased in non-survivors. Procedural characteristics of percutaneous coronary intervention (PCI) and ECMO were comparable in either group. The peak of blood lactate concentration predicted 30-day mortality independently of age, sex and ECMO duration. The cutoff value, determined by receiver operating characteristic (ROC) curve analysis, was found at 11mmol/l. CONCLUSIONS: The peak of serum lactate under ECMO in the first 24h predicted 30-day mortality in patients with ACS complicated with CS and CA.
BACKGROUND: Parameters allowing for outcome discrimination of extracorporeal membrane oxygenation (ECMO) therapy in acute coronary syndromes (ACS) complicated by refractory cardiogenic shock (CS) and/or cardio-respiratory arrest (CA) remain elusive. We aimed at evaluating the potential prognostic roles of blood and procedural parameters associated with 30-day mortality following ECMO. METHODS AND RESULTS: A group of 29 patients with ACS complicated by CS and/or CA, who underwent ECMO at a single center, was retrospectively analyzed. Eighteen patients (62%) died at 30-day follow up. "Survivors" and "non-survivors" had similar demographics, clinical and biochemical characteristics at admission, except for blood lactate peak in the first 24h that was increased in non-survivors. Procedural characteristics of percutaneous coronary intervention (PCI) and ECMO were comparable in either group. The peak of blood lactate concentration predicted 30-day mortality independently of age, sex and ECMO duration. The cutoff value, determined by receiver operating characteristic (ROC) curve analysis, was found at 11mmol/l. CONCLUSIONS: The peak of serum lactate under ECMO in the first 24h predicted 30-day mortality in patients with ACS complicated with CS and CA.
Authors: Fernando Luís Scolari; Daniel Schneider; Débora Vacaro Fogazzi; Miguel Gus; Marciane Maria Rover; Marcely Gimenes Bonatto; Gustavo Neves de Araújo; André Zimerman; Daniel Sganzerla; Lívia Adams Goldraich; Cassiano Teixeira; Gilberto Friedman; Carisi Anne Polanczyk; Luis Eduardo Rohde; Regis Goulart Rosa; Rodrigo Vugman Wainstein Journal: BMC Cardiovasc Disord Date: 2020-11-24 Impact factor: 2.298
Authors: Serafina Valente; Massimo Massetti; Italo Porto; Alessio Mattesini; Domenico D'Amario; Carlotta Sorini Dini; Roberta Della Bona; Marco Scicchitano; Rocco Vergallo; Antonio Martellini; Simona Caporusso; Carlo Trani; Francesco Burzotta; Piergiorgio Bruno; Carlo Di Mario; Filippo Crea Journal: Intern Emerg Med Date: 2020-08-09 Impact factor: 3.397