Tim R Glowka1, Jens-Christian Schewe2, Stefan Muenster3, Christian Putensen4, Jörg C Kalff5, Dimitrios Pantelis6. 1. Department of Surgery, University of Bonn, Bonn, Germany. Electronic address: tim.glowka@ukbonn.de. 2. Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany. Electronic address: jens-christian.schewe@ukbonn.de. 3. Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany. Electronic address: stefan.muenster@ukbonn.de. 4. Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany. Electronic address: christian.putensen@ukbonn.de. 5. Department of Surgery, University of Bonn, Bonn, Germany. Electronic address: kalff@uni-bonn.de. 6. Department of Surgery, University of Bonn, Bonn, Germany. Electronic address: dimitrios.pantelis@ukbonn.de.
Abstract
PURPOSE: Extracorporeal membrane oxygenation (ECMO) is increasingly used with various indications. The clinical course can be complicated by an abdominal compartment syndrome (ACS). A decompressive laparotomy (DL) can be an option. MATERIALS AND METHODS: Between 2014 and 2016 175 patients underwent ECMO support. Indications, demographic data, comorbidities, morbidity, mortality and length of stay were analyzed. RESULTS: Indications for ECMO were acute respiratory distress syndrome (n = 65), postpericardiotomy syndrome (n = 37), myocardial infarction (n = 26), extracorporeal cardiopulmonary resuscitation (n = 11), and others (n = 36). ECMO support was performed as veno-venous (VV, n = 91) or veno-arterial (VA, n = 84). Eleven patients developed ACS (VV-ECMO: n = 4; VA-ECMO: n = 7) and underwent DL. Three patients survived to hospital discharge. Risk factors were age (57 vs. 60.5 years, P = 0.032), a Charlson comorbidity index >1 (CCI, P = 0.004), a Simplified Acute Physiology Score (SAPS II) ≥ 42 at admission to ICU (P = 0.013) and ≥44 at the beginning of ECMO support (P = 0.004). When an ACS/DL occurred, mortality did not differ (DL: n = 11; 73% vs. no DL: n = 164; 65%; P = 0.749). Multivarate analysis revealed CCI and SAPS as independent predictors for mortality. CONCLUSIONS: Approximately 10% of patients undergoing VA-ECMO support developed an ACS. If DL is undertaken, SAPS II scores can be used as predictive factor for mortality.
PURPOSE: Extracorporeal membrane oxygenation (ECMO) is increasingly used with various indications. The clinical course can be complicated by an abdominal compartment syndrome (ACS). A decompressive laparotomy (DL) can be an option. MATERIALS AND METHODS: Between 2014 and 2016 175 patients underwent ECMO support. Indications, demographic data, comorbidities, morbidity, mortality and length of stay were analyzed. RESULTS: Indications for ECMO were acute respiratory distress syndrome (n = 65), postpericardiotomy syndrome (n = 37), myocardial infarction (n = 26), extracorporeal cardiopulmonary resuscitation (n = 11), and others (n = 36). ECMO support was performed as veno-venous (VV, n = 91) or veno-arterial (VA, n = 84). Eleven patients developed ACS (VV-ECMO: n = 4; VA-ECMO: n = 7) and underwent DL. Three patients survived to hospital discharge. Risk factors were age (57 vs. 60.5 years, P = 0.032), a Charlson comorbidity index >1 (CCI, P = 0.004), a Simplified Acute Physiology Score (SAPS II) ≥ 42 at admission to ICU (P = 0.013) and ≥44 at the beginning of ECMO support (P = 0.004). When an ACS/DL occurred, mortality did not differ (DL: n = 11; 73% vs. no DL: n = 164; 65%; P = 0.749). Multivarate analysis revealed CCI and SAPS as independent predictors for mortality. CONCLUSIONS: Approximately 10% of patients undergoing VA-ECMO support developed an ACS. If DL is undertaken, SAPS II scores can be used as predictive factor for mortality.
Authors: Gennaro Martucci; Michele Amata; Fabrizio di Francesco; Mario Traina; Antonio Arcadipane; Roberto Lorusso; Antonino Granata Journal: Endosc Int Open Date: 2021-05-27
Authors: Mathias Schmandt; Tim R Glowka; Stefan Kreyer; Thomas Muders; Stefan Muenster; Nils Ulrich Theuerkauf; Jörg C Kalff; Christian Putensen; Jens-Christian Schewe; Stefan Felix Ehrentraut Journal: J Clin Med Date: 2021-03-02 Impact factor: 4.241