Mudit Kaushal1, Joseph Schwartz2, Nitish Gupta3, Jay Im3, Jonathan Leff4, William A Jakobleff5, Galina Leyvi4. 1. Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Weill Cornell Medical Center, New York, NY. Electronic address: Muk9011@NYP.org. 2. Division of Adult Cardiothoracic Anesthesiology, Department of Anesthesiology, Montefiore Medical Center, Bronx, NY. 3. Department of Anesthesiology, Montefiore Medical Center, Bronx, NY. 4. Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Montefiore Medical Center, Bronx, NY. 5. Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Montefiore Medical Center, Bronx, NY.
Abstract
OBJECTIVE: Investigate how a multitude of patient demographics and extracorporeal membranous oxygenation (ECMO)-related complications affect 30-day survival or survival to discharge. DESIGN: Retrospective observational study. SETTING: Urban university hospital, quaternary care center. PARTICIPANTS: Patients who underwent ECMO circulatory support from January 2012 to May 2016. INTERVENTIONS: Date-based data extraction, univariate and multivariate regression analysis. MEASUREMENTS AND MAIN RESULTS: The hospital database contained complete data for 235 adult patients who received venoarterial ECMO (74.04 %) and venovenous ECMO (25.96 %); 106 patients (45.11%) survived. The independent predictors significant in the odds of in-hospital mortality in a multiregression model were age (odds ratio [OR] = 1.028, p = 0.008), extracorporeal cardiopulmonary resuscitation (ECPR) after unsuccessful high-quality CPR (OR = 7.93, p =0.002), cardiogenic shock as the primary indication for circulatory support (OR = 2.58, p = 0.02), acute kidney injury (AKI) before ECMO initiation (OR = 7.53, p < 0.001), time spent on ECMO in days (OR = 1.08, p = 0.03), and limb ischemia (OR = 3.18, p = 0.047). CONCLUSION: The most significant findings of advancing age, time spent on ECMO, AKI, ECMO use in the setting of cardiogenic shock, ECPR, and limb ischemia as a complication of ECMO all independently increase the odds of in-hospital and 30-day mortality. To the best of the authors' knowledge, this study is the first to demonstrate a significant relationship between limb ischemia and mortality.
OBJECTIVE: Investigate how a multitude of patient demographics and extracorporeal membranous oxygenation (ECMO)-related complications affect 30-day survival or survival to discharge. DESIGN: Retrospective observational study. SETTING: Urban university hospital, quaternary care center. PARTICIPANTS: Patients who underwent ECMO circulatory support from January 2012 to May 2016. INTERVENTIONS: Date-based data extraction, univariate and multivariate regression analysis. MEASUREMENTS AND MAIN RESULTS: The hospital database contained complete data for 235 adult patients who received venoarterial ECMO (74.04 %) and venovenous ECMO (25.96 %); 106 patients (45.11%) survived. The independent predictors significant in the odds of in-hospital mortality in a multiregression model were age (odds ratio [OR] = 1.028, p = 0.008), extracorporeal cardiopulmonary resuscitation (ECPR) after unsuccessful high-quality CPR (OR = 7.93, p =0.002), cardiogenic shock as the primary indication for circulatory support (OR = 2.58, p = 0.02), acute kidney injury (AKI) before ECMO initiation (OR = 7.53, p < 0.001), time spent on ECMO in days (OR = 1.08, p = 0.03), and limb ischemia (OR = 3.18, p = 0.047). CONCLUSION: The most significant findings of advancing age, time spent on ECMO, AKI, ECMO use in the setting of cardiogenic shock, ECPR, and limb ischemia as a complication of ECMO all independently increase the odds of in-hospital and 30-day mortality. To the best of the authors' knowledge, this study is the first to demonstrate a significant relationship between limb ischemia and mortality.
Authors: Rahul S Loungani; Marat Fudim; Dave Ranney; Ajar Kochar; Marc D Samsky; Desiree Bonadonna; Akinobu Itoh; Hiroo Takayama; Koji Takeda; Daniel Wojdyla; Adam D DeVore; Mani Daneshmand Journal: J Card Fail Date: 2021-01-13 Impact factor: 5.712
Authors: Sebastian D Sahli; Alexander Kaserer; Donat R Spahn; Markus J Wilhelm; Julia Braun; Maximilian Halbe; Yuliya Dahlem; Muriel A Spahn; Julian Rössler; Bernard Krüger; Francesco Maisano Journal: J Thorac Dis Date: 2022-06 Impact factor: 3.005