Gislaine Rodrigues Nakasato1, Beatriz Murata Murakami2, Maria Aparecida Batistão Gonçalves3, Juliana de Lima Lopes4, Camila Takao Lopes5. 1. Escola Paulista de Enfermagem da Universidade Federal de São Paulo, Rua Napoleão de Barros 754, CEP 04024-002, Vila Clementino, São Paulo-SP, Brazil. Electronic address: gnakasato@hcor.com.br. 2. Instituto Israelita de Ensino e Pesquisa do Hospital Israelita Albert Einstein, Brazil. Electronic address: beatriz.murakami@einstein.br. 3. Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Dr. Enéas Carvalho de Aguiar Avenue, 44, CEP 05403-900, Cerqueira César, São Paulo - SP, Brazil. Electronic address: maria.goncalves@incor.usp.br. 4. Escola Paulista de Enfermagem da Universidade Federal de São Paulo, Rua Napoleão de Barros 754, CEP 04024-002, Vila Clementino, São Paulo-SP, Brazil. Electronic address: juliana.lima@unifesp.br. 5. Escola Paulista de Enfermagem da Universidade Federal de São Paulo, Rua Napoleão de Barros 754, CEP 04024-002, Vila Clementino, São Paulo-SP, Brazil. Electronic address: ctlopes@unifesp.br.
Abstract
INTRODUCTION: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a complex technology associated with risks and complications. OBJECTIVE: To identify predictors of complications related to VA-ECMO in adults. METHODS: A retrospective cohort study, including 63 adult patients undergoing VA-ECMO, performed at two institutions in Brazil, from the time both centers implemented VA-ECMO (1999 in Institution A and 2012 in Institution B) treatment through March of 2018. The association between independent variables (institution, demographic, indications for ECMO, and pre-ECMO clinical characteristics) and the outcomes (neurological, renal, vascular, hemorrhagic, infectious, and mechanical complications) was investigated by means of multiple logistic regressions. RESULTS: Predictors of neurological complications were refractory cardiogenic shock following cardiotomy (OR = 0.10; 95% CI 0.00-1.01; p = 0.049) and following heart or lung transplant (OR = 0.04; 95% CI 0.00-0.42; p = 0.018). The use of inotropes/vasopressors was a predictor of vascular complications (OR = 7.72; 95% CI 1.83-39.87; p = 0.008). The levels of CK-MB were a predictor of renal complications (OR = 0.87; 95% CI 0.72-0.97; p = 0.046). Predictors of infectious complications were total bilirubin (OR = 0.02; 95% CI 0.00-0.26; p = 0.038) and body weight odds (OR = 1.24; 95% CI 1.08-1.61; p = 0.028). Class III heart failure was a predictor of mechanical complications (OR = 0.07; 95% CI 0.00-0.66; p = 0.034). CONCLUSION: Identifying predictors of complications may contribute to the indications for VA-ECMO.
INTRODUCTION: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a complex technology associated with risks and complications. OBJECTIVE: To identify predictors of complications related to VA-ECMO in adults. METHODS: A retrospective cohort study, including 63 adult patients undergoing VA-ECMO, performed at two institutions in Brazil, from the time both centers implemented VA-ECMO (1999 in Institution A and 2012 in Institution B) treatment through March of 2018. The association between independent variables (institution, demographic, indications for ECMO, and pre-ECMO clinical characteristics) and the outcomes (neurological, renal, vascular, hemorrhagic, infectious, and mechanical complications) was investigated by means of multiple logistic regressions. RESULTS: Predictors of neurological complications were refractory cardiogenic shock following cardiotomy (OR = 0.10; 95% CI 0.00-1.01; p = 0.049) and following heart or lung transplant (OR = 0.04; 95% CI 0.00-0.42; p = 0.018). The use of inotropes/vasopressors was a predictor of vascular complications (OR = 7.72; 95% CI 1.83-39.87; p = 0.008). The levels of CK-MB were a predictor of renal complications (OR = 0.87; 95% CI 0.72-0.97; p = 0.046). Predictors of infectious complications were total bilirubin (OR = 0.02; 95% CI 0.00-0.26; p = 0.038) and body weight odds (OR = 1.24; 95% CI 1.08-1.61; p = 0.028). Class III heart failure was a predictor of mechanical complications (OR = 0.07; 95% CI 0.00-0.66; p = 0.034). CONCLUSION: Identifying predictors of complications may contribute to the indications for VA-ECMO.
Authors: Anne Willers; Justyna Swol; Hergen Buscher; Zoe McQuilten; Sander M J van Kuijk; Hugo Ten Cate; Peter T Rycus; Stephen McKellar; Roberto Lorusso; Joseph E Tonna Journal: Crit Care Med Date: 2022-02-03 Impact factor: 9.296