Robert Winzer1, Dieter Fedders2, Moritz Backes2, Till Ittermann3, Matthias Gründling4, Birger Mensel5, Hanns-Christoph Held6, Marie-Luise Kromrey7, Jürgen Weitz6, Ralf-Thorsten Hoffmann2, Robin Bülow7, Jens-Peter Kühn2. 1. Institute and Policlinic for Diagnostic and Interventional Radiology, University Hospital, Carl Gustav Carus University, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany. robert.winzer@uniklinikum-dresden.de. 2. Institute and Policlinic for Diagnostic and Interventional Radiology, University Hospital, Carl Gustav Carus University, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany. 3. Institute for Community Medicine, University Medicine Greifswald, Domstraße 11, 17489, Greifswald, Germany. 4. Department of Anesthesia and Intensive Care, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany. 5. Zentrum für Diagnostische/Interventionelle Radiologie Und Neuroradiologie, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99438, Bad Berka, Germany. 6. Visceral, Thoracic and Vascular Surgery, Carl Gustav Carus University, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany. 7. Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
Abstract
PURPOSE: To investigate the outcome of local intra-arterial papaverine infusion therapy in patients with non-occlusive mesenteric ischemia (NOMI), and factors influencing survival, in comparison with a conservative approach. METHODS: From 2013 to 2019, patients with NOMI confirmed by imaging were included in a retrospective two-center study. According to different in-house standard procedures, patients were treated in each center either conservatively or interventionally by a standardized local infusion of intra-arterial papaverine into the splanchnic arteries. Thirty-day mortality and factors influencing the outcome, such as different demographics and laboratories, were compared between groups using Kaplan-Meier survival analysis and Cox regression, respectively. RESULTS: A total of 66 patients with NOMI were included, with n = 35 treated interventionally (21 males, mean age 67.7 ± 12.3 years) and n = 31 treated conservatively (18 females, mean age 71.6 ± 9.6 years). There was a significant difference in 30-day mortality between the interventional (65.7%; 12/35 survived) and the conservative group (96.8%; 1/31 survived) (hazard ratio 2.44; P = 0.005). Thresholds associated with a worse outcome of interventional therapy are > 7.68 mmol/l for lactate, < 7.31 for pH and < - 4.55 for base excess. CONCLUSION: Local intra-arterial papaverine infusion therapy in patients with NOMI significantly increases survival rate in comparison with conservative treatment. High lactate levels, low pH and high base excess, and high demand for catecholamines are associated with a poor outcome. LEVEL OF EVIDENCE: Level III.
PURPOSE: To investigate the outcome of local intra-arterial papaverine infusion therapy in patients with non-occlusive mesenteric ischemia (NOMI), and factors influencing survival, in comparison with a conservative approach. METHODS: From 2013 to 2019, patients with NOMI confirmed by imaging were included in a retrospective two-center study. According to different in-house standard procedures, patients were treated in each center either conservatively or interventionally by a standardized local infusion of intra-arterial papaverine into the splanchnic arteries. Thirty-day mortality and factors influencing the outcome, such as different demographics and laboratories, were compared between groups using Kaplan-Meier survival analysis and Cox regression, respectively. RESULTS: A total of 66 patients with NOMI were included, with n = 35 treated interventionally (21 males, mean age 67.7 ± 12.3 years) and n = 31 treated conservatively (18 females, mean age 71.6 ± 9.6 years). There was a significant difference in 30-day mortality between the interventional (65.7%; 12/35 survived) and the conservative group (96.8%; 1/31 survived) (hazard ratio 2.44; P = 0.005). Thresholds associated with a worse outcome of interventional therapy are > 7.68 mmol/l for lactate, < 7.31 for pH and < - 4.55 for base excess. CONCLUSION: Local intra-arterial papaverine infusion therapy in patients with NOMI significantly increases survival rate in comparison with conservative treatment. High lactate levels, low pH and high base excess, and high demand for catecholamines are associated with a poor outcome. LEVEL OF EVIDENCE: Level III.
Authors: Nina Rittgerodt; Thorben Pape; Sascha David; Klaus Stahl; Markus Busch; Lena S Becker; Andrea Schneider; Heiner Wedemeyer; Benjamin Seeliger; Julius Schmidt; Anna Maria Hunkemöller; Jan Fuge; Wolfgang Knitsch; Christine Fegbeutel; Hans-Jörg Gillmann; Bernhard C Meyer; Marius M Hoeper; Jan B Hinrichs Journal: Crit Care Date: 2022-04-04 Impact factor: 9.097