Which Factors Influence on Mortality in Patients Undergoing Veno-Venous Extracorporeal Membrane Oxygenation (ECMO)?
-
Alireza jahangirifard
,
Mandana Hosseinzadeh
,
Sepideh Nazari
,
Amir Bahrami Ahmadi
,
Farhad Gorjipour
,
Seyed Bashir Mirtajani
,
Zargham Hossein Ahmadi
Abstract
Background: There are inconclusive data of Ven venous extracorporeal membrane oxygenation (VV‐ECMO) VV‐ECMO for a therapeutic strategy for acute respiratory distress syndrome (ARDS).
Methods: Totally 28 critically ill patients were included into the study between 23 September 2013 and 20 january 2020. Critically ill adult patients who were refractory to conventional therapeutic modalities were eligible for veno-venous ECMO and study inclusion.
Results: Of a total of 28 patients, 15 patients (53.6%) survived and 13 (46.42%) died. Gender frequency had no significant difference between survivors and non-survivors (P=0.07). Mean of age and BMI had no significant differences between the mentioned groups also (P>0.05). It was the same for BSA and the two groups were in the same situation (1.82±0.37 vs. 1.79±0.29; P=0.81). There were no significant differences between survivors and non-survivors regarding ECMO time (114.49±91.05 vs. 162.62±100.17 minutes; P=0.20) and ICU stays (9.65±5.11 vs. 8.93±4.96; P=0.10). The average time of ICU stay was 9.29±5.16 days. The ejection fraction in survives was significantly higher than non-survivors (52.14±6.42 vs. 57.31±4.39; P=0.02). Those patients who were in the non-survivors group had lower blood pressure (MAP<65mmHg) during the study (P=0.049), however, did not find any significant differences between the groups regarding inotropes or vasoconstrictors.
Conclusion: In this study, the mortality rate was 46.42%. Bleeding, hypotension and dialysis were the risk factors for mortality among study participants.
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[2] Ferguson ND, Fan E, Camporota L, Antonelli M, Anzueto A, Beale R, et al. The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med. 2012; 38(10):1573-82.
[3] Richard C, Argaud L, Blet A, Boulain T, Contentin L, Dechartres A, et al. Extracorporeal life support for patients with acute respiratory distress syndrome: report of a Consensus Conference. Ann Intensive Care. 2014; 4:15.
[4] Schmidt M, Pellegrino V, Combes A, Scheinkestel C, Cooper DJ, Hodgson C. Mechanical ventilation during extracorporeal membrane oxygenation. Crit Care. 2014; 18(1):203.
[5] Vaquer S, de Haro C, Peruga P, Oliva JC, Artigas A. Systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome. Annals of Intensive Care. 2017; 7(1):51.
[6] Mosier JM, Kelsey M, Raz Y, Gunnerson KJ, Meyer R, Hypes CD, et al. Extracorporeal membrane oxygenation (ECMO) for critically ill adults in the emergency department: history, current applications, and future directions. Crit Care. 2015;19(1):1-8.
[7] Schmidt M, Bréchot N, Combes A. Ten situations in which ECMO is unlikely to be successful. Intensive Care Med. 2016; 42(5):750-752.
[8] Schmidt M, Pham T, Arcadipane A, Agerstrand C, Ohshimo S, Pellegrino V, et al. Mechanical ventilation management during extracorporeal membrane oxygenation for acute respiratory distress syndrome. An international multicenter prospective cohort. Am J Respir Crit Care Med. 2019; 200(8):1002-12.
[9] Pappalardo F, Pieri M, Greco T, Patroniti N, Pesenti A, Arcadipane A, et al. Predicting mortality risk in patients undergoing venovenous ECMO for ARDS due to influenza A (H1N1) pneumonia: the ECMOnet score. Intensive Care Med. 2013; 39(2):275-81.
[10] Brodie D, Bacchetta M. Extracorporeal membrane oxygenation for ARDS in adults. N Engl J Med. 2011;365(20):1905-14.
[11] Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374(9698):1351-63.
[12] Javidfar J, Brodie D, Iribarne A, Jurado J, Lavelle M, Brenner K, et al. Extracorporeal membrane oxygenation as a bridge to lung transplantation and recovery. J Thorac Cardiovasc Surg. 2012; 144(3):716-21.
[13] Toyoda Y, Bhama JK, Shigemura N, Zaldonis D, Pilewski J, Crespo M, et al. Efficacy of extracorporeal membrane oxygenation as a bridge to lung transplantation. J Thorac Cardiovasc Surg. 2013; 145(4):1065-71.
[14] Biscotti M, Gannon WD, Agerstrand C, Abrams D, Sonett J, Brodie D, et al. Awake extracorporeal membrane oxygenation as bridge to lung transplantation: a 9-year experience. Ann Thorac Surg. 2017; 104(2):412-9.
[15] Fuehner T, Kuehn C, Hadem J, Wiesner O, Gottlieb J, Tudorache I, et al. Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med. 2012;185(7):763-8.
[16] Hoetzenecker K, Donahoe L, Yeung JC, Azad S, Fan E, Ferguson ND, et al. Extracorporeal life support as a bridge to lung transplantation–experience of a high-volume transplant center. J Thorac Cardiovasc Surg. 2018; 155(3):1316-28. e1.
[17] Ahmadi ZH, Jahangirifard A, Farzanegan B, Tabarsi P, Abtahian Z, Abedini A, Sharifi M, Jadbabaei AN, Mafhumi Y, Moslem A, Sistani M. Extracorporeal membrane oxygenation and COVID‐19: the causes of failure. Journal of Cardiac Surgery. 2020; 35(10):2838-43.
[18] Schwarz B, Mair P, Margreiter J, Pomaroli A, Hoermann C, Bonatti J, et al. Experience with percutaneous venoarterial cardiopulmonary bypass for emergency circulatory support. Crit Care Med. 2003;31(3):758-64.
[19] Australia, New Zealand Extracorporeal Membrane Oxygenation Influenza I, Davies A, Jones D, Bailey M, Beca J, et al. Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress Syndrome. JAMA. 2009; 302(17):1888-95.
[20] Schmidt M, Stewart C, Bailey M, Nieszkowska A, Kelly J, Murphy L, et al. Mechanical ventilation management during extracorporeal membrane oxygenation for acute respiratory distress syndrome: a retrospective international multicenter study. Crit Care Med. 2015;43(3):654-64.
[21] Tulman DB, Stawicki SP, Whitson BA, Gupta SC, Tripathi RS, Firstenberg MS, et al. Veno-venous ECMO: a synopsis of nine key potential challenges, considerations, and controversies. BMC Anesthesiol. 2014; 14:65.
[22] Jahangirifard A, Salajegheh S, Arab S, Mirtajani SB, Radmand G, Farzanegan B. Thiamine can decrease lactate and creatinine level after coronary artery Bypass surgery in patients with mild systolic dysfunction. Journal of Cellular & Molecular Anesthesia. 2019; 3(4):136-42.
[23] Aubron C, Cheng AC, Pilcher D, Leong T, Magrin G, Cooper DJ, et al. Factors associated with outcomes of patients on extracorporeal membrane oxygenation support: a 5-year cohort study. Crit Care. 2013;17(2):R73.
[24] Del Sorbo L, Cypel M, Fan E. Extracorporeal life support for adults with severe acute respiratory failure. Lancet Respir Med. 2014;2(2):154-64.
[25] Vieira J, Frakes M, Cohen J, Wilcox S. Extracorporeal Membrane Oxygenation in Transport Part 2: Complications and Troubleshooting. Air Med J. 2020; 39(2):124-132.
[26] Karakala N, Juncos LA. Providing Continuous Ren,.al Replacement Therapy in Patients on Extracorporeal Membrane Oxygenation. Clin J Am Soc Nephrol. 2020; 15(5):704-6.
[27] Enger T, Philipp A, Videm V, Lubnow M, Wahba A, Fischer M, et al. Prediction of mortality in adult patients with severe acute lung failure receiving veno-venous extracorporeal membrane oxygenation: a prospective observational study. Crit Care. 2014; 18(2):R67.
[2] Ferguson ND, Fan E, Camporota L, Antonelli M, Anzueto A, Beale R, et al. The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med. 2012; 38(10):1573-82.
[3] Richard C, Argaud L, Blet A, Boulain T, Contentin L, Dechartres A, et al. Extracorporeal life support for patients with acute respiratory distress syndrome: report of a Consensus Conference. Ann Intensive Care. 2014; 4:15.
[4] Schmidt M, Pellegrino V, Combes A, Scheinkestel C, Cooper DJ, Hodgson C. Mechanical ventilation during extracorporeal membrane oxygenation. Crit Care. 2014; 18(1):203.
[5] Vaquer S, de Haro C, Peruga P, Oliva JC, Artigas A. Systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome. Annals of Intensive Care. 2017; 7(1):51.
[6] Mosier JM, Kelsey M, Raz Y, Gunnerson KJ, Meyer R, Hypes CD, et al. Extracorporeal membrane oxygenation (ECMO) for critically ill adults in the emergency department: history, current applications, and future directions. Crit Care. 2015;19(1):1-8.
[7] Schmidt M, Bréchot N, Combes A. Ten situations in which ECMO is unlikely to be successful. Intensive Care Med. 2016; 42(5):750-752.
[8] Schmidt M, Pham T, Arcadipane A, Agerstrand C, Ohshimo S, Pellegrino V, et al. Mechanical ventilation management during extracorporeal membrane oxygenation for acute respiratory distress syndrome. An international multicenter prospective cohort. Am J Respir Crit Care Med. 2019; 200(8):1002-12.
[9] Pappalardo F, Pieri M, Greco T, Patroniti N, Pesenti A, Arcadipane A, et al. Predicting mortality risk in patients undergoing venovenous ECMO for ARDS due to influenza A (H1N1) pneumonia: the ECMOnet score. Intensive Care Med. 2013; 39(2):275-81.
[10] Brodie D, Bacchetta M. Extracorporeal membrane oxygenation for ARDS in adults. N Engl J Med. 2011;365(20):1905-14.
[11] Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374(9698):1351-63.
[12] Javidfar J, Brodie D, Iribarne A, Jurado J, Lavelle M, Brenner K, et al. Extracorporeal membrane oxygenation as a bridge to lung transplantation and recovery. J Thorac Cardiovasc Surg. 2012; 144(3):716-21.
[13] Toyoda Y, Bhama JK, Shigemura N, Zaldonis D, Pilewski J, Crespo M, et al. Efficacy of extracorporeal membrane oxygenation as a bridge to lung transplantation. J Thorac Cardiovasc Surg. 2013; 145(4):1065-71.
[14] Biscotti M, Gannon WD, Agerstrand C, Abrams D, Sonett J, Brodie D, et al. Awake extracorporeal membrane oxygenation as bridge to lung transplantation: a 9-year experience. Ann Thorac Surg. 2017; 104(2):412-9.
[15] Fuehner T, Kuehn C, Hadem J, Wiesner O, Gottlieb J, Tudorache I, et al. Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med. 2012;185(7):763-8.
[16] Hoetzenecker K, Donahoe L, Yeung JC, Azad S, Fan E, Ferguson ND, et al. Extracorporeal life support as a bridge to lung transplantation–experience of a high-volume transplant center. J Thorac Cardiovasc Surg. 2018; 155(3):1316-28. e1.
[17] Ahmadi ZH, Jahangirifard A, Farzanegan B, Tabarsi P, Abtahian Z, Abedini A, Sharifi M, Jadbabaei AN, Mafhumi Y, Moslem A, Sistani M. Extracorporeal membrane oxygenation and COVID‐19: the causes of failure. Journal of Cardiac Surgery. 2020; 35(10):2838-43.
[18] Schwarz B, Mair P, Margreiter J, Pomaroli A, Hoermann C, Bonatti J, et al. Experience with percutaneous venoarterial cardiopulmonary bypass for emergency circulatory support. Crit Care Med. 2003;31(3):758-64.
[19] Australia, New Zealand Extracorporeal Membrane Oxygenation Influenza I, Davies A, Jones D, Bailey M, Beca J, et al. Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress Syndrome. JAMA. 2009; 302(17):1888-95.
[20] Schmidt M, Stewart C, Bailey M, Nieszkowska A, Kelly J, Murphy L, et al. Mechanical ventilation management during extracorporeal membrane oxygenation for acute respiratory distress syndrome: a retrospective international multicenter study. Crit Care Med. 2015;43(3):654-64.
[21] Tulman DB, Stawicki SP, Whitson BA, Gupta SC, Tripathi RS, Firstenberg MS, et al. Veno-venous ECMO: a synopsis of nine key potential challenges, considerations, and controversies. BMC Anesthesiol. 2014; 14:65.
[22] Jahangirifard A, Salajegheh S, Arab S, Mirtajani SB, Radmand G, Farzanegan B. Thiamine can decrease lactate and creatinine level after coronary artery Bypass surgery in patients with mild systolic dysfunction. Journal of Cellular & Molecular Anesthesia. 2019; 3(4):136-42.
[23] Aubron C, Cheng AC, Pilcher D, Leong T, Magrin G, Cooper DJ, et al. Factors associated with outcomes of patients on extracorporeal membrane oxygenation support: a 5-year cohort study. Crit Care. 2013;17(2):R73.
[24] Del Sorbo L, Cypel M, Fan E. Extracorporeal life support for adults with severe acute respiratory failure. Lancet Respir Med. 2014;2(2):154-64.
[25] Vieira J, Frakes M, Cohen J, Wilcox S. Extracorporeal Membrane Oxygenation in Transport Part 2: Complications and Troubleshooting. Air Med J. 2020; 39(2):124-132.
[26] Karakala N, Juncos LA. Providing Continuous Ren,.al Replacement Therapy in Patients on Extracorporeal Membrane Oxygenation. Clin J Am Soc Nephrol. 2020; 15(5):704-6.
[27] Enger T, Philipp A, Videm V, Lubnow M, Wahba A, Fischer M, et al. Prediction of mortality in adult patients with severe acute lung failure receiving veno-venous extracorporeal membrane oxygenation: a prospective observational study. Crit Care. 2014; 18(2):R67.
| Files | ||
| Issue | Vol 8 No 2 (2022): Spring |
|
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v8i2.9151 | |
| Keywords | ||
| veno-venous ECMO acute respiratory distress syndrome (ARDS mortality | ||
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How to Cite
1.
jahangirifard A, Hosseinzadeh M, Nazari S, Bahrami Ahmadi A, Gorjipour F, Mirtajani SB, Hossein Ahmadi Z. Which Factors Influence on Mortality in Patients Undergoing Veno-Venous Extracorporeal Membrane Oxygenation (ECMO)?. Arch Anesth & Crit Care. 2022;8(2):118-122.
