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Incidence and predictors of weaning failure from veno-arterial extracorporeal membrane oxygenation therapy in patients with cardiogenic shock
A. Dettling, C. Kellner, J. Sundermeyer, BN. Beer, L. Besch, LF. Bertoldi, S. Blankenberg, J. Dauw, D. Eckner, I. Eitel, T. Graf, P. Horn, J. Jozwiak-Nozdrzykowska, P. Kirchhof, S. Kluge, J. Krais, D. von Lewinski, A. Linke, P. Luedike, E....
Jazyk angličtina Země Anglie, Velká Británie
Typ dokumentu časopisecké články, multicentrická studie
PubMed
39823252
DOI
10.1002/ejhf.3583
Knihovny.cz E-zdroje
- MeSH
- incidence MeSH
- kardiogenní šok * terapie mortalita etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mimotělní membránová oxygenace * metody MeSH
- mortalita v nemocnicích trendy MeSH
- neúspěšná terapie MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
AIMS: This study aimed to investigate incidence and predictors of weaning failure and in-hospital death after successful weaning from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiogenic shock (CS). METHODS AND RESULTS: Overall, 685 patients with CS treated with VA-ECMO from 23 tertiary care centres in 7 countries were analysed (median age 57 [interquartile range 49-66] years, 542 [79.1%] male, median lactate 7.6 [interquartile range 4.1-12.7] mmol/L). The cause of CS was acute myocardial infarction in 438 (63.9%) patients, and 431 (62.9%) patients presented with cardiac arrest. A total of 410 patients (59.9%) were successfully weaned from VA-ECMO, whereas in 275 patients (40.1%) weaning failed (i.e. patients died on or within 48 h after VA-ECMO support). Of the successfully weaned patients, 150 (36.6%) died before hospital discharge. On multivariable logistic regression, predictors for both patient groups varied: age (per 10 years, odds ratio [OR] 1.49, 95% confidence interval [CI] 1.25-1.76; p < 0.001) and cardiac arrest before VA-ECMO implantation (OR 1.64, 95% CI 1.01-2.64; p = 0.04) were associated with weaning failure, whereas lactate clearance within 24 h after VA-ECMO initiation was associated with successful weaning (OR 0.21, 95% CI 0.1-0.44; p < 0.001). In-hospital death after successful weaning was more likely with higher age (per 10 years, OR 1.56, 95% CI 1.24-1.97; p < 0.001), renal replacement therapy (OR 2.56, 95% CI 1.4-4.68; p = 0.002) and bleeding events (OR 2.93, 95% CI 1.4-6.14; p = 0.004). CONCLUSION: Weaning from VA-ECMO fails in 40% of patients treated with VA-ECMO for CS. When successful, survival after VA-ECMO weaning mostly depends on age and the incidence of device- and shock-related complications.
Anesthesia and Intensive Care Fondazione Policlinico San Matteo Hospital IRCCS Pavia Italy
Cardio Center Humanitas Clinical and Research Center IRCCS Rozzano Italy
Cariovascular Center Aalst OLV Hospital Aalst Belgium
Department of Cardiology IKEM Prague Czech Republic
Department of Cardiology Paracelsus Medical University Nürnberg Nürnberg Germany
Department of Cardiology University Heart and Vascular Center Hamburg Hamburg Germany
Department of Cardiothoracic Surgery University Heart and Vascular Center Hamburg Hamburg Germany
Department of Clinical Surgical Diagnostic and Paediatric Sciences University of Pavia Italy
Department of Internal Medicine 1 University Hospital Jena Jena Germany
Department of Internal Medicine 1 University Hospital Würzburg Würzburg Germany
Department of Internal Medicine 2 University Medical Center Regensburg Regensburg Germany
Department of Medicine 1 University Hospital LMU Munich Munich Germany
Department of Perioperative Medicine St Bartholomew's Hospital London UK
Division of Cardiology Department of Internal Medicine Medical University of Graz Graz Austria
German Center for Cardiovascular Research Partner site Hamburg Kiel Lübeck Hamburg Germany
IRCCS Fondazione Don Gnocchi ONLUS Santa Maria Nascente Milan Italy
Medizinische Klinik 2 Kliniken Nordoberpfalz AG Weiden Germany
University Heart Center Lübeck University Hospital Schleswig Holstein Lübeck Germany
University Medical Center Hamburg Eppendorf Department of Intensive Care Medicine Hamburg Germany
Citace poskytuje Crossref.org
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