Cause of In-Hospital Death After Weaning from Venoarterial-Extracorporeal Membrane Oxygenation
Purpose A survival gap between weaning from venoarterial-extracorporeal membrane oxygenation (VA-ECMO) and the hospital discharge has been consistently reported. The aim of this study is to investigate the clinical features of patients who underwent successful VA-ECMO decannulation at our institutio...
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| Veröffentlicht in: | Journal of intensive care medicine 2022-12, Vol.37 (12), p.1545-1552 |
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| creator | Bjelic, Milica Kumar, Neil Gu, Yang Chase, Karin Paic, Frane Gosev, Igor |
| description | Purpose
A survival gap between weaning from venoarterial-extracorporeal membrane oxygenation (VA-ECMO) and the hospital discharge has been consistently reported. The aim of this study is to investigate the clinical features of patients who underwent successful VA-ECMO decannulation at our institution and to identify the major contributors responsible for adverse outcomes.
Methods
We retrospectively reviewed all patients supported with VA-ECMO in our institution between January 2013 and June 2020. Only patients that survived VA-ECMO and underwent successful decannulation were included and dichotomized based on survival to hospital discharge: non-survivors versus survivors. The primary study outcome was the cause of death after successful VA-ECMO decannulation.
Results
Of the 262 adult patients who underwent VA-ECMO decannulation, 72 (27.5%) patients did not survive to hospital discharge. Non-survivors were older (62 vs. 54 years, p |
| doi_str_mv | 10.1177/08850666221086839 |
| format | Article |
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A survival gap between weaning from venoarterial-extracorporeal membrane oxygenation (VA-ECMO) and the hospital discharge has been consistently reported. The aim of this study is to investigate the clinical features of patients who underwent successful VA-ECMO decannulation at our institution and to identify the major contributors responsible for adverse outcomes.
Methods
We retrospectively reviewed all patients supported with VA-ECMO in our institution between January 2013 and June 2020. Only patients that survived VA-ECMO and underwent successful decannulation were included and dichotomized based on survival to hospital discharge: non-survivors versus survivors. The primary study outcome was the cause of death after successful VA-ECMO decannulation.
Results
Of the 262 adult patients who underwent VA-ECMO decannulation, 72 (27.5%) patients did not survive to hospital discharge. Non-survivors were older (62 vs. 54 years, p < 0.001) and suffering from many pre-existing comorbidities. Pneumonia and sepsis were the most frequent infectious complication and almost twice as likely in non-survivors. Major causes of death were: cardiovascular (31.9%), infections (25.0%) and neurological (20.8%). The survival curve demonstrated that 51.4% of our patients died within 8 days after decannulation. Multivariate analysis identified older age, central venous cannulation, pulmonary bleeding and infection, dialysis after VA-ECMO, sepsis, and ischemic stroke (OR = 7.86, 95% CI: 2.76-2.43, p < 0.001) as factors significantly predisposing to patients’ death.
Conclusion
In our study, one-third of patients decannulated off VA-ECMO did not survive to hospital discharge due to end-stage heart failure, infections or neurological injury. The first 8 post-decannulation days were recognized as a critical period where thorough strategies to prevent acquired infections and cautious support of end-organ function should be warranted. Future large-scale trials are needed to confirm our results.</description><identifier>ISSN: 0885-0666</identifier><identifier>EISSN: 1525-1489</identifier><identifier>DOI: 10.1177/08850666221086839</identifier><identifier>PMID: 35285729</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><ispartof>Journal of intensive care medicine, 2022-12, Vol.37 (12), p.1545-1552</ispartof><rights>The Author(s) 2022</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c340t-9f73be4ef4ae36e6b4795455b3d3e326b7c35d195627939e69c498f115739a193</citedby><cites>FETCH-LOGICAL-c340t-9f73be4ef4ae36e6b4795455b3d3e326b7c35d195627939e69c498f115739a193</cites><orcidid>0000-0001-6984-3653 ; 0000-0002-0198-0077 ; 0000-0003-0468-8511</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/08850666221086839$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/08850666221086839$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35285729$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bjelic, Milica</creatorcontrib><creatorcontrib>Kumar, Neil</creatorcontrib><creatorcontrib>Gu, Yang</creatorcontrib><creatorcontrib>Chase, Karin</creatorcontrib><creatorcontrib>Paic, Frane</creatorcontrib><creatorcontrib>Gosev, Igor</creatorcontrib><title>Cause of In-Hospital Death After Weaning from Venoarterial-Extracorporeal Membrane Oxygenation</title><title>Journal of intensive care medicine</title><addtitle>J Intensive Care Med</addtitle><description>Purpose
A survival gap between weaning from venoarterial-extracorporeal membrane oxygenation (VA-ECMO) and the hospital discharge has been consistently reported. The aim of this study is to investigate the clinical features of patients who underwent successful VA-ECMO decannulation at our institution and to identify the major contributors responsible for adverse outcomes.
Methods
We retrospectively reviewed all patients supported with VA-ECMO in our institution between January 2013 and June 2020. Only patients that survived VA-ECMO and underwent successful decannulation were included and dichotomized based on survival to hospital discharge: non-survivors versus survivors. The primary study outcome was the cause of death after successful VA-ECMO decannulation.
Results
Of the 262 adult patients who underwent VA-ECMO decannulation, 72 (27.5%) patients did not survive to hospital discharge. Non-survivors were older (62 vs. 54 years, p < 0.001) and suffering from many pre-existing comorbidities. Pneumonia and sepsis were the most frequent infectious complication and almost twice as likely in non-survivors. Major causes of death were: cardiovascular (31.9%), infections (25.0%) and neurological (20.8%). The survival curve demonstrated that 51.4% of our patients died within 8 days after decannulation. Multivariate analysis identified older age, central venous cannulation, pulmonary bleeding and infection, dialysis after VA-ECMO, sepsis, and ischemic stroke (OR = 7.86, 95% CI: 2.76-2.43, p < 0.001) as factors significantly predisposing to patients’ death.
Conclusion
In our study, one-third of patients decannulated off VA-ECMO did not survive to hospital discharge due to end-stage heart failure, infections or neurological injury. The first 8 post-decannulation days were recognized as a critical period where thorough strategies to prevent acquired infections and cautious support of end-organ function should be warranted. Future large-scale trials are needed to confirm our results.</description><issn>0885-0666</issn><issn>1525-1489</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9kEtPwzAQhC0EoqXwA7ggH7mk-J34WJVCkYp64XEjctJNSZXEwU6k9t_jqoULEqeVdr8Z7QxC15SMKY3jO5IkkiilGKMkUQnXJ2hIJZMRFYk-RcP9PdoDA3Th_YYQyhmn52jAJUtkzPQQfUxN7wHbAj810dz6tuxMhe_BdJ94UnTg8DuYpmzWuHC2xm_QWOPCujRVNNt2zuTWtdZBED1DnTnTAF5ud2toTFfa5hKdFabycHWcI_T6MHuZzqPF8vFpOllEOReki3QR8wwEFMIAV6AyEWsppMz4igNnKotzLldUS8VizTUonQudFJTKmGtDNR-h24Nv6-xXD75L69LnUFXhH9v7lCmeaCFC5IDSA5o7672DIm1dWRu3SylJ97Wmf2oNmpujfZ_VsPpV_PQYgPEB8GYN6cb2rglx_3H8BsoRfyU</recordid><startdate>20221201</startdate><enddate>20221201</enddate><creator>Bjelic, Milica</creator><creator>Kumar, Neil</creator><creator>Gu, Yang</creator><creator>Chase, Karin</creator><creator>Paic, Frane</creator><creator>Gosev, Igor</creator><general>SAGE Publications</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6984-3653</orcidid><orcidid>https://orcid.org/0000-0002-0198-0077</orcidid><orcidid>https://orcid.org/0000-0003-0468-8511</orcidid></search><sort><creationdate>20221201</creationdate><title>Cause of In-Hospital Death After Weaning from Venoarterial-Extracorporeal Membrane Oxygenation</title><author>Bjelic, Milica ; Kumar, Neil ; Gu, Yang ; Chase, Karin ; Paic, Frane ; Gosev, Igor</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c340t-9f73be4ef4ae36e6b4795455b3d3e326b7c35d195627939e69c498f115739a193</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bjelic, Milica</creatorcontrib><creatorcontrib>Kumar, Neil</creatorcontrib><creatorcontrib>Gu, Yang</creatorcontrib><creatorcontrib>Chase, Karin</creatorcontrib><creatorcontrib>Paic, Frane</creatorcontrib><creatorcontrib>Gosev, Igor</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of intensive care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bjelic, Milica</au><au>Kumar, Neil</au><au>Gu, Yang</au><au>Chase, Karin</au><au>Paic, Frane</au><au>Gosev, Igor</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cause of In-Hospital Death After Weaning from Venoarterial-Extracorporeal Membrane Oxygenation</atitle><jtitle>Journal of intensive care medicine</jtitle><addtitle>J Intensive Care Med</addtitle><date>2022-12-01</date><risdate>2022</risdate><volume>37</volume><issue>12</issue><spage>1545</spage><epage>1552</epage><pages>1545-1552</pages><issn>0885-0666</issn><eissn>1525-1489</eissn><abstract>Purpose
A survival gap between weaning from venoarterial-extracorporeal membrane oxygenation (VA-ECMO) and the hospital discharge has been consistently reported. The aim of this study is to investigate the clinical features of patients who underwent successful VA-ECMO decannulation at our institution and to identify the major contributors responsible for adverse outcomes.
Methods
We retrospectively reviewed all patients supported with VA-ECMO in our institution between January 2013 and June 2020. Only patients that survived VA-ECMO and underwent successful decannulation were included and dichotomized based on survival to hospital discharge: non-survivors versus survivors. The primary study outcome was the cause of death after successful VA-ECMO decannulation.
Results
Of the 262 adult patients who underwent VA-ECMO decannulation, 72 (27.5%) patients did not survive to hospital discharge. Non-survivors were older (62 vs. 54 years, p < 0.001) and suffering from many pre-existing comorbidities. Pneumonia and sepsis were the most frequent infectious complication and almost twice as likely in non-survivors. Major causes of death were: cardiovascular (31.9%), infections (25.0%) and neurological (20.8%). The survival curve demonstrated that 51.4% of our patients died within 8 days after decannulation. Multivariate analysis identified older age, central venous cannulation, pulmonary bleeding and infection, dialysis after VA-ECMO, sepsis, and ischemic stroke (OR = 7.86, 95% CI: 2.76-2.43, p < 0.001) as factors significantly predisposing to patients’ death.
Conclusion
In our study, one-third of patients decannulated off VA-ECMO did not survive to hospital discharge due to end-stage heart failure, infections or neurological injury. The first 8 post-decannulation days were recognized as a critical period where thorough strategies to prevent acquired infections and cautious support of end-organ function should be warranted. Future large-scale trials are needed to confirm our results.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>35285729</pmid><doi>10.1177/08850666221086839</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-6984-3653</orcidid><orcidid>https://orcid.org/0000-0002-0198-0077</orcidid><orcidid>https://orcid.org/0000-0003-0468-8511</orcidid></addata></record> |
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| title | Cause of In-Hospital Death After Weaning from Venoarterial-Extracorporeal Membrane Oxygenation |
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