RESUMEN
ABO blood group has been shown to be a major determinant of plasma von Willebrand factor (vWF) levels. O blood group is associated with the lowest vWF levels and confers an increased risk of hemorrhagic events, while AB blood group has the highest levels and is associated with thromboembolic events. We hypothesized in extracorporeal membrane oxygenation (ECMO) patients that O blood type would have the highest and AB blood type would have the lowest transfusions, with an inverse relationship to survival. A retrospective analysis of 307 VA-ECMO patients at a major quaternary referral hospital was performed. The distribution of blood groups included 124 group O (40%), 122 group A (40%), 44 group B (14%), and 17 group AB (6%) patients. Regarding usage of packed red blood cells, fresh frozen plasma, and platelets, there was a non-statistically significant difference in transfusions, with group O having the least and group AB having the most requirements. However, there was a statistically significant difference in cryoprecipitate usage when comparing to group O: group A (1.77, 95% CI: 1.05-2.97, P < .05), group B (2.05, 95% CI: 1.16-3.63, P < .05), and group AB (3.43, 95% CI: 1.71-6.90, P < .001). Furthermore, a 20% increase in length of days on ECMO was associated with a 2-12% increase in blood product usage. The cumulative 30-day mortality rate for groups O and A was 60%, group B was 50%, and group AB was 40%; the 1-year mortality rate for groups O and A was 65%, group B was 57%, and group AB was 41%; however, the mortality differences were not statistically significant.
Asunto(s)
Oxigenación por Membrana Extracorpórea , Factor de von Willebrand , Humanos , Sistema del Grupo Sanguíneo ABO , Oxigenación por Membrana Extracorpórea/efectos adversos , Estudios Retrospectivos , Hemorragia/etiología , Hemorragia/terapiaRESUMEN
BACKGROUND: Ischemic time (IT) under the new heart transplant (HTx) allocation system has increased compared to the old system. We investigated the effect of IT and donor age on post-HTx survival. METHODS: The United Network for Organ Sharing (UNOS) database was analyzed to identify adult HTx between October 2015 and August 2020. Recipients were stratified by donor age, transplantation era, and IT. Kaplan-Meier and log-rank tests were used to compare 180-day post-HTx mortality. Cox proportional hazards modeling and propensity score matching were performed to adjust for confounders. RESULTS: Under the new system (N = 3654), IT≥4 h led to decreased survival compared to IT < 4 h (91.4% vs. 93.7%; P = .02), although this decrease was undetectable among those with donors ≥39 years old (90.4% vs. 91.1%; P = .73). IT≥4 h led to decreased survival with donors < 39 years old (91.7% vs. 94.6%; P < .01). Under the old system (N = 5987), IT≥4 h resulted in decreased survival (89.8% vs. 93.9%; P < .01), including with donors ≥39 years old (86.9% vs. 92.4%; P < .01). CONCLUSIONS: IT≥4 h remains a risk for post-HTx mortality under the new system. However, the magnitude of this effect is blunted when donor age is ≥39 years, likely secondary to increased allocation of these organs to lower status, more stable recipients.
Asunto(s)
Trasplante de Corazón , Adulto , Bases de Datos Factuales , Supervivencia de Injerto , Humanos , Estudios Retrospectivos , Donantes de TejidosRESUMEN
Given the increased need for mechanical circulatory support and subsequent development of right ventricular assist devices (RVAD), appropriate imaging needs to be described to facilitate care in patients with cardiogenic shock and heart failure. We present three cases in which the upper esophageal aortic arch short axis (UE AA SAX) view on transesophageal echocardiography (TEE) was utilized to effectively image RVADs: to confirm normal positioning, to detect and guide repositioning, and to visualize malfunction. These cases support the importance of the UE AA SAX TEE view in RVAD outflow imaging and, when obtainable, should be included in routine RVAD assessment.
Asunto(s)
Insuficiencia Cardíaca , Corazón Auxiliar , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Ecocardiografía Transesofágica , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/cirugía , Humanos , Resultado del TratamientoRESUMEN
BACKGROUND: Acute decompensated heart failure in patients with coronavirus disease 2019 (COVID-19) is becoming increasingly common. AIMS: In this case report, we describe the successful use of an Impella 5.5 (Abiomed) to treat cardiogenic shock refractory to inotropic therapy. MATERIALS & METHODS: Transthoracic and transesophageal echocardiography confirmed severely diminished left ventricular ejection fraction and a reverse-transcription polymerase chain reaction test revealed that the patient was COVID-19 positive during his hospital admission. RESULTS: Following initiation of inotropic therapy, we placed an Impella 5.5 for further cardiac support. The patient's LVEF and cardiac index improved after 21 days on the Impella 5.5 and was maintained following explant. DISCUSSION & CONCLUSION: The findings reported here demonstrate successful use of an Impella 5.5 to improve native heart function in refractory cardiogenic shock and further indicate its use as an option for those in acute decompensated heart failure who have tested positive for COVID-19 infection.
Asunto(s)
COVID-19 , Corazón Auxiliar , Humanos , Estudios Retrospectivos , SARS-CoV-2 , Choque Cardiogénico/etiología , Choque Cardiogénico/terapia , Volumen Sistólico , Resultado del Tratamiento , Función Ventricular IzquierdaAsunto(s)
Choque Séptico , Vasoplejía , Humanos , Óxido Nítrico , Vasoplejía/tratamiento farmacológico , Azul de MetilenoRESUMEN
OBJECTIVES: At a quaternary care center that regularly performs and cares for patients undergoing extracorporeal membrane oxygenation (ECMO), a database of all adult patients since 2009 was assembled with echocardiographic parameters of left (LV) and right (RV) ventricular function. From the database, 175 venoarterial (VA) and 74 venovenous (VV) ECMO patients were analyzed to compare the decannulation echocardiographic assessments of biventricular function before, during, and after ECMO in survivors and nonsurvivors. DESIGN: Retrospective chart review-based study. SETTING: A single quaternary care center. PARTICIPANTS: All adult patients who received ECMO from 2009 to 2017 with both survival data and echographic studies were included in this retrospective study. INTERVENTIONS: When indicated, transthoracic and transesophageal echocardiograms were performed for ECMO patients. The results of these echocardiograms were reviewed retrospectively, and differences between survivors and nonsurvivors were examined. MEASUREMENTS AND MAIN RESULTS: A retrospective chart review of before, during cannulation, and after decannulation echocardiographic assessments of biventricular function was performed. On average, VA ECMO survivors had better post-decannulation LV function than did nonsurvivors by a full clinical grade-mild impairment versus moderate impairment (p < 0.001). RV function comparison was similar-mild impairment in survivors versus moderate impairment in nonsurvivors (pâ¯=â¯0.007). LV and RV function before and during ECMO in survivors was not different from that of nonsurvivors. The change in biventricular function from before to after cannulation and during cannulation to post-cannulation was approximately a full clinical grade better in survivors than nonsurvivors (p < 0.01 in all cases). In VV ECMO patients, post-decannulation RV function was significantly worse in nonsurvivors (moderate dysfunction vs borderline normal function) (pâ¯=â¯0.013). CONCLUSIONS: Retrospective chart review of 249 patients suggests that echocardiographic assessment of biventricular function before ECMO cannulation is not prognostic in VA or VV ECMO patients. Post-decannulation assessment of biventricular function may aid in triaging more "at risk" patients because nonsurvivors have significantly worse biventricular function after decannulation. The failure to improve biventricular function from the before to after ECMO phases and the during to after ECMO phases is concerning for a poor prognosis.
Asunto(s)
Ecocardiografía Transesofágica/métodos , Oxigenación por Membrana Extracorpórea/métodos , Atención Perioperativa/métodos , Función Ventricular Izquierda/fisiología , Función Ventricular Derecha/fisiología , Ecocardiografía Transesofágica/tendencias , Oxigenación por Membrana Extracorpórea/tendencias , Humanos , Atención Perioperativa/tendencias , Estudios RetrospectivosAsunto(s)
COVID-19/mortalidad , COVID-19/terapia , Oxigenación por Membrana Extracorpórea/métodos , Mortalidad Hospitalaria , Periodo Periparto , Mujeres Embarazadas , Análisis de Supervivencia , Adulto , COVID-19/epidemiología , Estudios de Cohortes , Femenino , Humanos , Embarazo , Sistema de Registros/estadística & datos numéricos , Estudios Retrospectivos , SARS-CoV-2 , Estados UnidosAsunto(s)
Oxigenación por Membrana Extracorpórea , Síndrome de Dificultad Respiratoria , Oxigenación por Membrana Extracorpórea/efectos adversos , Humanos , Hipoxia/diagnóstico por imagen , Hipoxia/etiología , Síndrome de Dificultad Respiratoria/diagnóstico por imagen , Síndrome de Dificultad Respiratoria/terapia , Estudios RetrospectivosAsunto(s)
Estenosis de la Válvula Aórtica , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Reemplazo de la Válvula Aórtica Transcatéter , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/cirugía , Prótesis Valvulares Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Humanos , Prótesis e Implantes , Diseño de Prótesis , Tecnología , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Resultado del TratamientoAsunto(s)
Reposicionamiento de Medicamentos/tendencias , Hidroxocobalamina/uso terapéutico , Vasoplejía/tratamiento farmacológico , Complejo Vitamínico B/uso terapéutico , Reposicionamiento de Medicamentos/métodos , Exantema/inducido químicamente , Humanos , Hidroxocobalamina/efectos adversos , Hipertensión/inducido químicamente , Resultado del Tratamiento , Vasoplejía/diagnóstico , Vasoplejía/metabolismo , Complejo Vitamínico B/efectos adversosRESUMEN
Regardless of the type, extracorporeal membrane oxygenation (ECMO) requires the use of large intravascular cannulas and results in multiple abnormalities including non-physiologic blood flow, hemodynamic perturbation, rapid changes in blood oxygen and carbon dioxide levels, coagulation abnormalities, and a significant systemic inflammatory response. Among other sequelae, neurologic complications are an important source of mortality and long-term morbidity. The frequency of neurologic complications varies and is likely underreported due to the high mortality rate. Neurologic complications in patients supported by ECMO include ischemic and hemorrhagic stroke, hypoxic brain injury, intracranial hemorrhage, and brain death. In addition to the disease process that necessitates ECMO, cannulation strategies and physiologic disturbances influence neurologic outcomes in this high-risk population. For example, the overall documented rate of neurologic complications in the venovenous ECMO population is lower, but a higher rate of intracranial hemorrhage exists. Meanwhile, in the venoarterial ECMO population, ischemia and global hypoperfusion seem to compose a higher percentage of neurologic complications. In what follows, the literature is reviewed to discuss the pathophysiology, incidence, risk factors, and outcomes related to short-term neurologic complications in patients supported by ECMO.