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New-Onset Atrial Arrhythmias Are Independently Associated With In-Hospital Mortality in Veno-Venous Extracorporeal Membrane Oxygenation.
Li, Cecilia; Pajoumand, Mehrnaz; Lambert, Kerry; Najia, Laila; Bathula, Allison L; Mazzeffi, Michael A; Galvagno, Samuel M; Tabatabai, Ali; Grazioli, Alison; Dahi, Siamak; Hochberg, Eric S; Plazak, Michael E.
  • Li C; Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD.
  • Pajoumand M; Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD.
  • Lambert K; Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD.
  • Najia L; Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD.
  • Bathula AL; Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD.
  • Mazzeffi MA; Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD; Department of Anesthesiology and Critical Care Medicine, The George Washington University Hospital, Washington, DC.
  • Galvagno SM; Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD.
  • Tabatabai A; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
  • Grazioli A; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
  • Dahi S; Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
  • Hochberg ES; Department of Trauma Surgery, R. Adams Cowley Shock Trauma Center, Baltimore, MD.
  • Plazak ME; Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD. Electronic address: michael.plazak@umm.edu.
J Cardiothorac Vasc Anesth ; 36(6): 1648-1655, 2022 06.
Статья в английский | MEDLINE | ID: covidwho-1991701
ABSTRACT

OBJECTIVE:

To explore if atrial arrhythmias are associated with in-hospital mortality in veno-venous extracorporeal membrane oxygenation (VV-ECMO) patients.

DESIGN:

Retrospective observational cohort study.

SETTING:

Quaternary care academic medical center.

PARTICIPANTS:

Patients with respiratory failure requiring VV-ECMO for >24 hours between January 1, 2016, and January 1, 2019.

INTERVENTIONS:

None, observational study. MEASUREMENTS AND MAIN

RESULTS:

Two hundred nineteen VV-ECMO patients were included. Patients were stratified by absence or presence of clinically significant atrial arrhythmias during the VV-ECMO run. Atrial arrhythmias were defined as either atrial fibrillation or atrial flutter that occurred during VV-ECMO and required pharmacologic or electrical intervention. The primary outcome was in-hospital mortality. Secondary outcomes included a composite of thrombotic events, which included ischemic stroke and on-pump arterial thrombosis. Other objectives of this analysis included characterization of atrial arrhythmia incidence, risk factors, and management. A total of 67 patients (30.5%) experienced new-onset atrial arrhythmias post-ECMO cannulation. Age, male sex, and norepinephrine use were independently associated with atrial arrhythmia development. In-hospital mortality was significantly higher in the atrial arrhythmia group (38.8% v 19.1%; p = 0.003). In the multivariate logistic regression analysis, atrial arrhythmias during VV-ECMO were independently associated with increased odds of in-hospital mortality (odds ratio, 2.21; 95% confidence interval, 1.08-4.55; p = 0.03), after controlling for Respiratory Extracorporeal Membrane Oxygenation Survival Prediction score, acute renal failure, total norepinephrine dose, and total cannulation time.

CONCLUSIONS:

New-onset atrial arrhythmias are a frequent complication during VV-ECMO and are independently associated with excessive in-hospital mortality. Thus, their presence may serve as an important prognostic tool in this patient population.
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Полный текст: Имеется в наличии Коллекция: Международные базы данных база данных: MEDLINE Основная тема: Thrombosis / Extracorporeal Membrane Oxygenation Тип исследования: Когортное исследование / Наблюдательное исследование / Прогностическое исследование Пределы темы: Люди / Мужчины Язык: английский Журнал: J Cardiothorac Vasc Anesth Тематика журнала: Анестезиология / Кардиология Год: 2022 Тип: Статья Аффилированная страна: J.jvca.2021.12.012

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Полный текст: Имеется в наличии Коллекция: Международные базы данных база данных: MEDLINE Основная тема: Thrombosis / Extracorporeal Membrane Oxygenation Тип исследования: Когортное исследование / Наблюдательное исследование / Прогностическое исследование Пределы темы: Люди / Мужчины Язык: английский Журнал: J Cardiothorac Vasc Anesth Тематика журнала: Анестезиология / Кардиология Год: 2022 Тип: Статья Аффилированная страна: J.jvca.2021.12.012