Extubation of patients undergoing extracorporeal life support. A retrospective study.

INTRODUCTION: The use of extracorporeal life support (ECLS) is increasing worldwide, in particular for the management of refractory cardiac arrest, cardiogenic shock and post cardiopulmonary bypass ventricular failure. Extubation of patients under extracorporeal membrane oxygenation (ECMO) for respiratory failure is a growing practice for adult and pediatric patients, especially for lung transplantation candidates. Because of potential complications and, specifically, accidental arterial decannulation, extubation of patients under ECLS is not standard practice. Our goal was to evaluate the interest in patient extubation under ECLS. MATERIALS AND METHODS: We performed a monocentric, retrospective study of all ECLS cases between January 2014 and January 2016. We excluded patients who died within the first 48 hours of ECLS. RESULTS: We analyzed 57 of the initial 109 patients included in the study. The initial SOFA score was higher in the non-extubated group under ECLS, without significant difference (8.6 ± 2.8 vs 7.2 ± 2.1, p=0.065). Patients who were not extubated had a higher rate of acquired ventilator pneumonia (61.9% vs 26.7%, p=0.03). Moreover, patients who were extubated under ECLS had better 30-day survival rates (73.3% vs 40.5%, p=0.04). In multivariate analyses, the independent factors associated with mortality were age, duration of ECLS and the lack of extubation under ECLS. CONCLUSION: Extubation of patients under ECLS is safe and feasible. Furthermore, in extubated patients, we observed fewer cases of ventilator-associated pneumonia and better 30-day survival rates.

Comparable Outcome of Out-of-Hospital Cardiac Arrest and In-Hospital Cardiac Arrest Treated With Extracorporeal Life Support.

Extracorporeal life support (ECLS) has shown benefits in the management of refractory in-hospital cardiac arrest (IHCA) by improving survival. Nonetheless, the results concerning out-of-hospital refractory cardiac arrests (OHCA) remain uncertain. The aim of our investigation was to compare survival between the two groups. We realized a single-center retrospective, observational study of all patients who presented IHCA or OHCA treated with ECLS between 2011 and 2015. Multivariate analysis was realized to determine independent factors associated with mortality. Over the 4-year period, 65 patients were included, 43 in the IHCA group (66.2%), and 22 (33.8%) in the OHCA group. The duration of low flow was significantly longer in the OHCA group (60 vs. 90 min, P = 0.004). Survival to discharge from the hospital was identical in the two groups (27% in the OHCA group vs. 23% in the IHCA group, P = 0.77). All surviving patients in the OHCA group had a cerebral performance categories score of 1-2. In multivariate analysis, we found that the initial lactate level and baseline blood creatinine were independently associated with mortality. We found comparable survival and neurological score in patients who presented IHCA and OHCA treated with ECLS. We believe that appropriate selection of patients and optimization of organ perfusion during resuscitation can lead to good results in patients with OHCA treated with ECLS.

Expiratory abdominal muscle thickness, a new point of care ultrasound measure for respiratory muscle mass in the intensive care unit: a prospective observational cohort study.

BACKGROUND: Even if expiratory muscles are key muscles in intensive care unit (ICU) patients, the association between their thickness and mortality has never been assessed. This study aimed to determine whether expiratory abdominal muscle thickness assessed by ultrasonography (US) was associated with 28-day mortality in ICU patients. BASIC PROCEDURES: US expiratory abdominal muscle thickness was measured within the first 12 h after ICU admission. The primary endpoint was 28-day mortality. MAIN FINDINGS: In 310 analyzed patients, a thinner total abdominal expiratory muscle thickness at admission was associated with 28-day mortality (median value with interquartile range: 10.8 [10; 14.6] versus 16.5 [13.4; 20.7] mm). Total abdominal expiratory muscle thickness had an area under the curve of 0.78 [0.71;0.86] to discriminate 28-day mortality. CONCLUSIONS: US expiratory abdominal muscle thickness was associated with 28-day mortality, supporting its use in predicting ICU patient outcome.