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Crit Care ; 23(1): 320, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533785


BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) can be a rescue therapy for patients in cardiogenic shock or in refractory cardiac arrest. After cannulation, vasoplegia and cardiac depression are frequent. In literature, there are conflicting data on inotropic therapy in these patients. METHODS: Analysis of a retrospective registry of all patients treated with VA-ECMO in a university hospital center between October 2010 and December 2018 for cardiogenic shock or extracorporeal cardiopulmonary resuscitation (eCPR) with a focus on individual early inotropic therapy. RESULTS: A total of 231 patients (age 58.6 ± 14.3, 29.9% female, 58% eCPR, in-house survival 43.7%) were analyzed. Of these, 41.6% received no inotrope therapy within the first 24 h (survival 47.9%), 29.0% received an inodilator (survival 52.2%), and 29.0% received epinephrine (survival 25.0%). Survival of patients with epinephrine was significantly worse compared to other patient groups when evaluating 30-day survival (p = 0.034/p = 0.005) and cumulative incidence of in-hospital death (p = 0.001). In a multivariate logistic regression analysis, treatment with epinephrine was associated with mortality in the whole cohort (OR 0.38, p = 0.011) as well as after propensity score matching (OR 0.24, p = 0.037). We found no significant differences between patients with inodilator treatment and those without. CONCLUSION: Early epinephrine therapy within the first 24 h after cannulation for VA-ECMO was associated with poor survival compared to patients with or without any inodilator therapy. Until randomized data are available, epinephrine should be avoided in patients on VA-ECMO.

J Crit Care ; 37: 130-135, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27718412


PURPOSE: For circulatory support, venoarterial extracorporeal membrane oxygenation (VA-ECMO) is dependent on sufficient venous drainage ensured by fluid therapy. Volume overload however is linked to poor prognosis. This study therefore evaluates volume therapy in VA-ECMO. MATERIAL AND METHODS: We report data of a single center registry of all patients after VA-ECMO implantation treated between 2010 and 2015. RESULTS: A total of 195 patients were included in this registry with a medium age of 58.2 ± 1.1 years, 71.8% were male. A positive fluid balance was detected in 94.7% at day 1 (day 2: 93.7%, day 3: 92.6%). Consistently, survivors had a lower fluid balance when compared to non-survivors (P < .001). Three hours post-implantation, patients above the 75th percentile had a hazard ratio of 6.03 when compared to average survival (P < .05). AUC at that time point was 0.726 as calculated by ROC. Patients below the 50th percentile (fluid balance below 8500 mL after 24 hours) had the best prognosis after VA-ECMO implantation (P < .001). CONCLUSIONS: Higher fluid balance was consistently linked to poor survival. We found no evidence to support a liberal fluid therapy in VA-ECMO patients, especially not the early after implantation. With a retrospective study, one cannot clarify if lower fluid balance might improve outcomes or represents a prognostic marker.

Oxigenação por Membrana Extracorpórea , Hidratação , Insuficiência Cardíaca/terapia , Ressuscitação , Cuidados Críticos , Feminino , Alemanha , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Sistema de Registros , Estudos Retrospectivos , Equilíbrio Hidroeletrolítico
PLoS One ; 11(7): e0159973, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27467697


AIMS: Bleeding is a frequent complication in patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO). An indication for dual antiplatelet therapy due to coronary stent implantation is present in a considerable number of these patients. The objective of this retrospective study was to evaluate if dual antiplatelet therapy (DAPT) significantly increases the high intrinsic bleeding risk in patients on VA-ECMO. METHODS AND RESULTS: A total of 93 patients were treated with VA-ECMO between October 2010 and October 2013. Average time on VA-ECMO was 58.9 ± 1.7 hours. Dual antiplatelet therapy was given to 51.6% of all patients. Any bleeding was recorded in 60.2% of all patients. There was no difference in bleeding incidence in patients on DAPT when compared to those without any antiplatelet therapy including any bleeding (66.7% vs. 57.1%, p = 0.35), BARC3 bleeding (43.8% vs. 33.3%, p = 0.31) or pulmonary bleeding (16.7% vs. 19.0%, p = 0.77). This holds true after adjustment for confounders. Rate of transfusion of red blood cells were similar in patients with or without DAPT (35.4% vs. 28.6%, p = 0.488). CONCLUSIONS: Bleeding on VA-ECMO is frequent. This registry recorded no statistical difference in bleeding in patients on dual antiplatelet therapy when compared to no antiplatelet therapy. When indicated, DAPT should not be withheld from VA ECMO patients.

Oxigenação por Membrana Extracorpórea/efeitos adversos , Hemorragia/etiologia , Inibidores da Agregação de Plaquetas/administração & dosagem , Idoso , Transfusão de Componentes Sanguíneos , Estudos de Casos e Controles , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade