Current aspects of extracorporeal membrane oxygenation in a tertiary referral centre: determinants of survival at follow-up
Rattachement africain : fr, ch. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
OBJECTIVES: To describe the clinical results (both early and at follow-up) of patients currently receiving extracorporeal membrane oxygenation (ECMO) therapy for cardiac and/or pulmonary failure. To assess the effect of indications, clinical presentations and ECMO modalities on early/late clinical outcomes. To identify baseline factors associated with worse survival at follow-up. METHODS: We reviewed the prospectively collected data of 325 patients receiving ECMO therapy at a tertiary referral centre during the 2005-2013 period. Follow-up was prospectively conducted by dedicated personnel (average: 84 ± 86 days, 100% complete). Survival was analysed by stratified Kaplan-Meier curves. RESULTS: Veno-arterial (VA) ECMO was employed in 80% of cases (due to early graft failure (EGF) in 13% of cases, post-cardiotomy in 29%, primary cardiogenic shock in 42% for miscellaneous aetiologies, other indications in 15.4%) and veno-venous (VV) ECMO in the remainders (adult respiratory distress syndrome). In the VA and VV groups, weaning rates were 59 and 53%, survival at 30th postimplantation day was 44 and 45% and survival at the end of the follow-up was 41 and 45%, respectively. Implantation under advanced life support (ALS) occurred in 15% of cases (26% survival at 30 days). VA patients had a higher rate of thrombotic/haemorrhagic complications and of transfusion of blood products and shorter ventilation time. Worse early and follow-up survival were observed among patients aged ≥65 years, having pH ≤ 7, lactates >12 mmol/l, creatinine >200 μmol/l at implantation or receiving ECMO under ALS. No difference in survival was noted among VA vs VV patients. Patients receiving ECMO for EGF displayed better early and late survival (64% at 30 days and 53% at 6 months) than post-cardiotomy (36 and 34%, respectively), post-acute myocardial infarction (48 and 40%) and the remaining patients (46 and 45%). CONCLUSIONS: Despite most critical baseline conditions, ECMO therapy is confirmed useful for the treatment of patients with acute cardiopulmonary failure refractory to conventional treatments. The ECMO modality (VA vs VV), as well as indications to support, identifies different patient profiles and dissimilar outcomes. Preimplantation markers of gravity and end-organ damage are useful in the stratification of expected survival. These may facilitate clinical decision-making and appropriate allocation of hospital resources.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Current aspects of extracorporeal membrane oxygenation in a tertiary referral centre: determinants of survival at follow-up
- Date Crossref
- 26/02/2014
- Éditeur
- Oxford University Press (OUP)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Centre Hospitalier Universitaire de Rennes pays non établi dans la noticeÉtablissement de santé
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Laboratoire Traitement du Signal et de l'Image pays non établi dans la noticeStructure de recherche
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Federal Office of Meteorology and Climatology MeteoSwiss pays non établi dans la noticeOrganisme public
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Université Rennes 2 pays non établi dans la noticeUniversité ou école supérieure
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Université de Rennes pays non établi dans la noticeUniversité ou école supérieure
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Foie pays non établi dans la noticeStructure de recherche
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Rennes University Hospital Department of Vascular and Cardio-Thoracic Surgery pays non établi dans la noticeUniversité ou école supérieure
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Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes] pays non établi dans la noticeInstitution
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Service de cardiologie et maladies vasculaires [Rennes] = Cardiac pays non établi dans la noticeInstitution
Centre Hospitalier Universitaire de Rennes, Laboratoire Traitement du Signal et de l'Image et Federal Office of Meteorology and Climatology MeteoSwiss, avec 6 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.