Complications of veno-arterial extracorporeal membrane oxygenation for refractory cardiogenic shock or cardiac arrest

Abstract

Background:

The frequency of using veno-arterial extracorporeal membrane oxygenation increased, especially in patients with refractory cardiogenic shock or cardiac arrest. However, data of complications of veno-arterial extracorporeal membrane oxygenation are lacking. This study sought to investigate the incidence of veno-arterial extracorporeal membrane oxygenation complications for acute myocardial infarction patients with refractory cardiogenic shock or cardiac arrest and its relationship with patient survival.

Methods:

This study included 151 consecutive patients who underwent veno-arterial extracorporeal membrane oxygenation between 2006 and 2018 at a single referral center. We divided the patients into those who survived for 30 days after veno-arterial extracorporeal membrane oxygenation (n = 57, 38%; group 1) and those who died within 30 days after veno-arterial extracorporeal membrane oxygenation support (n = 94, 62%; group 2). The major adverse clinical events associated with veno-arterial extracorporeal membrane oxygenation were defined as first occurrence of infection, major bleeding, and stroke.

Results:

Adverse clinical events associated with veno-arterial extracorporeal membrane oxygenation occurred in 34 (59.6%) and 56 (59.6%) patients in groups 1 and 2, respectively. Group 2 had more patients who underwent new renal replacement therapy (21.1% vs 37.2%, p = 0.037). After multivariable analysis, cardiac arrest was independently associated with 30-day mortality (odds ratio = 3.6; 95% confidence interval = 1.7–7.63; p = 0.001). After excluding patients who died within 48 h after undergoing veno-arterial extracorporeal membrane oxygenation, new renal replacement therapy (odds ratio = 4.47; 95% confidence interval = 1.58–12.61; p = 0.005) and major adverse clinical events (odds ratio = 2.66; 95% confidence interval = 1.01–7.03; p = 0.049) were independently associated with 30-day mortality.

Conclusion:

Although veno-arterial extracorporeal membrane oxygenation can improve the survival, it is associated with morbidity. Therefore, risk–benefit analysis for veno-arterial extracorporeal membrane oxygenation and prevention of complications are important to improve prognosis.

Keywords

Cardiac arrest cardiogenic shock veno-arterial extracorporeal membrane oxygenation complications

Get full access to this article

View all access options for this article.

References

Werdan

Gielen

Ebelt

, et al. Mechanical circulatory support in cardiogenic shock. Eur Heart J. Jan 2014; 35(3): 156–167.

Brodie

Vincent

Brochard

, et al. Research in extracorporeal life support: a call to action. Chest 2018; 153(4): 788–791.

Ouweneel

Schotborgh

Limpens

, et al. Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis. Intensive Care Med 2016; 42(12): 1922–1934.

Neumann

Sousa-Uva

Ahlsson

, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J 2019; 40: 87–165.

Link

Berkow

Kudenchuk

, et al. Part 7: adult advanced cardiovascular life support: 2015 AHA guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015; 132(18 Suppl. 2): S444–S464.

Barge-Caballero

Almenar-Bonet

Gonzalez-Vilchez

, et al. Clinical outcomes of temporary mechanical circulatory support as a direct bridge to heart transplantation: a nationwide Spanish registry. Eur J Heart Fail 2018; 20(1): 178–186.

Thiele

Zeymer

Neumann

, et al. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012; 367(14): 1287–1296.

Lim

Howell

Ranasinghe

Extracorporeal life support: physiological concepts and clinical outcomes. J Card Fail 2017; 23(2): 181–196.

Leick

Liebetrau

Szardien

, et al. Door-to-implantation time of extracorporeal life support systems predicts mortality in patients with out-of-hospital cardiac arrest. Clin Res Cardiol 2013; 102(9): 661–669.

10.

Debaty

Babaz

Durand

, et al. Prognostic factors for extracorporeal cardiopulmonary resuscitation recipients following out-of-hospital refractory cardiac arrest. Resuscitation 2017; 112: 1–10.

11.

D’Arrigo

Cacciola

Dennis

, et al. Predictors of favourable outcome after in-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation: a systematic review and meta-analysis. Resuscitation 2017; 121: 62–70.

12.

McRae

dePerrot

Principles and indications of extracorporeal life support in general thoracic surgery. J Thorac Dis 2018; 10(Suppl. 8): S931–S946.

13.

Lorusso

Gelsomino

Parise

, et al. Neurologic injury in adults supported with veno-venous extracorporeal membrane oxygenation for respiratory failure. Crit Care Med 2017; 45(8): 1389–1397.

14.

Luyt

Brechot

Demondion

, et al. Brain injury during venovenous extracorporeal membrane oxygenation. Intensive Care Med 2016; 42(5): 897–907.

15.

Sklar

Lequier

, et al. Anticoagulation practices and the prevalence of major bleeding, thromboembolic events, and mortality in venoarterial extracorporeal membrane oxygenation. J Crit Care 2017; 39: 87–96.

16.

Pollak

Yacobobich

Tamary

, et al. Heparin-induced thrombocytopenia and extracorporeal membrane oxygenation. J Extra Corpor Technol 2011; 43(1): 5–12.

17.

Mazzeffi

Kiefer

Greenwood

, et al. Epidemiology of gastrointestinal bleeding in adult patients on extracorporeal life support. Intensive Care Med 2015; 41(11): 2015.

18.

Biffi

DiBella

Scaravilli

, et al. Infections during extracorporeal membrane oxygenation: epidemiology, risk factors, pathogenesis and prevention. Int J Antimicrob Agents 2017; 50(1): 9–16.

19.

Rungatscher

Merlini

DeRita

, et al. Diagnosis of infection in paediatric veno-arterial cardiac extracorporeal membrane oxygenation: role of procalcitonin and C-reactive protein. Eur J Cardiothorac Surg 2013; 43(5): 1043–1049.

20.

Villa

Katz

Ronco

Extracorporeal membrane oxygenation and the kidney. Cardiorenal Med 2015; 6(1): 50–60.

21.

Fleming

Askenazi

Bridges

, et al. A multicenter international survey of renal supportive therapy during ECMO: the kidney intervention during extracorporeal membrane oxygenation (KIDMO) group. ASAIO J 2012; 58(4): 407–414.

22.

Paden

Conrad

Rycus

, et al. Extracorporeal life support organization registry report 2012. ASAIO J 2013; 59(3): 202–210.

23.

Zangrillo

Landoni

Biondi-Zoccai

, et al. A meta-analysis of complications and mortality of extracorporeal membrane oxygenation. Crit Care Resusc 2013; 15(3): 172–178.

24.

Murphy

Hockings

Andrews

, et al. Extracorporeal membrane oxygenation-hemostatic complications. Transfus Med Rev 2015; 29(2): 90–101.

25.

Heilmann

Geisen

Beyersdorf

, et al. Acquired von Willebrand syndrome in patients with extracorporeal life support (ECLS). Intensive Care Med 2012; 38(1): 62–68.

26.

Mutlak

Reyher

Meybohm

, et al. Multiple electrode aggregometry for the assessment of acquired platelet dysfunctions during extracorporeal circulation. Thorac Cardiovasc Surg 2015; 63(1): 21–27.

27.

McILwain

Timpa

Kurundkar

, et al. Plasma concentrations of inflammatory cytokines rise rapidly during ECMO-related SIRS due to the release of preformed stores in the intestine. Lab Invest 2010; 90(1): 128–139.

28.

Gaer

Shaw

Wild

, et al. Effect of cardiopulmonary bypass on gastrointestinal perfusion and function. Ann Thorac Surg 1994; 57(2): 371–375.

29.

Bizzarro

Conrad

Kaufman

, et al. Infections acquired during extracorporeal membrane oxygenation in neonates, children, and adults. Pediatr Crit Care Med 2011; 12(3): 277–281.

30.

Vogel

Lew

Kao

, et al. Defining risk for infectious complications on extracorporeal life support. J Pediatr Surg 2011; 46(12): 2260–2264.

31.

Chen

Yin

, et al. Combination of extracorporeal membrane oxygenation and continuous renal replacement therapy in critically ill patients: a systematic review. Crit Care 2014; 18(6): 675.