Beer, Benedikt N. and Kellner, Caroline and Gossling, Alina and Sundermeyer, Jonas and Besch, Lisa and Dettling, Angela and Kirchhof, Paulus and Blankenberg, Stefan and Bernhardt, Alexander M. and Brunner, Stefan and Colson, Pascal and Eckner, Dennis and Frank, Derk and Eitel, Ingo and Frey, Norbert and Eden, Matthias and Graf, Tobias and Kupka, Danny and Landmesser, Ulf and Majunke, Nicolas and Maniuc, Octavian and Moebius-Winkler, Sven and Morrow, David A. and Mourad, Marc and Noel, Curt and Nordbeck, Peter and Orban, Martin and Pappalardo, Federico and Patel, Sandeep M. and Pauschinger, Matthias and Reichenspurner, Hermann and Schulze, P. Christian and Schwinger, Robert H. G. and Wechsler, Antonia and Skurk, Carsten and Thiele, Holger and Varshney, Anubodh S. and Sag, Can Martin and Krais, Jannis and Westermann, Dirk and Schrage, Benedikt (2023) Complications in patients with cardiogenic shock on veno-arterial extracorporeal membrane oxygenation therapy: distribution and relevance. Results from an international, multicentre cohort study. OXFORD UNIV PRESS, OXFORD.
Full text not available from this repository. (Request a copy)Abstract
Aims Veno-arterial extracorporeal membrane oxygenation therapy (VA-ECMO) restores circulation and tissue oxygenation in cardiogenic shock (CS) patients, but can also lead to complications. This study aimed to quantify VA-ECMO complications and analyse their association with overall survival as well as favourable neurological outcome (cerebral performance categories 1 + 2).Methods and results All-comer patients with CS treated with VA-ECMO were retrospectively enrolled from 16 centres in four countries (2005-2019). Neurological, bleeding, and ischaemic adverse events (AEs) were considered. From these, typical VA-ECMO complications were identified and analysed separately as device-related complications. n = 501. Overall, 118 were women (24%), median age was 56.0 years, median lactate was 8.1 mmol/L. Acute myocardial infarction caused CS in 289 patients (58%). Thirty-days mortality was 40% (198/501 patients). At least one device-related complication occurred in 252/486 (52%) patients, neurological AEs in 108/469 (23%), bleeding in 192/480 (40%), ischaemic AEs in 123/478 (26%). The 22% of patients with the most AEs accounted for 50% of all AEs. All types of AEs were associated with a worse prognosis. Aside from neurological ones, all AEs and device-related complications were more likely to occur in women; although prediction of AEs outside of neurological AEs was generally poor.Conclusion Therapy and device-related complications occur in half of all patients treated with VA-ECMO and are associated with a worse prognosis. They accumulate in some patients, especially in women. Aside from neurological events, identification of patients at risk is difficult, highlighting the need to establish additional quantitative markers of complication risk to guide VA-ECMO treatment in CS. Graphical abstract
| Item Type: | Other |
|---|---|
| Uncontrolled Keywords: | ACUTE MYOCARDIAL-INFARCTION; SUPPORT; MANAGEMENT; OUTCOMES; LIFE; Cardiogenic shock; Mechanical circulatory support; Neurological outcome; Complications; Adverse events; VA-ECMO |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin II |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 07 May 2024 06:22 |
| Last Modified: | 07 May 2024 06:22 |
| URI: | https://pred.uni-regensburg.de/id/eprint/60877 |
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