Weaning-Related Shock in Patients With ECMO: Incidence, Mortality, and Predisposing Factors - Sorbonne Université Access content directly
Journal Articles Journal of Cardiothoracic and Vascular Anesthesia Year : 2021

Weaning-Related Shock in Patients With ECMO: Incidence, Mortality, and Predisposing Factors

Abstract

Objective: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) commonly is used to manage refractory cardiogenic shock after cardiac surgery, with 31% to 76% of patients successfully weaned off their ECMO. However, it is associated with high mortality rates, and 20% to 65% of weaned patients do not survive to hospital discharge. This study aimed to assess the incidence of ECMO weaning-related shock, the risk factors, and prognosis in the intensive care unit (ICU).Design: Retrospective observational cohort study.Setting: Surgical ICU of Cardiology Institute of Pitié-Salpêtrière University Hospital (Paris-France).Participants: Patients who were assisted with a peripheral VA-ECMO from January 2015 to December 2017 were included. Patients with venovenous, central, or right ECMO were excluded.Measurements: The authors collected data on patients' characteristics, during and after surgery. The indications for VA-ECMO implantation were ventricular dysfunction, primary graft dysfunction, and refractory cardiac arrest. Weaning-related shock was defined as the need to introduce or increase the dose of catecholamine at ECMO explantation or in the following week.Results: After weaning off VA-ECMO, 56 of 146 patients (38.4%) presented weaning-related shock: 55% were septic shocks, 12.5 % were caused by right ventricle failure, and 7.1% by hemorrhage. ICU mortality was 42% versus 8% in patients who did not present shock. Multivariate analysis showed that patients with pulmonary hypertension and those with norepinephrine before weaning were more likely to develop shock.Conclusion: ECMO weaning-related shock is frequent in patients with refractory cardiogenic shock after cardiac surgery. This is most commonly caused by sepsis and causes higher mortality rates, calling for further evaluation.
Fichier principal
Vignette du fichier
S1053077020307424.pdf (341.73 Ko) Télécharger le fichier
Origin Files produced by the author(s)

Dates and versions

hal-03101556 , version 1 (15-12-2022)

Licence

Identifiers

Cite

Joanna Tohme, Camille Piat, Nadia Aissat, Guillaume Lebreton, Baptiste Duceau, et al.. Weaning-Related Shock in Patients With ECMO: Incidence, Mortality, and Predisposing Factors. Journal of Cardiothoracic and Vascular Anesthesia, 2021, 35 (1), pp.41-47. ⟨10.1053/j.jvca.2020.07.069⟩. ⟨hal-03101556⟩
38 View
54 Download

Altmetric

Share

Gmail Mastodon Facebook X LinkedIn More