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Early predictors of mortality in refractory cardiogenic shock following acute coronary syndrome treated with extracorporeal membrane oxygenator.
Torre, Tiziano; Toto, Francesca; Klersy, Catherine; Theologou, Thomas; Casso, Gabriele; Gallo, Michele; Surace, Giuseppina Gabriella; Franciosi, Giorgio; Demertzis, Stefanos; Ferrari, Enrico.
Afiliación
  • Torre T; Cardiac Surgery Department, Cardiocentro Ticino, Via Tesserete, 48, 6900, Lugano, Switzerland. tiziano.torre@cardiocentro.org.
  • Toto F; Cardiac Surgery Department, Cardiocentro Ticino, Via Tesserete, 48, 6900, Lugano, Switzerland.
  • Klersy C; Service of Clinical Epidemiology and Biometry, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy.
  • Theologou T; Cardiac Surgery Department, Cardiocentro Ticino, Via Tesserete, 48, 6900, Lugano, Switzerland.
  • Casso G; Anesthesiology Department, Cardiocentro Ticino, Lugano, Switzerland.
  • Gallo M; Cardiac Surgery Department, Cardiocentro Ticino, Via Tesserete, 48, 6900, Lugano, Switzerland.
  • Surace GG; Cardiac Surgery Department, Cardiocentro Ticino, Via Tesserete, 48, 6900, Lugano, Switzerland.
  • Franciosi G; Cardiac Surgery Department, Cardiocentro Ticino, Via Tesserete, 48, 6900, Lugano, Switzerland.
  • Demertzis S; Cardiac Surgery Department, Cardiocentro Ticino, Via Tesserete, 48, 6900, Lugano, Switzerland.
  • Ferrari E; Cardiac Surgery Department, Cardiocentro Ticino, Via Tesserete, 48, 6900, Lugano, Switzerland.
J Artif Organs ; 24(3): 327-335, 2021 Sep.
Article en En | MEDLINE | ID: mdl-33677800
We aimed to analyze the outcome and identify predictors of hospital mortality in patients with refractory cardiac arrest (CA) complicating acute coronary syndromes (ACS) and requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO) treatment. Between Jan-2005 and Dec-2019, 51 patients underwent urgent VA-ECMO implantation for CA in ACS. Patients were divided in two groups: "in-hospital" cardiac arrest (IHCA) and "out-of-hospital" cardiac arrest (OHCA). Prospectively collected data were retrospectively analyzed and compared between groups. Predictors for hospital mortality were investigated. IHCA and OHCA patients were 32 (62.7%) and 19 (37.3%), respectively. The groups differed for: male gender (72% vs 95%; p = 0.070), lactate peak level (8.5 ± 4.3vs10.7 ± 2.9; p = 0.023), total elapsed time from CA to VA-ECMO implantation in both groups (p < 0.001) and elapsed time from CA (IHCA group) or hospital arrival (OHCA group) to VA-ECMO implantation (38 min vs 80 min; p = 0.001). At logistic regression analysis, concomitant lactate level greater than 8.0 mmol/L and elapsed time from CA to VA-ECMO ≥ 30 min were predictors of increased mortality (OR 3.9; 95% CI 1.19-12.79; p = 0.025) for the entire population. In-hospital mortality was 60.8% (31/51 patients): 68.4% in OHCA group and 56.2% in IHCA group. No risk factors related to 30-day mortality resulted significant at univariable analysis. When rapidly instituted, VA-ECMO improves survival in patients with refractory cardiac arrest allowing coronary syndrome treatment. The association of an elapsed time from CA to VA-ECMO implantation longer than 30 min and a preoperative lactate peak level over 8.0 mmol/L predict a poor outcome, independently from being IHCA or OHCA.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Reanimación Cardiopulmonar / Síndrome Coronario Agudo / Paro Cardíaco Extrahospitalario Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans / Male Idioma: En Revista: J Artif Organs Asunto de la revista: ENGENHARIA BIOMEDICA Año: 2021 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Japón
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Reanimación Cardiopulmonar / Síndrome Coronario Agudo / Paro Cardíaco Extrahospitalario Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans / Male Idioma: En Revista: J Artif Organs Asunto de la revista: ENGENHARIA BIOMEDICA Año: 2021 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Japón