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The association of modifiable mechanical ventilation settings, blood gas changes and survival on extracorporeal membrane oxygenation for cardiac arrest.
Tonna, Joseph E; Selzman, Craig H; Bartos, Jason A; Presson, Angela P; Ou, Zhining; Jo, Yeonjung; Becker, Lance B; Youngquist, Scott T; Thiagarajan, Ravi R; Austin Johnson, M; Cho, Sung-Min; Rycus, Peter; Keenan, Heather T.
Afiliación
  • Tonna JE; Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT, USA; Division of Emergency Medicine, Department of Surgery, University of Utah Health, Salt Lake City, UT, USA. Electronic address: https://twitter.com/JoeTonnaMD.
  • Selzman CH; Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT, USA.
  • Bartos JA; Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
  • Presson AP; Division of Epidemiology, Department of Internal Medicine, University of Utah Health, Salt Lake City, UT, USA.
  • Ou Z; Division of Epidemiology, Department of Internal Medicine, University of Utah Health, Salt Lake City, UT, USA.
  • Jo Y; Division of Epidemiology, Department of Internal Medicine, University of Utah Health, Salt Lake City, UT, USA.
  • Becker LB; Department of Emergency Medicine, North Shore University Hospital, Northwell Health System, Manhasset, NY, USA.
  • Youngquist ST; Division of Emergency Medicine, Department of Surgery, University of Utah Health, Salt Lake City, UT, USA.
  • Thiagarajan RR; Division of Cardiac Critical Care, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
  • Austin Johnson M; Division of Emergency Medicine, Department of Surgery, University of Utah Health, Salt Lake City, UT, USA.
  • Cho SM; Division of Neuroscience Critical Care, Department of Neurology, Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
  • Rycus P; Extracorporeal Life Support Organization, Ann Arbor, MI, USA.
  • Keenan HT; Division of Pediatric Critical Care, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA.
Resuscitation ; 174: 53-61, 2022 05.
Article en En | MEDLINE | ID: mdl-35331803
RESEARCH QUESTION: Given the relative independence of ventilator settings from gas exchange and plasticity of blood gas values during extracorporeal cardiopulmonary resuscitation (ECPR), do mechanical ventilation parameters and blood gas values influence survival? METHODS: Observational cohort study of 7488 adult patients with ECPR from the Extracorporeal Life Support Organization (ELSO) Registry. We performed case-mix adjustment for severity of illness and patient type using generalized estimating equation logistic regression to determine factors associated with hospital survival accounting for clustering by center, standardizing variables by 1 standard deviation (SD) of their values. We examined non-linear relationships between ventilatory and blood gas values with hospital survival. RESULTS: Hospital survival was decreased with higher PaO2 on ECMO (OR 0.69, per 1SD increase [95% CI 0.64, 0.74]; p < 0.001) and with any relative changes in PaCO2 (pre-arrest to on-ECMO) in a non-linear fashion. Survival was worsened with any peak inspiratory pressure >20 cmH20 (OR 0.69, per 1SD [0.64, 0.75]; p < 0.001) and above 40% fraction of inspired oxygen (OR 0.75, per 1SD [0.69, 0.82]; p < 0.001), and with higher dynamic driving pressure (OR 0.72, per 1 SD increase [0.65, 0.79]; <0.001). Ventilation settings and blood gas values varied widely across hospitals, but were not associated with annual hospital ECPR case volume. CONCLUSION: Lower ventilatory pressures, avoidance of hyperoxia, and relatively unchanged CO2 (pre- to on-ECMO) were all associated with survival in patients after ECPR, yet varied across hospitals. Our findings represent potential targets for prospective trials for this rapidly growing therapy to test if these associations have causality.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Oxigenación por Membrana Extracorpórea / Reanimación Cardiopulmonar / Paro Cardíaco Tipo de estudio: Observational_studies / Risk_factors_studies Límite: Adult / Humans Idioma: En Revista: Resuscitation Año: 2022 Tipo del documento: Article Pais de publicación: Irlanda
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Oxigenación por Membrana Extracorpórea / Reanimación Cardiopulmonar / Paro Cardíaco Tipo de estudio: Observational_studies / Risk_factors_studies Límite: Adult / Humans Idioma: En Revista: Resuscitation Año: 2022 Tipo del documento: Article Pais de publicación: Irlanda