Dataset Information

Impact of Venoarterial Extracorporeal Membrane Oxygenation on Alkaline Phosphatase Metabolism after Cardiac Surgery.

ABSTRACT: (1) Alkaline phosphatase (AP) is consumed during cardiopulmonary bypass (CPB). A high AP depletion leads to an impaired outcome after cardiac surgery. However, data is scarce on the postoperative course of AP under venoarterial ECMO (VA-ECMO) support. (2) A total of 239 patients with VA-ECMO support between 2000 and 2019 at the Department of Cardiac Surgery (Vienna General Hospital, Austria) were included in this retrospective analysis. Blood samples were collected at several timepoints (baseline, postoperative day (POD) 1-7, POD 14 and 30). Patients were categorized according to the relative AP drop (<60% vs. ≥60%) and ECMO duration (<5 days vs. ≥5 days). (3) Overall, 44.4% reached the baseline AP values within 5 days-this was only the case for 28.6% with a higher AP drop (compared to 62.7% with a lower drop; p = 0.000). A greater AP drop was associated with a significantly higher need for renal replacement therapy (40.9% vs. 61.9%; p = 0.002) and an impaired 1-year survival (51.4% vs. 66.0%; p = 0.031). (4) CPB exceeds the negative impact of VA-ECMO; still, ECMO seems to delay alkaline phosphatase recovery. A greater initial AP drop bears the risk of higher morbidity and mortality.

SUBMITTER: Poschner T

PROVIDER: S-EPMC8156119 | biostudies-literature | 2021 May

REPOSITORIES: biostudies-literature

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Impact of Venoarterial Extracorporeal Membrane Oxygenation on Alkaline Phosphatase Metabolism after Cardiac Surgery.

Poschner Thomas T Schaefer Anne-Kristin AK Hutschala Doris D Goliasch Georg G Riebandt Julia J Distelmaier Klaus K Bernardi Martin H MH Andreas Martin M Brands Ruud R Aref Tandis T Laufer Günther G Wiedemann Dominik D

Biomolecules 20210517 5

(1) Alkaline phosphatase (AP) is consumed during cardiopulmonary bypass (CPB). A high AP depletion leads to an impaired outcome after cardiac surgery. However, data is scarce on the postoperative course of AP under venoarterial ECMO (VA-ECMO) support. (2) A total of 239 patients with VA-ECMO support between 2000 and 2019 at the Department of Cardiac Surgery (Vienna General Hospital, Austria) were included in this retrospective analysis. Blood samples were collected at several timepoints (baselin ...[more]

PMID: 34067880

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Project description:BackgroundVenoarterial extracorporeal membrane oxygenation (VA ECMO) is a critical therapeutic intervention that is commonly used in the management of paediatric patients with congenital heart disease (CHD). This procedure can be initiated either inraoperatively or postoperatively. However, few studies have reported data on the comparative clinical outcomes associated with different timings of VA ECMO initiation. In this study, patient characteristics and clinical outcomes between intraoperative and postoperative VA ECMO in infants undergoing cardiac surgery were compared and predictors of ECMO initiation were determined, which may improve clinical outcomes.MethodsA total of 47 infants who received postcardiotomy VA ECMO support from September 2019 to December 2023 were included in this retrospective, single-centre observational study. Patients who received VA ECMO support in the operating room (intraoperative, n = 27) were compared with those who received it in the intensive care unit (postoperative, n = 20). Kaplan‒Meier curves were further analysed for survival and perioperative factors were evaluated to predict VA ECMO initiation.ResultsSurvival rates were greater in the intraoperative group (70.37% vs. 25%; P = 0.002), with a reduced risk of mortality (HR: 2.84; 95% CI: 1.23-6.55). The intraoperative group also had a higher ECMO weaning rate (88.89% vs. 45%, P < 0.001) and shorter VA ECMO duration (5.00 ± 1.80 days vs. 7.50 ± 2.76 days; P < 0.001). Continuous renal replacement therapy (CRRT) was needed in 100% of postoperative patients versus 70.40% of intraoperative patients (P = 0.014). The combination of preoperative lactate ≥ 6.495 mmol/L and cardiopulmonary bypass (CPB) time ≥ 138 min predicted the need for intraoperative VA ECMO [AUC (area under the curve): 0.893 (95% CI: 0.805-0.980, P < 0.001)].ConclusionsCompared with postoperative VA ECMO, the use of Intraoperative VA ECMO might improve clinical outcomes in infants undergoing cardiac surgery, highlighting the potential benefits of early intervention. The significant predictive value of the CPB time and preoperative lactate level may inform future clinical practices regarding the timing of ECMO initiation in paediatric patients postcardiotomy.

Project description:BackgroundRespiratory complications are common in patients who require venoarterial (VA) extracorporeal membrane oxygenation (ECMO) for cardiac indications. We aimed to examine the frequency and characteristics of patients who develop multi-lobar atelectasis early in the course of VA ECMO and to identify factors associated with its occurrence.MethodsWe performed a single-center retrospective review of consecutive pediatric subjects on VA ECMO in the cardiovascular ICU from 2014 to 2019. Chest radiographs before VA ECMO initiation and daily for up to 5 d of VA ECMO support were reviewed. Multi-lobar atelectasis was defined as the collapse of ≥2 lobes of the same lung. Patients with multi-lobar atelectasis before or immediately after VA ECMO cannulation were excluded. Bivariate comparisons and multivariable logistic regression analyses were performed to identify factors independently associated with lung collapse. Results of the multivariable analysis are provided as odds ratio (OR) with 95% CI.ResultsWe reviewed 119 VA ECMO runs in 101 unique subjects. Multi-lobar atelectasis occurred in 36 runs (30%), with an isolated collapse of the left lung occurring most frequently (no. runs = 20). VA ECMO runs complicated by multi-lobar atelectasis were significantly longer and associated with lower hospital survival (51% vs 77%, survival in subjects without multi-lobar atelectasis; P = .01). Multivariable logistic regression analysis identified a subsequent ECMO run during the same admission to be independently associated with multi-lobar atelectasis (OR 5.4, 95% CI 1.2-21.5). Subanalysis of the subjects with isolated left lung collapse revealed male sex (OR 8.9, 95% CI 1.6-48.2) and subsequent ECMO run during the same admission (OR 4.0, 95% CI 1.2-13.6) to be independently associated with this complication, and mechanical ventilation at least 12 h before ECMO may be protective (OR 0.22, 95% CI 0.07-0.76).ConclusionsMulti-lobar atelectasis commonly occurred in children who were receiving VA ECMO for cardiac failure and was associated with worse outcomes. Male patients, a subsequent VA ECMO run during the same hospitalization, and patients in whom mechanical ventilation was initiated shortly before ECMO cannulation may be at increased risk for this complication.

Dataset Information

Impact of Venoarterial Extracorporeal Membrane Oxygenation on Alkaline Phosphatase Metabolism after Cardiac Surgery.

Publications

Impact of Venoarterial Extracorporeal Membrane Oxygenation on Alkaline Phosphatase Metabolism after Cardiac Surgery.

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