Vascular complications in adult postcardiotomy cardiogenic shock patients receiving venoarterial extracorporeal membrane oxygenation

Feng Yang,Yongchao Cui,Dengbang Hou,Jinhong Wang,Zhongtao Du,Chunjing Jiang,Yu Jiang,Xiaotong Hou,Zhichen Xing,Xing Hao,Xiaomeng Wang,Xiaofang Yang

doi:10.1186/s13613-018-0417-3

Abstract

BackgroundThe rate, prognostic impacts, and predisposing factors of major vascular complications (MVCs) in patients underwent venoarterial extracorporeal membrane oxygenation (VA-ECMO) by surgical cut-down are poorly understood. The purpose of this study was to identify these parameters in adult VA-ECMO patients.MethodsAdult postcardiotomy cardiogenic shock (PCS) patients receiving VA-ECMO by femoral surgical cut-down cannulation from January 2004 to December 2015 were enrolled in this study. Patients were separated into two groups depending on the presence of MVCs. Multivariate logistic regression was performed to identify factors independently associated with MVCs.ResultsOf 432 patients with PCS treated with VA-ECMO, 252 patients (58.3%) were weaned off VA-ECMO and 153 patients (35.4%) survived to discharge. MVCs were seen in 72 patients (16.7%), including bleeding or hematoma in the cannulation site (8.6%), limb ischemia requiring fasciotomy (8.6%), femoral artery embolism (0.7%), and retroperitoneal bleeding (0.7%). The rate of survival to discharge was 16.7 and 39.2% in patients with or without MVCs, respectively (p < 0.001). Obesity, concomitant with intra-aortic balloon pump (IABP), Sequential Organ Failure Assessment (SOFA) score at 24 h post-ECMO, and hemostasis disorder were shown to be associated with MVCs. MVCs were an independent risk factor for in-hospital mortality by multivariate analysis (odds ratio 3.91; 95% confidence interval, 1.67–9.14; p = 0.013).ConclusionsMVCs are common and associated with higher in-hospital mortality among adult PCS patients receiving peripheral VA-ECMO support. The obesity, concomitant with IABP, SOFA score at 24 h post-ECMO, and hemostasis disorder were independent risk factor of MVCs.

Highlights

The rate, prognostic impacts, and predisposing factors of major vascular complications (MVCs) in patients underwent venoarterial extracorporeal membrane oxygenation (VA-ECMO) by surgical cut-down are poorly understood
ECMO patients with MVCs had bigger body surface area (BSA), Impact of MVCs on survival The MVCs had a significant impact on in-hospital mortality (Fig. 2)
Presence of MVCs, renal dysfunction requiring continuous renal replacement treatment (CRRT), severe bleeding, and neurologic complications were independent risk factors associated with in-hospital mortality

Summary

Introduction

The rate, prognostic impacts, and predisposing factors of major vascular complications (MVCs) in patients underwent venoarterial extracorporeal membrane oxygenation (VA-ECMO) by surgical cut-down are poorly understood. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) may Successful cannulation is the prerequisite and basis for VA-ECMO support for achieving good clinical results. Percutaneous and surgical cut-down vascular cannulations are commonly performed for VA-ECMO. Major vascular complications (MVCs) can occur from cannulation of the femoral vessels. The actual prevalence of MVCs and outcomes of PCS patients underwent VA-ECMO by surgical cut-down is still unclear. Only a few studies have reported on MVCs in PCS patients from single-center experience [10,11,12]. We elucidated the prevalence of MVCs and their impact on in-hospital mortality in adult PCS patients receiving peripheral VA-ECMO by surgical cut-down. We assessed the possible risk factors associated with the occurrence of MVCs

Objectives

Methods

Results

Discussion

Conclusion