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Rilinger J, Book R, Kaier K, Giani M, Fumagalli B, Jäckel M, Bemtgen X, Zotzmann V, Biever PM, Foti G, Westermann D, Lepper PM, Supady A, Staudacher DL, Wengenmayer T. A Mortality Prediction Score for Patients With Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO): The PREDICT VV-ECMO Score. ASAIO J 2024; 70:293-298. [PMID: 37934747 PMCID: PMC10977052 DOI: 10.1097/mat.0000000000002088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Mortality prediction for patients with the severe acute respiratory distress syndrome (ARDS) supported with veno-venous extracorporeal membrane oxygenation (VV-ECMO) is challenging. Clinical variables at baseline and on day 3 after initiation of ECMO support of all patients treated from October 2010 through April 2020 were analyzed. Multivariate logistic regression analysis was used to identify score variables. Internal and external (Monza, Italy) validation was used to evaluate the predictive value of the model. Overall, 272 patients could be included for data analysis and creation of the PREDICT VV-ECMO score. The score comprises five parameters (age, lung fibrosis, immunosuppression, cumulative fluid balance, and ECMO sweep gas flow on day 3). Higher score values are associated with a higher probability of hospital death. The score showed favorable results in derivation and external validation cohorts (area under the receiver operating curve, AUC derivation cohort 0.76 [95% confidence interval, CI, 0.71-0.82] and AUC validation cohort 0.74 [95% CI, 0.67-0.82]). Four risk classes were defined: I ≤ 30, II 31-60, III 61-90, and IV ≥ 91 with a predicted mortality of 28.2%, 56.2%, 84.8%, and 96.1%, respectively. The PREDICT VV-ECMO score suggests favorable performance in predicting hospital mortality under ongoing ECMO support providing a sound basis for further evaluation in larger cohorts.
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Affiliation(s)
- Jonathan Rilinger
- From the Department of Interdisciplinary Medical Intensive Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Cardiology and Angiology, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rebecca Book
- From the Department of Interdisciplinary Medical Intensive Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marco Giani
- Department School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive care, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Benedetta Fumagalli
- Department School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive care, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Markus Jäckel
- From the Department of Interdisciplinary Medical Intensive Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Cardiology and Angiology, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Xavier Bemtgen
- From the Department of Interdisciplinary Medical Intensive Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Viviane Zotzmann
- From the Department of Interdisciplinary Medical Intensive Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Paul M. Biever
- From the Department of Interdisciplinary Medical Intensive Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Giuseppe Foti
- Department School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive care, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Dirk Westermann
- Department of Cardiology and Angiology, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp M. Lepper
- Department of Internal Medicine V – Pneumology, Allergology and Critical Care Medicine, Saarland University Medical Center and University of Saarland, Homburg, Germany
| | - Alexander Supady
- From the Department of Interdisciplinary Medical Intensive Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Dawid L. Staudacher
- From the Department of Interdisciplinary Medical Intensive Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tobias Wengenmayer
- From the Department of Interdisciplinary Medical Intensive Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Bemtgen X, Kaier K, Rilinger J, Rottmann F, Supady A, von Zur Mühlen C, Westermann D, Wengenmayer T, Staudacher DL. Myocarditis mortality with and without COVID-19: insights from a national registry. Clin Res Cardiol 2024; 113:216-222. [PMID: 36565377 PMCID: PMC9789728 DOI: 10.1007/s00392-022-02141-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 12/07/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Myocarditis in context of a SARS-CoV-2 infection is vividly discussed in the literature. Real-world data however are sparse, and relevance of the myocarditis diagnosis to outcome in coronavirus disease (COVID-19) is unclear. PATIENTS AND METHODS Retrospective analysis of 75,304 patients hospitalized in Germany with myocarditis between 2007 and 2020 is reported by DESTATIS. Patients hospitalized between 01/2016 and 12/2019 served as reference cohort for the COVID-19 patients hospitalized in 2020. RESULTS A total of 75,304 patients were hospitalized between 2007 and 2020 (age 42.5 years, 30.1% female, hospital mortality 2.4%). In the reference cohort, 24,474 patients (age 42.8 years, 29.5% female, hospital mortality 2.2%) were registered. In 2020, annual myocarditis hospitalizations dropped by 19.6% compared to reference (4921 vs. 6119 annual hospitalization), of which 443/4921 (9.0%) were connected to COVID-19. In 2020, hospital mortality of myocarditis in non-COVID-19 patients increased significantly compared to reference (2.9% vs. 2.2%, p = 0.008, OR 1.31, 95% CI 1.08-1.60). In COVID-19 myocarditis, hospital mortality was even higher compared to reference (13.5% vs. 2.2%, p < 0.001, OR 6.93, 95% CI 5.18-9.18). CONCLUSION The burden of patients with myocarditis and COVID-19 in 2020 was low. Hospital mortality was more than sixfold higher in patients with myocarditis and COVID-19 compared to those with myocarditis but without COVID-19.
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Affiliation(s)
- Xavier Bemtgen
- Interdisciplinary Medical Intensive Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Klaus Kaier
- Faculty of Medicine, Institute for Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany
| | - Jonathan Rilinger
- Department of Cardiology and Angiology, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Felix Rottmann
- Department of Medicine IV - Nephrology and Primary Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Supady
- Interdisciplinary Medical Intensive Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Constantin von Zur Mühlen
- Department of Cardiology and Angiology, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tobias Wengenmayer
- Interdisciplinary Medical Intensive Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dawid L Staudacher
- Interdisciplinary Medical Intensive Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Oettinger V, Hilgendorf I, Wolf D, Rilinger J, Maier A, Zehender M, Westermann D, Kaier K, von Zur Mühlen C. Comparing balloon-expandable and self-expanding transfemoral transcatheter aortic valve replacement based on subgroups in Germany 2019/2020. Clin Res Cardiol 2024; 113:168-176. [PMID: 37982864 PMCID: PMC10808194 DOI: 10.1007/s00392-023-02326-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/16/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Previously, overall comparable outcomes were seen for balloon-expandable (BE) or self-expanding (SE) transfemoral transcatheter aortic valve replacement (TAVR). However, subgroup analyses based on large case numbers are still needed. METHODS German national data of all BE and SE transfemoral TAVR treating aortic valve stenosis in 2019 and 2020 were analysed. We then compared different outcomes and performed a subgroup analysis for the endpoint in-hospital mortality. RESULTS Overall, 46,243 TAVR were analysed, 19,910 BE, and 26,333 SE. Patients in the SE group had a significantly higher logistic EuroSCORE (13.61 vs 12.66%, p < 0.001), age (81.55 vs 79.99a, p < 0.001), and proportion of women (54.82 vs 40.06%, p < 0.001). Both groups showed a similar in-hospital mortality with 2.37% in BE and 2.35% in SE (p = 0.916). In-hospital mortality also did not differ significantly after risk adjustment (OR = 0.98 [0.86, 1.13], p = 0.799). Patients in the SE group had a significantly lower risk of major bleeding (OR = 0.83 [0.73, 0.95], p = 0.006), but a significantly higher risk of stroke (OR = 1.38 [1.19, 1.59], p < 0.001), delirium (OR = 1.15 [1.06, 1.24], p = 0.001), and permanent pacemaker implantation (OR = 1.29 [1.21, 1.37], p < 0.001). In the subgroup analysis of in-hospital mortality, there were no significant differences in any of the observed subgroups (age < 75/75-79/80-84/ ≥ 85a, logistic EuroSCORE < 4/4- < 9/ ≥ 9, gender, NYHA III/IV, previous CABG, peripheral vascular disease, COPD, pulmonary hypertension, renal disease GFR < 30 ml/min, and diabetes mellitus). CONCLUSION In the direct comparison of balloon-expandable and self-expanding TAVR, there are no differences for in-hospital mortality in subgroups.
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Affiliation(s)
- Vera Oettinger
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
- Center for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Ingo Hilgendorf
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Dennis Wolf
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Jonathan Rilinger
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Alexander Maier
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
- Center for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Manfred Zehender
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
- Center for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Klaus Kaier
- Center for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center-University of Freiburg, Freiburg, Germany
| | - Constantin von Zur Mühlen
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
- Center for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Heidenreich A, Stachon P, Oettinger V, Hilgendorf I, Heidt T, Rilinger J, Zehender M, Westermann D, von Zur Mühlen C, Kaier K. Impact of the COVID-19 pandemic on aortic valve replacement procedures in Germany. BMC Cardiovasc Disord 2023; 23:187. [PMID: 37024779 PMCID: PMC10079149 DOI: 10.1186/s12872-023-03213-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 03/29/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND COVID-19 has caused the deferral of millions of elective procedures, likely resulting in a backlog of cases. We estimate the number of postponed surgical aortic valve replacement (sAVR) and transcatheter aortic valve replacement (TAVR) procedures during the first two waves of the COVID-19 pandemic in Germany. METHODS Using German national records, all isolated TAVR and sAVR procedures between 2007 and 2020 were identified. Using weekly TAVR and sAVR procedures between 2017 and 2019, we created a forecast for 2020 and compared it with the observed number of procedures in 2020. RESULTS In Germany, a total of 225,398 isolated sAVR and 159,638 isolated TAVR procedures were conducted between 2007 and 2020 that were included in our analysis. The reduction in all AVR procedures (sAVR and TAVR) for the entire year 2020 was 19.07% (95%CI: 15.19-22.95%). During the first wave of the pandemic (week 12-21), the mean weekly reduction was 32.06% (23.44-40.68%) and during the second wave of the pandemic (week 41-52), the mean weekly reduction was 25.58% (14.19-36.97%). The number of sAVR procedures decreased more than the number of TAVR procedures (24.63% vs. 16.42% for the entire year 2020). CONCLUSION The first year of the COVID-19 pandemic saw a substantial postponing of AVR procedures in Germany. Postponing was higher for sAVR than for TAVR procedures and less pronounced during the second wave of the COVID-19 pandemic.
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Affiliation(s)
- Adrian Heidenreich
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
- Centre of Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Stachon
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
- Centre of Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Vera Oettinger
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
- Centre of Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ingo Hilgendorf
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Timo Heidt
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Jonathan Rilinger
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Manfred Zehender
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
- Centre of Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dirk Westermann
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Constantin von Zur Mühlen
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
- Centre of Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Centre of Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
- Institute of Medical Biometry and Medical Informatics, Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg, Freiburg, Germany.
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Giani M, Rezoagli E, Guervilly C, Rilinger J, Duburcq T, Petit M, Textoris L, Garcia B, Wengenmayer T, Bellani G, Grasselli G, Pesenti A, Combes A, Foti G, Schmidt M. Timing of Prone Positioning During Venovenous Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome. Crit Care Med 2023; 51:25-35. [PMID: 36519981 DOI: 10.1097/ccm.0000000000005705] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To assess the association of timing to prone positioning (PP) during venovenous extracorporeal membrane oxygenation (V-V ECMO) with the probability of being discharged alive from the ICU at 90 days (primary endpoint) and the improvement of the respiratory system compliance (Cpl,rs). DESIGN Pooled individual data analysis from five original observational cohort studies. SETTING European extracorporeal membrane oxygenation (ECMO) centers. PATIENTS Acute respiratory distress syndrome (ARDS) patients who underwent PP during ECMO. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Time to PP during V-V ECMO was explored both as a continuous and a categorical variable with Cox proportional hazard models. Three hundred patients were included in the analysis. The longer the time to PP during V-V ECMO, the lower the adjusted probability of alive ICU discharge (adjusted hazard ratio [HR] 0.90 for each day increase; 95% CI, 0.87-0.93). Two hundred twenty-three and 77 patients were included in the early PP (≤ 5 d) and late PP (> 5 d) groups, respectively. The cumulative 90-day probability of being discharged alive from the ICU was 61% in the early PP group vs 36% in the late PP group (log-rank test, p <0.001). This benefit was maintained after adjustment for confounders (adjusted HR, 2.52; 95% CI, 1.66-3.81; p <0.001). In the early PP group, PP was associated with a significant improvement of Cpl,rs (4 ± 9 mL/cm H2O vs 0 ± 12 in the late PP group, p=0.038). CONCLUSIONS In a large cohort of ARDS patients on ECMO, early PP during ECMO was associated with a higher probability of being discharged alive from the ICU at 90 days and a greater improvement of Cpl,rs.
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Affiliation(s)
- Marco Giani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive care, ASST Monza, Monza, Italy
| | - Emanuele Rezoagli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive care, ASST Monza, Monza, Italy
| | - Christophe Guervilly
- Medical Intensive Care Unit North Hospital, Department of Anaesthesiology and Critical Care, APHM, Marseille, France
- CER- eSS, Center for Studies and Research On Health Services and Quality of Life EA3279, Aix-Marseille University, Marseille, France
| | - Jonathan Rilinger
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Thibault Duburcq
- Service de Médecine Intensive-Réanimation, Department of Anaesthesiology and Critical Care, CHU Lille, F-59000 Lille, France
| | - Matthieu Petit
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP, Sorbonne Université Hôpital Pitié- Salpêtrière, Paris, France
| | - Laura Textoris
- Medical Intensive Care Unit North Hospital, Department of Anaesthesiology and Critical Care, APHM, Marseille, France
| | - Bruno Garcia
- Service de Médecine Intensive-Réanimation, Department of Anaesthesiology and Critical Care, CHU Lille, F-59000 Lille, France
| | - Tobias Wengenmayer
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Giacomo Bellani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive care, ASST Monza, Monza, Italy
| | - Giacomo Grasselli
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Antonio Pesenti
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Alain Combes
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP, Sorbonne Université Hôpital Pitié- Salpêtrière, Paris, France
- INSERM, UMRS 1166, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France
| | - Giuseppe Foti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive care, ASST Monza, Monza, Italy
| | - Matthieu Schmidt
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP, Sorbonne Université Hôpital Pitié- Salpêtrière, Paris, France
- INSERM, UMRS 1166, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France
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Rilinger J, Heidt T, Bode C, Von Zur Muehlen C. Robotic-assisted PCI – insights from a monocenter registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Robotics in interventional cardiology is a rapidly evolving technique, which is still in an early phase of development and clinical application. Beside the pivotal studies, there is limited real world data on success rates and safety of this new technology.
Purpose
To investigate the success rate as well as the safety profile of robotic-assisted percutaneous coronary intervention (R-PCI) and compare it with manual PCI (M-PCI).
Methods
We report preliminary data of our ongoing, prospective FRiK registry, started in mid 2021. This registry focuses on success rates and safety, radiation dose of patients and personnel, long-term outcome (after 6, 12 and 24 months), as well as on economic aspects and the learning curve of the interventionalists. Moreover, the R-PCI is compared with the M-PCI in these categories.
Results
So far, 51 patients (age 69 (62–80) years, BMI 28.4 (25.2–32) kg/m2, 74.5% male), received R-PCI. PCI success rate was 100%, with 15% requiring manual assistance (Figure 1). Rate of complications (myocardial infarction after PCI, dissection, stent thrombosis, pericardial effusion, target lesion revascularization and MACE (major adverse cardiovascular events) was 0%.
Compared with 41 M-PCI patients (Table 1), treated by the same interventionalists, there was a higher median procedural time (diagnostic and intervention) 106 (82–127) min vs. 71 (54–93) min (p<0.001) and fluoroscopy time 20.3 (14.8–28.5) min vs. 14.8 (10.4–22.4) min (p=0.012) in R-PCI patients. However, there was no significant difference between the dose-area product 4662.4 (3019.4–6399.2) cGy cm2 vs. 4193.9 (2759.9–6254.3) cGy cm2 (p=0.487) and contrast volume use 200 (150–280) ml vs. 180 (145–255) ml (p=0.587).
Conclusion
Preliminary results of R-PCI showed a high success rate, low rates for need of manual assistance, and a very high safety profile without any complications. The dose-area product and contrast volume use were comparable between R-PCI and M-PCI, whereas R-PCI showed a longer procedural and fluoroscopy time. Future steps will include a larger number of cases and definitions of patient cases with optimal eligibility for R-PCI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Rilinger
- University Heart Center Freiburg-Bad Krozingen , Freiburg , Germany
| | - T Heidt
- University Heart Center Freiburg-Bad Krozingen , Freiburg , Germany
| | - C Bode
- University Heart Center Freiburg-Bad Krozingen , Freiburg , Germany
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Jäckel M, Kaier K, Rilinger J, Bemtgen X, Zotzmann V, Zehender M, von Zur Mühlen C, Stachon P, Bode C, Wengenmayer T, Staudacher DL. Annual hospital procedural volume and outcome in extracorporeal membrane oxygenation for respiratory failure. Artif Organs 2022; 46:2469-2477. [PMID: 35841283 DOI: 10.1111/aor.14364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/01/2022] [Accepted: 07/06/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The hospital mortality of patients suffering from pulmonary failure requiring venovenous extracorporeal membrane oxygenation (V-V ECMO) or extracorporeal carbon dioxide removal (ECCO2 R) is high. It is unclear whether outcome correlates with a hospital's annual procedural volume. METHODS Data on all V-V ECMO and ECCO2 R cases treated from 2007 to 2019 was retrieved from the German Institute for Medical Documentation and Information. Comorbidities and outcomes were assessed by DRG, OPS, and ICD codes. The study population was divided into 5 groups depending on annual hospital V-V ECMO and ECCO2 R volumes (<10 cases; 10-19 cases; 20-29 cases; 30-49 cases; ≥50 cases). Primary outcome was hospital mortality. RESULTS A total of 25,096 V-V ECMO and 3,607 ECCO2 R cases were analyzed. V-V ECMO hospitals increased from 89 in 2007 to 214 in 2019. Hospitals handling <10 cases annually increased especially (64 in 2007 to 149 in 2019). V-V ECMO cases rose from 807 in 2007 to 2,597 in 2019. Over 50% were treated in hospitals handling ≥30 cases annually. Hospital mortality was independent of the annual hospital procedural volume (55.3%; 61.3%; 59.8%; 60.2%; 56.3%, respectively, p=0.287). We detected no differences when comparing hospitals handling <30 cases to those with ≥30 annually (p=0.659). The numbers of ECCO2 R hospitals and cases has dropped since 2011 (287 in 2007 to 48 in 2019). No correlation between annual hospital procedural volume and hospital mortality was identified (p=0.914). CONCLUSION The number of hospitals treating patients requiring V-V ECMO and V-V ECMO cases rose from 2007 to 2019, while ECCO2 R hospitals and their case numbers decreased. We detected no correlation between annual hospital V-V ECMO or ECCO2 R volume and hospital mortality.
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Affiliation(s)
- Markus Jäckel
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany.,Interdisciplinary Medical Intensive Care (IMIT), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.,Center of Big Data Analysis in Cardiology (CeBAC), Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Germany.,Center of Big Data Analysis in Cardiology (CeBAC), Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jonathan Rilinger
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany.,Interdisciplinary Medical Intensive Care (IMIT), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Xavier Bemtgen
- Interdisciplinary Medical Intensive Care (IMIT), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Viviane Zotzmann
- Interdisciplinary Medical Intensive Care (IMIT), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Manfred Zehender
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany.,Center of Big Data Analysis in Cardiology (CeBAC), Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Constantin von Zur Mühlen
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany.,Center of Big Data Analysis in Cardiology (CeBAC), Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Stachon
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany.,Center of Big Data Analysis in Cardiology (CeBAC), Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
| | - Tobias Wengenmayer
- Interdisciplinary Medical Intensive Care (IMIT), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Dawid L Staudacher
- Interdisciplinary Medical Intensive Care (IMIT), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Bemtgen X, Rilinger J, Holst M, Rottmann F, Lang CN, Jäckel M, Zotzmann V, Benk C, Wengenmayer T, Supady A, Staudacher DL. Carboxyhemoglobin (CO-Hb) Correlates with Hemolysis and Hospital Mortality in Extracorporeal Membrane Oxygenation: A Retrospective Registry. Diagnostics (Basel) 2022; 12:diagnostics12071642. [PMID: 35885547 PMCID: PMC9324470 DOI: 10.3390/diagnostics12071642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/27/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Patients supported with extracorporeal membrane oxygenation (ECMO) may develop elevated carboxyhemoglobin (CO-Hb), a finding described in the context of hemolysis. Clinical relevance of elevated CO-Hb in ECMO is unclear. We therefore investigated the prognostic relevance of CO-Hb during ECMO support. Methods: Data derives from a retrospective single-center registry study. All ECMO patients in a medical ICU from October 2010 through December 2019 were considered. Peak arterial CO-Hb value during ECMO support and median CO-Hb values determined by point-of-care testing for distinct time intervals were determined. Groups were divided by CO-Hb (<2% or ≥2%). The primary endpoint was hospital survival. Results: A total of 729 patients with 59,694 CO-Hb values met the inclusion criteria. Median age (IQR) was 59 (48−68) years, 221/729 (30.3%) were female, and 278/729 (38.1%) survived until hospital discharge. Initial ECMO configuration was veno-arterial in 431/729 (59.1%) patients and veno-venous in 298/729 (40.9%) patients. Markers for hemolysis (lactate dehydrogenase, bilirubin, hemolysis index, and haptoglobin) all correlated significantly with higher CO-Hb (p < 0.001, respectively). Hospital survival was significantly higher in patients with CO-Hb < 2% compared to CO-Hb ≥ 2%, evaluating time periods 24−48 h (48.6% vs. 35.2%, p = 0.003), 48−72 h (51.5% vs. 36.8%, p = 0.003), or >72 h (56.9% vs. 31.1%, p < 0.001) after ECMO cannulation. Peak CO-Hb was independently associated with lower hospital survival after adjustment for confounders. Conclusions: In ECMO, CO-Hb correlates with hemolysis and hospital survival. If high CO-Hb measured should trigger a therapeutic intervention in order to reduce hemolysis has to be investigated in prospective trials.
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Affiliation(s)
- Xavier Bemtgen
- Interdisciplinary Medical Intensive Care (IMIT), Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (C.N.L.); (V.Z.); (T.W.); (A.S.); (D.L.S.)
- Correspondence: ; Tel.: +49-(0)761/270-34010
| | - Jonathan Rilinger
- Department of Cardiology and Angiology, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.R.); (M.J.)
| | - Manuel Holst
- Department of Hematology, Oncology, and Stem Cell Transplantation, Faculty of Medicine, Freiburg University Medical Center, 79106 Freiburg, Germany;
| | - Felix Rottmann
- Department of Nephrology, Faculty of Medicine, Freiburg University Medical Center, 79106 Freiburg, Germany;
| | - Corinna N. Lang
- Interdisciplinary Medical Intensive Care (IMIT), Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (C.N.L.); (V.Z.); (T.W.); (A.S.); (D.L.S.)
| | - Markus Jäckel
- Department of Cardiology and Angiology, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.R.); (M.J.)
| | - Viviane Zotzmann
- Interdisciplinary Medical Intensive Care (IMIT), Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (C.N.L.); (V.Z.); (T.W.); (A.S.); (D.L.S.)
| | - Christoph Benk
- Department of Cardiovascular Surgery, Heart Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Tobias Wengenmayer
- Interdisciplinary Medical Intensive Care (IMIT), Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (C.N.L.); (V.Z.); (T.W.); (A.S.); (D.L.S.)
| | - Alexander Supady
- Interdisciplinary Medical Intensive Care (IMIT), Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (C.N.L.); (V.Z.); (T.W.); (A.S.); (D.L.S.)
- Heidelberg Institute of Global Health, University of Heidelberg, 69117 Heidelberg, Germany
| | - Dawid L. Staudacher
- Interdisciplinary Medical Intensive Care (IMIT), Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (C.N.L.); (V.Z.); (T.W.); (A.S.); (D.L.S.)
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Papazian L, Schmidt M, Hajage D, Combes A, Petit M, Lebreton G, Rilinger J, Giani M, Le Breton C, Duburcq T, Jozwiak M, Wengenmayer T, Roux D, Parke R, Loundou A, Guervilly C, Boyer L. Effect of prone positioning on survival in adult patients receiving venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis. Intensive Care Med 2022; 48:270-280. [PMID: 35037993 PMCID: PMC8762989 DOI: 10.1007/s00134-021-06604-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/17/2021] [Indexed: 11/29/2022]
Abstract
Purpose Previous studies support the potential efficacy of venovenous extracorporeal membrane oxygenation (vvECMO) for improving survival in severe acute respiratory distress syndrome (ARDS) cases. Prone positioning (PP) has been shown to improve the outcomes of moderate-to-severe ARDS patients. Few studies and no randomized controlled trials have evaluated the effect of PP performed in ECMO patients. Methods We performed a systematic review and meta-analysis examining the effect of prone positioning for ARDS patients receiving vvECMO on survival. All authors were contacted to obtain complementary information not mentioned in the original articles. The main objective was to compare 28-day survival in vvECMO patients with PP to vvECMO patients without PP (controls). Results Thirteen studies with a combined population of 1836 patients satisfied the inclusion criteria. PP was associated with a significant improvement in 28-day survival (503 survivors among 681 patients in the PP group [74%; 95% CI 71–77] vs. 450 survivors among 770 patients in the control group [58%, 95% CI 55–62]; RR 1.31 [95% CI 1.21–1.41]; I2 22% [95% CI 0–62%]; P < 0.0001). Survival was also improved in terms of other endpoints (60-day survival, 90-day survival, ICU survival, and hospital survival). In contrast, the duration of mechanical ventilation was increased in vvECMO patients with PP (mean difference 11.4 days [95% CI 9.2–13.5]; 0.64 [95% CI 0.50–0.78]; I2 8%; P < 0.0001). Conclusion According to this meta-analysis, survival was improved when prone positioning was used in ARDS patients receiving vvECMO. The impact of this combination on survival should be investigated in prospective randomized controlled trials. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-021-06604-x.
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Affiliation(s)
- Laurent Papazian
- Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Hôpital Nord, Chemin Des Bourrely, 13015, Marseille, France.
- Aix-Marseille Université, Faculté de Médecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, 13005, Marseille, France.
| | - Matthieu Schmidt
- Sorbonne Université, GRC 30, RESPIRE, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Médecine Intensive Réanimation, Institut de Cardiologie, AP-HP Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - David Hajage
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, AP-HP Hôpital Pitié-Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie, 75013, Paris, France
| | - Alain Combes
- Sorbonne Université, GRC 30, RESPIRE, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Médecine Intensive Réanimation, Institut de Cardiologie, AP-HP Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Matthieu Petit
- Sorbonne Université, GRC 30, RESPIRE, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Médecine Intensive Réanimation, Institut de Cardiologie, AP-HP Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Guillaume Lebreton
- Sorbonne Université, INSERM UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France
- Department of Cardiovascular and Thoracic Surgery, Institut de Cardiologie, AP-HP Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Jonathan Rilinger
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
- Department of Cardiology and Angiology I, Faculty of Medicine, Heart Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Marco Giani
- Department of Emergency and Intensive Care, School of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Monza, Italy
| | - Camille Le Breton
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, DMU ESPRIT, Médecine Intensive Réanimation, 92700, Colombes, France
- Faculté de Santé, Université de Paris, UFR de Médecine, 75006, Paris, France
| | | | - Mathieu Jozwiak
- CHU de Nice, Hôpital Archet 1, Médecine Intensive Réanimation, 06200, Nice, France
- Equipe 2 CARRES, UR2CA, Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
| | - Tobias Wengenmayer
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
- Department of Cardiology and Angiology I, Faculty of Medicine, Heart Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Damien Roux
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, DMU ESPRIT, Médecine Intensive Réanimation, 92700, Colombes, France
- Faculté de Santé, Université de Paris, UFR de Médecine, 75006, Paris, France
| | - Rachael Parke
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Anderson Loundou
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - Christophe Guervilly
- Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Hôpital Nord, Chemin Des Bourrely, 13015, Marseille, France
- Aix-Marseille Université, Faculté de Médecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, 13005, Marseille, France
| | - Laurent Boyer
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France
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10
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Giani M, Rezoagli E, Guervilly C, Rilinger J, Duburcq T, Petit M, Textoris L, Garcia B, Wengenmayer T, Grasselli G, Pesenti A, Combes A, Foti G, Schmidt M. Prone positioning during venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a pooled individual patient data analysis. Crit Care 2022; 26:8. [PMID: 34986895 PMCID: PMC8731201 DOI: 10.1186/s13054-021-03879-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/22/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Prone positioning (PP) reduces mortality of patients with acute respiratory distress syndrome (ARDS). The potential benefit of prone positioning maneuvers during venovenous extracorporeal membrane oxygenation (ECMO) is unknown. The aim of this study was to evaluate the association between the use of prone positioning during extracorporeal support and ICU mortality in a pooled population of patients from previous European cohort studies. METHODS We performed a pooled individual patient data analysis of European cohort studies which compared patients treated with prone positioning during ECMO (Prone group) to "conventional" ECMO management (Supine group) in patients with severe ARDS. RESULTS 889 patients from five studies were included. Unadjusted ICU mortality was 52.8% in the Supine Group and 40.8% in the Prone group. At a Cox multiple regression analysis PP during ECMO was not significantly associated with a reduction of ICU mortality (HR 0.67 95% CI: 0.42-1.06). Propensity score matching identified 227 patients in each group. ICU mortality of the matched samples was 48.0% and 39.6% for patients in the Supine and Prone group, respectively (p = 0.072). CONCLUSIONS In a large population of ARDS patients receiving venovenous extracorporeal support, the use of prone positioning during ECMO was not significantly associated with reduced ICU mortality. The impact of this procedure will have to be definitively assessed by prospective randomized controlled trials.
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Affiliation(s)
- Marco Giani
- School of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Rianimazione generaleVia Pergolesi 33, 20900, Monza, Italy. .,Department of Emergency and Intensive Care, ASST Monza, Monza, Italy.
| | - Emanuele Rezoagli
- School of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Rianimazione generaleVia Pergolesi 33, 20900, Monza, Italy
| | - Christophe Guervilly
- Medical Intensive Care, Unit North Hospital, APHM, Marseille, France.,CER- eSS, Center for Studies and Research On Health Services and Quality of Life EA3279, Aix-Marseille University, Marseille, France
| | - Jonathan Rilinger
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Thibault Duburcq
- Service de Médecine Intensive-Réanimation, CHU Lille, 59000, Lille, France
| | - Matthieu Petit
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP, Sorbonne Université Hôpital Pitié- Salpêtrière, Paris, France
| | - Laura Textoris
- Medical Intensive Care, Unit North Hospital, APHM, Marseille, France
| | - Bruno Garcia
- Service de Médecine Intensive-Réanimation, CHU Lille, 59000, Lille, France
| | - Tobias Wengenmayer
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Giacomo Grasselli
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Antonio Pesenti
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Alain Combes
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP, Sorbonne Université Hôpital Pitié- Salpêtrière, Paris, France.,Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Giuseppe Foti
- School of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Rianimazione generaleVia Pergolesi 33, 20900, Monza, Italy.,Department of Emergency and Intensive Care, ASST Monza, Monza, Italy
| | - Matthieu Schmidt
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP, Sorbonne Université Hôpital Pitié- Salpêtrière, Paris, France.,Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France
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11
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Jäckel M, Aicher N, Bemtgen X, Rilinger J, Zotzmann V, Biever PM, Supady A, Stachon P, Duerschmied D, Wengenmayer T, Bode C, Staudacher DL. Advantages of score-based delirium detection compared to a clinical delirium assessment-a retrospective, monocentric cohort study. PLoS One 2021; 16:e0259841. [PMID: 34843524 PMCID: PMC8629257 DOI: 10.1371/journal.pone.0259841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/28/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose Delirium is an underdiagnosed complication on intensive care units (ICU). We hypothesized that a score-based delirium detection using the Nudesc score identifies more patients compared to a traditional diagnosis of delirium by ICU physicians. Methods In this retrospective study, all patients treated on a general medical ICU with 30 beds in a university hospital in 2019 were analyzed. Primary outcome was a documented physician diagnosis of delirium, or a delirium score ≥2 using the Nudesc. Results In 205/943 included patients (21.7%), delirium was diagnosed by ICU physicians compared to 438/943 (46.4%; ratio 2.1) by Nudesc≥2. Both assessments were independent predictors of ICU stay (p<0.01). The physician diagnosis however was no independent predictor of mortality (OR 0.98 (0.57–1.72); p = 0.989), in contrast to the score-based diagnosis (OR 2.31 (1.30–4.10); p = 0.004). Subgroup analysis showed that physicians underdiagnosed delirium in case of hypoactive delirium and delirium in patients with female gender and in patients with an age below 60 years. Conclusion Delirium in patients with hypoactive delirium, female patients and those below 60 years was underdiagnosed by physicians. The score-based delirium diagnosis detected delirium more frequently and correlated with ICU mortality and stay.
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Affiliation(s)
- Markus Jäckel
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Nico Aicher
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Xavier Bemtgen
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Jonathan Rilinger
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Viviane Zotzmann
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Paul Marc Biever
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Alexander Supady
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Peter Stachon
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Daniel Duerschmied
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Tobias Wengenmayer
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Dawid Leander Staudacher
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany
- * E-mail:
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12
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Rilinger J, Krötzsch K, Bemtgen X, Jäckel M, Zotzmann V, Lang CN, Kaier K, Duerschmied D, Supady A, Bode C, Staudacher DL, Wengenmayer T. Long-term survival and health-related quality of life in patients with severe acute respiratory distress syndrome and veno-venous extracorporeal membrane oxygenation support. Crit Care 2021; 25:410. [PMID: 34844654 PMCID: PMC8628468 DOI: 10.1186/s13054-021-03821-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/08/2021] [Indexed: 01/19/2023] Open
Abstract
Background There is limited information about the long-term outcome of patients suffering from acute respiratory distress syndrome (ARDS) supported with veno-venous extracorporeal membrane oxygenation (VV ECMO). Most studies focused on short- to mid-term follow-up. We aimed to investigate long-term survival and health-related quality of life (HRQL) in these patients. Methods We report retrospective data from a single-centre registry of patients with severe ARDS treated with VV ECMO at the Interdisciplinary Medical Intensive Care Unit at the Medical Centre, University of Freiburg, Germany, between 10/2010 and 06/2019. Follow-up data of all patients that survived the index hospitalisation were collected by telephone interviews from 02/2020 till 09/2020. Long-term survival, HRQL (Short-Form Health Survey-36 (SF-36), St. Georges Respiratory Questionnaire (SGRQ), Hospital Anxiety and Depression Scale (HADS)) and the return to work rate were documented. Results In total, 289 patients were treated with VV ECMO during the study period (median age 55 years, 67% males, hospital survival 45%). After a median duration of 3.9 years, follow-up assessment was complete in 94 of 129 hospital survivors (73%). Fifty-three patients completed the HRQL assessment. Hospital survivors showed a high 6- and 12-month survival rate (89% and 85%, respectively). Estimated survival rate of those discharged alive from ICU was 68.5% (95%-CI 56.9–80.1%) after 9.7 years. These patients reported high levels of HRQL (median SF-36 total score 73) and only few pulmonary (median SGRQ total score 19) and mental limitations (median HAD-D score 2 and HAD-A score 3). In total, 80% of the patients were able to resume employment. Conclusion This analysis of VV ECMO patients showed favourable long-term survival and high levels of HRQL suggesting promising prospects for VV ECMO survivors. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03821-0.
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Affiliation(s)
- Jonathan Rilinger
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany. .,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.
| | - Klara Krötzsch
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Xavier Bemtgen
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Markus Jäckel
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Viviane Zotzmann
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Corinna N Lang
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Duerschmied
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Alexander Supady
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.,Heidelberg Institute of Global Health, University of Heidelberg, Freiburg, Germany
| | - Christoph Bode
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Dawid L Staudacher
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Tobias Wengenmayer
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
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Montomoli J, Romeo L, Moccia S, Bernardini M, Migliorelli L, Berardini D, Donati A, Carsetti A, Bocci MG, Wendel Garcia PD, Fumeaux T, Guerci P, Schüpbach RA, Ince C, Frontoni E, Hilty MP, Vizmanos-Lamotte G, Tschoellitsch T, Meier J, Aguirre-Bermeo H, Apolo J, Martínez A, Jurkolow G, Delahaye G, Novy E, Losser MR, Wengenmayer T, Rilinger J, Staudacher DL, David S, Welte T, Stahl K, Pavlos” “A, Aslanidis T, Korsos A, Babik B, Nikandish R, Rezoagli E, Giacomini M, Nova A, Fogagnolo A, Spadaro S, Ceriani R, Murrone M, Wu MA, Cogliati C, Colombo R, Catena E, Turrini F, Simonini MS, Fabbri S, Potalivo A, Facondini F, Gangitano G, Perin T, Grazia Bocci M, Antonelli M, Gommers D, Rodríguez-García R, Gámez-Zapata J, Taboada-Fraga X, Castro P, Tellez A, Lander-Azcona A, Escós-Orta J, Martín-Delgado MC, Algaba-Calderon A, Franch-Llasat D, Roche-Campo F, Lozano-Gómez H, Zalba-Etayo B, Michot MP, Klarer A, Ensner R, Schott P, Urech S, Zellweger N, Merki L, Lambert A, Laube M, Jeitziner MM, Jenni-Moser B, Wiegand J, Yuen B, Lienhardt-Nobbe B, Westphalen A, Salomon P, Drvaric I, Hillgaertner F, Sieber M, Dullenkopf A, Petersen L, Chau I, Ksouri H, Sridharan GO, Cereghetti S, Boroli F, Pugin J, Grazioli S, Rimensberger PC, Bürkle C, Marrel J, Brenni M, Fleisch I, Lavanchy J, Perez MH, Ramelet AS, Weber AB, Gerecke P, Christ A, Ceruti S, Glotta A, Marquardt K, Shaikh K, Hübner T, Neff T, Redecker H, Moret-Bochatay M, Bentrup FZ, Studhalter M, Stephan M, Brem J, Gehring N, Selz D, Naon D, Kleger GR, Pietsch U, Filipovic M, Ristic A, Sepulcri M, Heise A, Franchitti Laurent M, Laurent JC, Wendel Garcia PD, Schuepbach R, Heuberger D, Bühler P, Brugger S, Fodor P, Locher P, Camen G, Gaspert T, Jovic M, Haberthuer C, Lussman RF, Colak E. Machine learning using the extreme gradient boosting (XGBoost) algorithm predicts 5-day delta of SOFA score at ICU admission in COVID-19 patients. J Intensive Med 2021; 1:110-116. [PMID: 36785563 PMCID: PMC8531027 DOI: 10.1016/j.jointm.2021.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/20/2021] [Accepted: 09/06/2021] [Indexed: 02/08/2023]
Abstract
Background Accurate risk stratification of critically ill patients with coronavirus disease 2019 (COVID-19) is essential for optimizing resource allocation, delivering targeted interventions, and maximizing patient survival probability. Machine learning (ML) techniques are attracting increased interest for the development of prediction models as they excel in the analysis of complex signals in data-rich environments such as critical care. Methods We retrieved data on patients with COVID-19 admitted to an intensive care unit (ICU) between March and October 2020 from the RIsk Stratification in COVID-19 patients in the Intensive Care Unit (RISC-19-ICU) registry. We applied the Extreme Gradient Boosting (XGBoost) algorithm to the data to predict as a binary outcome the increase or decrease in patients' Sequential Organ Failure Assessment (SOFA) score on day 5 after ICU admission. The model was iteratively cross-validated in different subsets of the study cohort. Results The final study population consisted of 675 patients. The XGBoost model correctly predicted a decrease in SOFA score in 320/385 (83%) critically ill COVID-19 patients, and an increase in the score in 210/290 (72%) patients. The area under the mean receiver operating characteristic curve for XGBoost was significantly higher than that for the logistic regression model (0.86 vs. 0.69, P < 0.01 [paired t-test with 95% confidence interval]). Conclusions The XGBoost model predicted the change in SOFA score in critically ill COVID-19 patients admitted to the ICU and can guide clinical decision support systems (CDSSs) aimed at optimizing available resources.
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Affiliation(s)
- Jonathan Montomoli
- Department of Anaesthesia and Intensive Care, Infermi Hospital, AUSL della Romagna, Rimini 47923, Italy
| | - Luca Romeo
- Department of Information Engineering, Università Politecnica delle Marche, Ancona 60131, Italy
| | - Sara Moccia
- Department of Information Engineering, Università Politecnica delle Marche, Ancona 60131, Italy,The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa 56127, Italy
| | - Michele Bernardini
- Department of Information Engineering, Università Politecnica delle Marche, Ancona 60131, Italy
| | - Lucia Migliorelli
- Department of Information Engineering, Università Politecnica delle Marche, Ancona 60131, Italy
| | - Daniele Berardini
- Department of Information Engineering, Università Politecnica delle Marche, Ancona 60131, Italy
| | - Abele Donati
- Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona 60126, Italy,Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Andrea Carsetti
- Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona 60126, Italy,Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Maria Grazia Bocci
- Department of Anaesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | | | - Thierry Fumeaux
- Swiss Society of Intensive Care Medicine, Basel 4001, Switzerland
| | - Philippe Guerci
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Nancy, Nancy 54511, France
| | - Reto Andreas Schüpbach
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich 8091, Switzerland
| | - Can Ince
- Department of Intensive Care Erasmus MC, University Medical Center Rotterdam, Rotterdam, 3015 GD, Netherlands,Corresponding author: Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - Emanuele Frontoni
- Department of Information Engineering, Università Politecnica delle Marche, Ancona 60131, Italy
| | - Matthias Peter Hilty
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich 8091, Switzerland
| | - RISC-19-ICU InvestigatorsAlfaro-FariasMarioMDVizmanos-LamotteGerardoMD, PhDTschoellitschThomasMDMeierJensMDAguirre-BermeoHernánMD, PhDApoloJaninaBScMartínezAlbertoMDJurkolowGeoffreyMDDelahayeGauthierMDNovyEmmanuelMDLosserMarie-ReineMD, PhDWengenmayerTobiasMDRilingerJonathanMDStaudacherDawid L.MDDavidSaschaMDWelteTobiasMDStahlKlausMDPavlos”“AgiosAslanidisTheodorosMD, PhDKorsosAnitaMDBabikBarnaMD, PhDNikandishRezaMDRezoagliEmanueleMD, PhDGiacominiMatteoMDNovaAliceMDFogagnoloAlbertoMDSpadaroSavinoMD, PhDCerianiRobertoMDMurroneMartinaMDWuMaddalena A.MDCogliatiChiaraMDColomboRiccardoMDCatenaEmanueleMDTurriniFabrizioMD, MScSimoniniMaria SoleMDFabbriSilviaMDPotalivoAntonellaMDFacondiniFrancescaMDGangitanoGianfilippoMDPerinTizianaMDGrazia BocciMariaMDAntonelliMassimoMDGommersDiederikMD, PhDRodríguez-GarcíaRaquelMDGámez-ZapataJorgeMDTaboada-FragaXianaMDCastroPedroMDTellezAdrianMDLander-AzconaArantxaMDEscós-OrtaJesúsMDMartín-DelgadoMaria C.MDAlgaba-CalderonAngelaMDFranch-LlasatDiegoMDRoche-CampoFerranMD, PhDLozano-GómezHerminiaMDZalba-EtayoBegoñaMD, PhDMichotMarc P.MDKlarerAlexanderEnsnerRolfMDSchottPeterMDUrechSeverinMDZellwegerNuriaMerkiLukasMDLambertAdrianaMDLaubeMarcusMDJeitzinerMarie M.RN, PhDJenni-MoserBeatriceRN, MScWiegandJanMDYuenBerndMDLienhardt-NobbeBarbaraWestphalenAndreaMDSalomonPetraMDDrvaricIrisMDHillgaertnerFrankMDSieberMarianneDullenkopfAlexanderMDPetersenLinaMDChauIvanMDKsouriHatemMD, PhDSridharanGovind OliverMDCereghettiSaraMDBoroliFilippoMDPuginJeromeMD, PhDGrazioliSergeMDRimensbergerPeter C.MDBürkleChristianMDMarrelJulienMDBrenniMirkoMDFleischIsabelleMDLavanchyJeromeMDPerezMarie-HeleneMDRameletAnne-SylvieMDWeberAnja BaltussenMDGereckePeterMDChristAndreasMDCerutiSamueleMDGlottaAndreaMDMarquardtKatharinaMDShaikhKarimMDHübnerTobiasMDNeffThomasMDRedeckerHermannMDMoret-BochatayMalloryMDBentrupFriederikeMeyer zuMD, MBAStudhalterMichaelMDStephanMichaelMDBremJanMDGehringNadineMDSelzDanielaMDNaonDidierMDKlegerGian-RetoMDPietschUrsMDFilipovicMiodragMDRisticAnetteMDSepulcriMichaelMDHeiseAntjeMDFranchitti LaurentMarileneMDLaurentJean-ChristopheMDWendel GarciaPedro D.MScSchuepbachRetoMDHeubergerDorotheaPhDBühlerPhilippMDBruggerSilvioMD, PhDFodorPatriciaMDLocherPascalMDCamenGiovanniMDGaspertTomislavMDJovicMarijaMDHaberthuerChristophMDLussmanRoger F.MDColakElifMD
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Rilinger J, Riefler AM, Bemtgen X, Jaeckel M, Zotzmann V, Biever PM, Duerschmied D, Benk C, Trummer G, Kaier K, Bode C, Staudacher DL, Wengenmayer T. Impact of pulse pressure on clinical outcome in extracorporeal cardiopulmonary resuscitation (eCPR) patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Hemodynamic response after successful extracorporeal cardiopulmonary resuscitation (eCPR) is very heterogeneous. Pulse pressure (PP) as an easy to access surrogate parameter and correlate for myocardial damage or recovery from it, might be a valuable tool to estimate the outcome of these patients.
Purpose
To investigate the predictive value of the surrogate parameter PP in eCPR patients.
Methods
We report retrospective data of a single-centre registry of eCPR patients, treated at our Interdisciplinary Medical Intensive Care Unit between 01/2017 and 01/2020. The association between PP of the first 10 days after eCPR and hospital survival was investigated. Moreover, patients were divided into three groups according to their PP (low (0–9 mmHg), mid (10–29 mmHg) and high (≥30 mmHg)) at each time point.
Results
143 patients (age 63 years, 74.1% male, 40% OHCA, average low flow time 49 min) were analysed. Overall hospital survival rate was 28%. A low PP both early after eCPR (after 1, 3, 6 and 12 hours) and in the further course after day 1 to day 8 was associated with reduced hospital survival. At each time point (1 hour to day 5) the classification of patients into a low, mid and high PP group was able to categorize the patients for a low (5–20%), moderate (20–40%) and high (50–70%) survival rate. A multivariable analysis showed that the mean PP of the first 24 hours was an independent predictor for survival (p=0.008, figure 1).
Conclusion
In this analysis, PP occurred to be a valuable parameter to estimate survival and maybe support clinical decision making in the further course of patients after eCPR.
Funding Acknowledgement
Type of funding sources: None. Figure 1. Survival of eCPR patients by mean 24hPP
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Affiliation(s)
- J Rilinger
- University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - A M Riefler
- University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - X Bemtgen
- University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - M Jaeckel
- University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - V Zotzmann
- University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - P M Biever
- University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - D Duerschmied
- University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - C Benk
- University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - G Trummer
- University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - K Kaier
- University of Freiburg, Freiburg, Germany
| | - C Bode
- University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - D L Staudacher
- University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - T Wengenmayer
- University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
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Jäckel M, Aicher N, Biever PM, Heine L, Bemtgen X, Rilinger J, Zotzmann V, Supady A, Stachon P, Wengenmayer T, Bode C, Staudacher DL. Delirium in Critically Ill Patients with and without COVID-19-A Retrospective Analysis. J Clin Med 2021; 10:jcm10194412. [PMID: 34640428 PMCID: PMC8509381 DOI: 10.3390/jcm10194412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Delirium complicating the course of Intensive care unit (ICU) therapy is a known driver of morbidity and mortality. It has been speculated that infection with the neurotrophic SARS-CoV-2 might promote delirium. METHODS Retrospective registry analysis including all patients treated at least 48 h on a medical intensive care unit. The primary endpoint was development of delirium as diagnosed by Nursing Delirium screening scale ≥2. Results were confirmed by propensity score matching. RESULTS 542 patients were included. The primary endpoint was reached in 352/542 (64.9%) patients, without significant differences between COVID-19 patients and non-COVID-19 patients (51.4% and 65.9%, respectively, p = 0.07) and correlated with prolonged ICU stay in both groups. In a subgroup of patients with ICU stay >10 days delirium was significantly lower in COVID-19 patients (p ≤ 0.01). After adjustment for confounders, COVID-19 correlated independently with less ICU delirium (p ≤ 0.01). In the propensity score matched cohort, patients with COVID-19 had significantly lower delirium incidence compared to the matched control patients (p ≤ 0.01). CONCLUSION Delirium is frequent in critically ill patients with and without COVID-19 treated at an intensive care unit. Data suggests that COVID-19 itself is not a driver of delirium per se.
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Affiliation(s)
- Markus Jäckel
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (N.A.); (P.M.B.); (L.H.); (X.B.); (J.R.); (V.Z.); (A.S.); (P.S.); (T.W.); (C.B.); (D.L.S.)
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Correspondence:
| | - Nico Aicher
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (N.A.); (P.M.B.); (L.H.); (X.B.); (J.R.); (V.Z.); (A.S.); (P.S.); (T.W.); (C.B.); (D.L.S.)
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Paul Marc Biever
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (N.A.); (P.M.B.); (L.H.); (X.B.); (J.R.); (V.Z.); (A.S.); (P.S.); (T.W.); (C.B.); (D.L.S.)
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Laura Heine
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (N.A.); (P.M.B.); (L.H.); (X.B.); (J.R.); (V.Z.); (A.S.); (P.S.); (T.W.); (C.B.); (D.L.S.)
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Xavier Bemtgen
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (N.A.); (P.M.B.); (L.H.); (X.B.); (J.R.); (V.Z.); (A.S.); (P.S.); (T.W.); (C.B.); (D.L.S.)
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Jonathan Rilinger
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (N.A.); (P.M.B.); (L.H.); (X.B.); (J.R.); (V.Z.); (A.S.); (P.S.); (T.W.); (C.B.); (D.L.S.)
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Viviane Zotzmann
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (N.A.); (P.M.B.); (L.H.); (X.B.); (J.R.); (V.Z.); (A.S.); (P.S.); (T.W.); (C.B.); (D.L.S.)
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Alexander Supady
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (N.A.); (P.M.B.); (L.H.); (X.B.); (J.R.); (V.Z.); (A.S.); (P.S.); (T.W.); (C.B.); (D.L.S.)
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Peter Stachon
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (N.A.); (P.M.B.); (L.H.); (X.B.); (J.R.); (V.Z.); (A.S.); (P.S.); (T.W.); (C.B.); (D.L.S.)
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Tobias Wengenmayer
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (N.A.); (P.M.B.); (L.H.); (X.B.); (J.R.); (V.Z.); (A.S.); (P.S.); (T.W.); (C.B.); (D.L.S.)
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (N.A.); (P.M.B.); (L.H.); (X.B.); (J.R.); (V.Z.); (A.S.); (P.S.); (T.W.); (C.B.); (D.L.S.)
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Dawid Leander Staudacher
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (N.A.); (P.M.B.); (L.H.); (X.B.); (J.R.); (V.Z.); (A.S.); (P.S.); (T.W.); (C.B.); (D.L.S.)
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
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Jäckel M, Kaier K, Rilinger J, Wolf D, Peikert A, Roth K, Oettinger V, Dawid Leander S, Zehender M, Bode C, Constantin VZM, Stachon P. Outcomes of female and male patients suffering from coronary artery disease: A nation-wide registry of patients admitted as emergency. Medicine (Baltimore) 2021; 100:e27298. [PMID: 34559142 PMCID: PMC8462577 DOI: 10.1097/md.0000000000027298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/02/2021] [Indexed: 11/25/2022] Open
Abstract
Presentation and mortality of coronary artery disease (CAD) substantially differs in both sexes. Most of the existing data analyzing sex differences is older than 10 years and mostly was retrieved in clinical trials, which are potentially structured with a bias against the inclusion of women, leading to a potential selection-bias. Meanwhile, with better diagnostic and therapeutic options, actual data analyzing sex differences in emergency CAD patients is rare.Data on all emergency case numbers with CAD diagnosis in Germany 2017 was retrieved from the German Institute for Medical Documentation and Information. DRG, OPS, and ICD codes were used to determine comorbidities, in-hospital course, and outcome. Competing risk regression analysis for in-hospital mortality was performed analyzing age, European System for Cardiac Operative Risk Evaluation (EuroSCORE), severity of CAD, clinical presentation type and sex.264,742 patients were included. Female patients were older and had more comorbidities. Three-vessel CAD was significantly less present in female patients (36.5% vs 47.5%; P < .001). After adjusting for age, EuroSCORE and severity of CAD, female sex was an independent predictor of lower in-hospital mortality (subdistribution hazard ratio [sHR] 0.94, 95% CI: 0.90-0.98, P = .002) in the whole cohort and in non-ST-segment elevation myocardial infarction (NSTEMI) patients (sHR 0.85, 95% CI: 0.79-0.92, P < .001), whereas in ST-segment elevation myocardial infarction (STEMI) patients, female sex was associated with a higher in-hospital mortality (sHR 1.07, 95% CI: 1.01-1.14, P = .029).In all patients admitted as emergency with CAD diagnosis and in all NSTEMI patients, female sex is protective, whereas in STEMI patients, females show a higher in-hospital mortality risk.
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Affiliation(s)
- Markus Jäckel
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
- Department of Internal Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Germany
- Center of Big Data Analysis in Cardiology, Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jonathan Rilinger
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
- Department of Internal Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Dennis Wolf
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
- Department of Internal Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Alexander Peikert
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
- Department of Internal Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Katrin Roth
- Department of Obstetrics and Gynecology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Vera Oettinger
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
- Department of Internal Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
- Center of Big Data Analysis in Cardiology, Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Staudacher Dawid Leander
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
- Department of Internal Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Manfred Zehender
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
- Department of Internal Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
- Center of Big Data Analysis in Cardiology, Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
- Department of Internal Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Von Zur Mühlen Constantin
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
- Department of Internal Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
- Center of Big Data Analysis in Cardiology, Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Stachon
- University Heart Center Freiburg, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
- Department of Internal Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
- Center of Big Data Analysis in Cardiology, Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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17
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Seiler F, Ahlgrim C, Birkner P, Wrobel N, Rilinger J, Grundmann S, Bode C, Pottgiesser T. Blood volume and hemoglobin mass in long-term heart transplant recipients with and without Anemia. J Cardiothorac Surg 2021; 16:159. [PMID: 34078389 PMCID: PMC8171054 DOI: 10.1186/s13019-021-01510-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In systolic chronic heart failure, a heterogeneous blood volume (BV) regulation can be found with plasma volume expansion in many cases, possibly leading to pseudoanemia. Little is known about the volume status after heart transplantation (HTX). So far, anemia of HTX recipients was solely investigated using hemoglobin-concentration that may be misleading in a clinical context. The objective of the study was whether a difference in plasma volume and red cell volume can be observed in clinically stable heart transplant recipients compared to matched control subjects. Secondary, the aim was to describe anemia in the long-term after HTX based on quantitative data. METHODS Blood volume and its constituents red cell volume and plasma volume were quantified using an abbreviated carbon monoxide rebreathing method (aCORM) with focus on its primary measure total hemoglobin mass (Hbmass) and coincidental anemia in 36 (7 women) heart transplant recipients. For comparison, a matched control group of 46 (5 women) healthy subjects was selected. RESULTS Neither Hbmass nor blood volumes were significantly different in HTX patients compared to matched healthy control group subjects. The prevalence of anemia 6.3 ± 4.3 years after transplantation was 19%. Hbmass and red cell volume were significantly lower in anemic HTX patients compared to non-anemic patients while plasma volume was not expanded. Various immunosuppressant regimens did not have an effect on Hbmass, plasma volume or red cell volume. CONCLUSIONS There was no difference in blood volumes and Hbmass between HTX patients and control subjects. The pathophysiologic blood volume regulation in chronic heart failure does not seem to be longer active in long-term HTX recipients. However, in the long-term after HTX, anemia occurs in a considerable number of patients as true anemia without a clear association with immunosuppression. TRIAL REGISTRATION German registry for clinical studies, DRKS00006078. Registered 09 May 2014, https://www.drks.de/drks_web/navigate.do?navigationId=trial . HTML&TRIAL_ID=DRKS00006078.
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Affiliation(s)
- Florian Seiler
- Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Christoph Ahlgrim
- Department of Cardiology and Angiology II, Heart Center, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Bad Krozingen, Germany
| | - Philipp Birkner
- Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Nina Wrobel
- Center for Medicine, Institute for Exercise- and Occupational Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jonathan Rilinger
- Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Sebastian Grundmann
- Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Torben Pottgiesser
- Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
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18
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Bemtgen X, Rilinger J, Jäckel M, Zotzmann V, Supady A, Benk C, Bode C, Wengenmayer T, Lother A, Staudacher DL. Admission blood glucose level and outcome in patients requiring venoarterial extracorporeal membrane oxygenation. Clin Res Cardiol 2021; 110:1484-1492. [PMID: 33944987 PMCID: PMC8405505 DOI: 10.1007/s00392-021-01862-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/19/2021] [Indexed: 11/26/2022]
Abstract
Background Patients with cardiogenic shock or cardiac arrest undergoing venoarterial extracorporeal membrane oxygenation (V-A ECMO) frequently present with blood glucose levels out of normal range. The clinical relevance of such findings in the context of V-A ECMO is unknown. We therefore investigated the prognostic relevance of blood glucose at time of cannulation for V-A ECMO. Methods We conducted a single-center retrospective registry study. All patients receiving V-A ECMO from October 2010 to January 2020 were included if blood glucose level at time of cannulation were documented. Patients were divided in five groups according to the initial blood glucose level ranging from hypoglycemic (< 80 mg/dl), normoglycemic (80–140 mg/dl), to mild (141-240 mg/dl), moderate (241–400 mg/dl), and severe (> 400 mg/dl) hyperglycemia, respectively. Clinical presentation, arterial blood gas analysis, and survival were compared between the groups. Results 392 patients met inclusion criteria. Median age was 62 years (51.5–70.0), SAPS II at admission was 54 (43.5–63.0), and 108/392 (27.6%) were female. 131/392 were discharged alive (hospital survival 33.4%). At time of cannulation, survivors had higher pH, hemoglobin, calcium, bicarbonate but lower potassium and lactate levels compared to non-survivors (all p < 0.01). Outcome of patients diagnosed with particularly high (> 400 mg/dl) and low (< 80 mg/dl) blood glucose at time of V-A ECMO cannulation, respectively, was worse compared to patients with normoglycemic, mildly or moderately elevated values (p = 0.02). Glucose was independently associated with poor outcome after adjustment for other predictors of survival and persisted in all investigated subgroups. Conclusion Arterial blood glucose at time of V-A ECMO cannulation predicts in-hospital survival of patients with cardiac shock or after ECPR. Whether dysglycemia represents a potential therapeutic target requires further evaluation in prospective studies. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-021-01862-7.
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Affiliation(s)
- Xavier Bemtgen
- Department of Cardiology and Angiology I (Heart Center Freiburg-Bad Krozingen), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany.
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany.
| | - Jonathan Rilinger
- Department of Cardiology and Angiology I (Heart Center Freiburg-Bad Krozingen), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Markus Jäckel
- Department of Cardiology and Angiology I (Heart Center Freiburg-Bad Krozingen), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Viviane Zotzmann
- Department of Cardiology and Angiology I (Heart Center Freiburg-Bad Krozingen), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Alexander Supady
- Department of Cardiology and Angiology I (Heart Center Freiburg-Bad Krozingen), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Christoph Benk
- Department of Cardiovascular Surgery (University Heart Center Freiburg-Bad Krozingen), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I (Heart Center Freiburg-Bad Krozingen), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Tobias Wengenmayer
- Department of Cardiology and Angiology I (Heart Center Freiburg-Bad Krozingen), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Achim Lother
- Department of Cardiology and Angiology I (Heart Center Freiburg-Bad Krozingen), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Dawid L Staudacher
- Department of Cardiology and Angiology I (Heart Center Freiburg-Bad Krozingen), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
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19
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Rilinger J, Zotzmann V, Bemtgen X, Rieg S, Biever PM, Duerschmied D, Pottgiesser T, Kaier K, Bode C, Staudacher DL, Wengenmayer T. Influence of immunosuppression in patients with severe acute respiratory distress syndrome on veno-venous extracorporeal membrane oxygenation therapy. Artif Organs 2021; 45:1050-1060. [PMID: 33725377 PMCID: PMC8250998 DOI: 10.1111/aor.13954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/15/2021] [Accepted: 03/09/2021] [Indexed: 12/11/2022]
Abstract
Prognosis of patients suffering from acute respiratory distress syndrome (ARDS) is poor. This is especially true for immunosuppressed patients. It is controverisal whether these patients should receive veno‐venous extracorporeal membrane oxygenation (VV ECMO) while evidence on this topic is sparse. We report retrospective data of a single‐center registry of patients with severe ARDS requiring ECMO support between October 2010 and June 2019. Patients were analyzed by their status of immunosuppression. ECMO weaning success and hospital survival were analyzed before and after propensity score matching (PSM). Moreover, ventilator free days (VFD) were compared. A total of 288 patients were analyzed (age 55 years, 67% male), 88 (31%) presented with immunosuppression. Survival rates were lower in immunosuppressed patients (27% vs. 53%, P < .001 and 27% vs. 48% after PSM, P = .006). VFD (60 days) were lower for patients with immunosuppression (11.9 vs. 22.4, P < .001), and immunosuppression was an independent predictor for mortality in multivariate analysis. Hospital survival was 20%, 14%, 35%, and 46% for patients with oncological malignancies, solid organ transplantation, autoimmune diseases, and HIV, respectively. In this analysis immunosuppression was an independent predictor for mortality. However, there were major differences in the weaning and survival rates between the etiologies of immunosuppression which should be considered in decision making.
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Affiliation(s)
- Jonathan Rilinger
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Viviane Zotzmann
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Xavier Bemtgen
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Paul M Biever
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Duerschmied
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Torben Pottgiesser
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dawid L Staudacher
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tobias Wengenmayer
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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20
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Rilinger J, Riefler AM, Bemtgen X, Jäckel M, Zotzmann V, Biever PM, Duerschmied D, Benk C, Trummer G, Kaier K, Bode C, Staudacher DL, Wengenmayer T. Impact of pulse pressure on clinical outcome in extracorporeal cardiopulmonary resuscitation (eCPR) patients. Clin Res Cardiol 2021; 110:1473-1483. [PMID: 33779810 PMCID: PMC8405467 DOI: 10.1007/s00392-021-01838-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/05/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Hemodynamic response to successful extracorporeal cardiopulmonary resuscitation (eCPR) is not uniform. Pulse pressure (PP) as a correlate for myocardial damage or recovery from it, might be a valuable tool to estimate the outcome of these patients. METHODS We report retrospective data of a single-centre registry of eCPR patients, treated at the Interdisciplinary Medical Intensive Care Unit at the Medical Centre, University of Freiburg, Germany, between 01/2017 and 01/2020. The association between PP of the first 10 days after eCPR and hospital survival was investigated. Moreover, patients were divided into three groups according to their PP [low (0-9 mmHg), mid (10-29 mmHg) and high (≥ 30 mmHg)] at each time point. RESULTS One hundred forty-three patients (age 63 years, 74.1% male, 40% OHCA, average low flow time 49 min) were analysed. Overall hospital survival rate was 28%. A low PP both early after eCPR (after 1, 3, 6 and 12 h) and after day 1 to day 8 was associated with reduced hospital survival. At each time point (1 h to day 5) the classification of patients into a low, mid and high PP group was able to categorize the patients for a low (5-20%), moderate (20-40%) and high (50-70%) survival rate. A multivariable analysis showed that the mean PP of the first 24 h was an independent predictor for survival (p = 0.008). CONCLUSION In this analysis, PP occurred to be a valuable parameter to estimate survival and maybe support clinical decision making in the further course of patients after eCPR.
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Affiliation(s)
- Jonathan Rilinger
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany. .,Department of Cardiology and Angiology I, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.
| | - Antonia M Riefler
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Xavier Bemtgen
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Markus Jäckel
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Viviane Zotzmann
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Paul M Biever
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Daniel Duerschmied
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Christoph Benk
- Department of Cardiovascular Surgery, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - Georg Trummer
- Department of Cardiovascular Surgery, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Dawid L Staudacher
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Tobias Wengenmayer
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
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21
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Bemtgen X, Zotzmann V, Benk C, Rilinger J, Steiner K, Asmussen A, Bode C, Wengenmayer T, Maier S, Staudacher DL. Thrombotic circuit complications during venovenous extracorporeal membrane oxygenation in COVID-19. J Thromb Thrombolysis 2021; 51:301-307. [PMID: 32653986 PMCID: PMC7353827 DOI: 10.1007/s11239-020-02217-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The novel coronavirus SARS-CoV-2 and the resulting disease COVID-19 causes pulmonary failure including severe courses requiring venovenous extracorporeal membrane oxygenation (V-V ECMO). Coagulopathy is a known complication of COVID-19 leading to thrombotic events including pulmonary embolism. It is unclear if the coagulopathy also increases thrombotic circuit complications of the ECMO. Aim of the present study therefor was to investigate the rate of V-V ECMO complications in COVID-19. We conducted a retrospective registry study including all patients on V-V ECMO treated at our centre between 01/2018 and 04/2020. COVID-19 cases were compared non- COVID-19 cases. All circuit related complications resulting in partial or complete exchange of the extracorporeal system were registered. In total, 66 patients were analysed of which 11 (16.7%) were SARS-CoV-2 positive. The two groups did not differ in clinical parameters including age (COVID-19 59.4 vs. non-COVID-19 58.1 years), gender (36.4% vs. 40%), BMI (27.8 vs. 24.2) and severity of illness as quantified by the RESP Score (1pt. vs 1pt.). 28 days survival was similar in both groups (72.7% vs. 58.2%). While anticoagulation was similar in both groups (p = 0.09), centrifugal pump head thrombosis was more frequent in COVID-19 (9/11 versus 16/55 p < 0.01). Neither the time to first exchange (p = 0.61) nor blood flow at exchange (p = 0.68) did differ in both groups. D-dimer levels prior to the thrombotic events were significantly higher in COVID-19 (mean 15.48 vs 26.59, p = 0.01). The SARS-CoV-2 induced infection is associated with higher rates of thrombotic events of the extracorporeal system during V-V ECMO therapy.
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Affiliation(s)
- Xavier Bemtgen
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Viviane Zotzmann
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Benk
- Department of Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jonathan Rilinger
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katrin Steiner
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Alexander Asmussen
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tobias Wengenmayer
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sven Maier
- Department of Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dawid L Staudacher
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Rieder M, Schubach F, Schmoor C, von Spee-Mayer C, Wengenmayer T, Rilinger J, Staudacher D, Bode C, Duerschmied D, Supady A. Cytokine adsorption in patients with severe COVID-19 pneumonia requiring extracorporeal membrane oxygenation: protocol for a randomised, controlled, open-label intervention, multicentre trial. BMJ Open 2021; 11:e043345. [PMID: 33455938 PMCID: PMC7813398 DOI: 10.1136/bmjopen-2020-043345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Veno-venous extracorporeal membrane oxygenation (V-V ECMO) is a last resort treatment option in patients with severe COVID-19 related acute respiratory distress syndrome (ARDS). Mortality in these critically ill patients is high. Elevated interleukin-6 (IL-6) levels in these severe courses are associated with poor outcome. Extracorporeal cytokine adsorption is an approach to lower elevated IL-6 levels. However, there is no randomised controlled data on the efficacy of cytokine adsorption and its effect on patient outcome in severe COVID-19 related ARDS requiring V-V ECMO support. METHODS AND ANALYSIS We here report the protocol of a 1:1 randomised, controlled, parallel group, open-label intervention, superiority multicentre trial to evaluate the effect of extracorporeal cytokine adsorption using the CytoSorb device in severe COVID-19 related ARDS treated with V-V ECMO. We hypothesise that extracorporeal cytokine adsorption in these patients is effectively reducing IL-6 levels by 75% or more after 72 hours as compared with the baseline measurement and also reducing time to successful V-V ECMO explantation. We plan to include a total of 80 patients at nine centres in Germany. ETHICS AND DISSEMINATION The protocol of this study was approved by the ethical committee of the University of Freiburg as the leading institution (EK 285/20). Additional votes will be obtained at all participating centres. TRIAL REGISTRATION NUMBERS NCT04385771 and DRKS 00021248.
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Affiliation(s)
- Marina Rieder
- Department of Medicine III (Interdisciplinary Medical Intensive Care), University of Freiburg, Faculty of Medicine, Freiburg, Baden-Württemberg, Germany
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Baden-Württemberg, Germany
| | - Fabian Schubach
- Medical Center - University of Freiburg, Clinical Trials Unit, University of Freiburg, Faculty of Medicine, Freiburg, Baden-Württemberg, Germany
| | - Claudia Schmoor
- Medical Center - University of Freiburg, Clinical Trials Unit, University of Freiburg, Faculty of Medicine, Freiburg, Baden-Württemberg, Germany
| | - Caroline von Spee-Mayer
- Medical Center - University of Freiburg, Clinical Trials Unit, University of Freiburg, Faculty of Medicine, Freiburg, Baden-Württemberg, Germany
| | - Tobias Wengenmayer
- Department of Medicine III (Interdisciplinary Medical Intensive Care), University of Freiburg, Faculty of Medicine, Freiburg, Baden-Württemberg, Germany
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Baden-Württemberg, Germany
| | - Jonathan Rilinger
- Department of Medicine III (Interdisciplinary Medical Intensive Care), University of Freiburg, Faculty of Medicine, Freiburg, Baden-Württemberg, Germany
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Baden-Württemberg, Germany
| | - Dawid Staudacher
- Department of Medicine III (Interdisciplinary Medical Intensive Care), University of Freiburg, Faculty of Medicine, Freiburg, Baden-Württemberg, Germany
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Baden-Württemberg, Germany
| | - Christoph Bode
- Department of Medicine III (Interdisciplinary Medical Intensive Care), University of Freiburg, Faculty of Medicine, Freiburg, Baden-Württemberg, Germany
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Baden-Württemberg, Germany
| | - Daniel Duerschmied
- Department of Medicine III (Interdisciplinary Medical Intensive Care), University of Freiburg, Faculty of Medicine, Freiburg, Baden-Württemberg, Germany
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Baden-Württemberg, Germany
| | - Alexander Supady
- Department of Medicine III (Interdisciplinary Medical Intensive Care), University of Freiburg, Faculty of Medicine, Freiburg, Baden-Württemberg, Germany
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Baden-Württemberg, Germany
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23
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Jäckel M, Rilinger J, Lang CN, Zotzmann V, Kaier K, Stachon P, Biever PM, Wengenmayer T, Duerschmied D, Bode C, Staudacher DL, Supady A. Outcome of acute respiratory distress syndrome requiring extracorporeal membrane oxygenation in Covid-19 or influenza: A single-center registry study. Artif Organs 2020; 45:593-601. [PMID: 33188714 PMCID: PMC7753485 DOI: 10.1111/aor.13865] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/18/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023]
Abstract
Veno‐venous extracorporeal membrane oxygenation (V‐V ECMO) is used to sustain blood oxygenation and decarboxylation in severe acute respiratory distress syndrome (ARDS). It is under debate if V‐V ECMO is as appropriate for coronavirus disease 2019 (Covid‐19) ARDS as it is for influenza. In this retrospective study, we analyzed all patients with confirmed SARS‐CoV‐2 or influenza A/B infection, ARDS and V‐V ECMO, treated at our medical intensive care unit (ICU) between October 2010 and June 2020. Baseline and procedural characteristics as well as survival 30 days after ECMO cannulation were analyzed. A total of 62 V‐V ECMO patients were included (15 with Covid‐19 and 47 with influenza). Both groups had similar baseline characteristics at cannulation. Thirty days after ECMO cannulation, 13.3% of all patients with Covid‐19 were discharged alive from our ICU compared to 44.7% with influenza (P = .03). Patients with Covid‐19 had fewer ECMO‐free days (0 (0‐9.7) days vs. 13.2 (0‐22.1) days; P = .05). Cumulative incidences of 30‐day‐survival showed no significant differences (48.6% in Covid‐19 patients, 63.7% in influenza patients; P = .23). ICU treatment duration was significantly longer in ARDS patients with V‐V ECMO for Covid‐19 compared to influenza. Thirty‐day mortality was higher in Covid‐19, but not significant.
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Affiliation(s)
- Markus Jäckel
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jonathan Rilinger
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Corinna Nadine Lang
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Viviane Zotzmann
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Center of Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute of Medical Biometry and Medical Informatics, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Stachon
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Paul Marc Biever
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tobias Wengenmayer
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Duerschmied
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dawid Leander Staudacher
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Supady
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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24
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Rilinger J, Zotzmann V, Bemtgen X, Schumacher C, Biever PM, Duerschmied D, Kaier K, Stachon P, von Zur Mühlen C, Zehender M, Bode C, Staudacher DL, Wengenmayer T. Prone positioning in severe ARDS requiring extracorporeal membrane oxygenation. Crit Care 2020; 24:397. [PMID: 32641155 PMCID: PMC7341706 DOI: 10.1186/s13054-020-03110-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/29/2020] [Indexed: 01/19/2023]
Abstract
Background Prone positioning (PP) has shown to improve survival in patients with severe acute respiratory distress syndrome (ARDS). To this point, it is unclear if PP is also beneficial for ARDS patients treated with veno-venous extracorporeal membrane oxygenation (VV ECMO) support. Methods We report retrospective data of a single-centre registry of patients with severe ARDS requiring VV ECMO support between October 2010 and May 2018. Patients were allocated to the PP group if PP was performed during VV ECMO treatment or the supine positioning group. VV ECMO weaning success and hospital survival were analysed before and after propensity score matching. Results A total of 158 patients could be analysed, and 38 patients (24.1%) received PP. There were no significant differences in VV ECMO weaning rate (47.4% vs. 46.7%, p = 0.94) and hospital survival (36.8% vs. 36.7%, p = 0.98) between the prone and supine groups, respectively. The analysis of 38 propensity score matched pairs also showed no difference in hospital survival (36.8% vs. 36.8%, p = 1.0) or VV ECMO weaning rate (47.4% vs. 44.7%, p = 0.82). Hospital survival was superior in the subgroup of patients treated with early PP (cutoff < 17 h via Youden’s Index) as compared to late or no PP (81.8% vs. 33.3%, p = 0.02). Conclusion In this propensity score matched cohort of severe ARDS patients requiring VV ECMO support, prone positioning at any time was not associated with improved weaning or survival. However, early initiation of prone positioning was linked to a significant reduction of hospital mortality.
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Affiliation(s)
- Jonathan Rilinger
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. .,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.
| | - Viviane Zotzmann
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Xavier Bemtgen
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Carin Schumacher
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Paul M Biever
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Daniel Duerschmied
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Stachon
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Constantin von Zur Mühlen
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Manfred Zehender
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Christoph Bode
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Dawid L Staudacher
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Tobias Wengenmayer
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
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Rilinger J, Kern WV, Duerschmied D, Supady A, Bode C, Staudacher DL, Wengenmayer T. A prospective, randomised, double blind placebo-controlled trial to evaluate the efficacy and safety of tocilizumab in patients with severe COVID-19 pneumonia (TOC-COVID): A structured summary of a study protocol for a randomised controlled trial. Trials 2020; 21:470. [PMID: 32493514 PMCID: PMC7267747 DOI: 10.1186/s13063-020-04447-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/23/2020] [Indexed: 11/29/2022] Open
Abstract
Objectives SARS-CoV2 infection leads to a concomitant pulmonary inflammation. This inflammation is supposed to be the main driver in the pathogenesis of lung failure (Acute Respiratory Distress Syndrome) in COVID-19. Objective of this study is to evaluate the efficacy and safety of a single dose treatment with Tocilizumab in patients with severe COVID-19. We hypothesize that Tocilizumab slows down the progression of SARS-CoV-2 induced pneumonia and inflammation. We expect an improvement in pulmonary function compared to placebo-treated patients. Desirable outcomes would be that tocilizumab reduces the number of days that patients are dependent on mechanical ventilation and reduces the invasiveness of breathing assistance. Furthermore, this treatment might result in fewer admissions to intensive care units. Next to these efficacy parameters, safety of a therapy with Tocilizumab in COVID-19 patients has to be monitored closely, since immunosuppression could lead to an increased rate of bacterial infections, which could negatively influence the patient’s outcome. Trial design Multicentre, prospective, 2-arm randomised (ratio 1:1), double blind, placebo-controlled trial with parallel group design. Participants Inclusion criteria
Proof of SARS-CoV2 (Symptoms and positive polymerase chain reaction (PCR)) Severe respiratory failure:
Ambient air SpO2 ≤ 92% or Need of ≥ 6l O2/min or NIV (non-invasive ventilation) or IMV (invasive mechanical ventilation)
Age ≥ 18 years
Exclusion criteria
Non-invasive or invasive mechanical ventilation ≥ 48 hours Pregnancy or breast feeding Liver injury or failure (AST/ALT ≥ 5x ULN) Leukocytes < 2 × 103/μl Thrombocytes < 50 × 103/μl Severe bacterial infection (PCT > 3ng/ml) Acute or chronic diverticulitis Immunosuppressive therapy (e.g. mycophenolate, azathioprine, methotrexate, biologicals, prednisolone >10mg/d; exceptions are: prednisolone ≤ 10mg/d, sulfasalazine or hydroxychloroquine) Known active or chronic tuberculosis Known active or chronic viral hepatitis Known allergic reactions to tocilizumab or its ingredients Life expectation of less than 1 year (independent of COVID-19) Participation in any other interventional clinical trial within the last 30 days before the start of this trial Simultaneous participation in other interventional trials (except for participation in COVID-19 trials) which could interfere with this trial; simultaneous participation in registry and diagnostic trials is allowed Failure to use one of the following safe methods of contraception: female condoms, diaphragm or coil, each used in combination with spermicides; intra-uterine device; hormonal contraception in combination with a mechanical method of contraception.
The data collection of the primary follow up (28 days after randomisation) takes place during the hospital stay. Subsequently, a telephone interview on the quality of life is conducted after 6 and 12 months. Participants will be recruited from inpatients at ten medical centres in Germany. Intervention and comparator Intervention arm: Application of 8mg/kg body weight (BW) Tocilizumab i.v. once immediately after randomisation (12 mg/kg for patients with <30kg BW; total dose should not exceed 800 mg) AND conventional treatment. Control arm: Placebo (NaCl) i.v. once immediately after randomisation AND conventional treatment. Main outcomes Primary endpoint is the number of ventilator free days (d) (VFD) in the first 28 days after randomisation. Non-invasive ventilation (NIV), Invasive mechanical ventilation (IMV) and extracorporeal membrane oxygenation (ECMO) are defined as ventilator days. VFD’s are counted as zero if the patient dies within the first 28 days. Randomisation The randomisation code will be generated by the CTU (Clinical Trials Unit, ZKS Freiburg) using the following procedure to ensure that treatment assignment is unbiased and concealed from patients and investigator staff. Randomisation will be stratified by centre and will be performed in blocks of variable length in a ratio of 1:1 within each centre. The block lengths will be documented separately and will not be disclosed to the investigators. The randomisation code will be produced by validated programs based on the Statistical Analysis System (SAS). Blinding (masking) Participants, caregivers, and the study team assessing the outcomes are blinded to group assignment. Numbers to be randomised (sample size) 100 participants will be randomised to each group (thus 200 participants in total). Trial Status Protocol Version: V 1.2, 16.04.2020. Recruitment began 27th April 2020 and is anticipated to be completed by December 2020. Trial registration The trial was registered before trial start in trial registries (EudraCT: No. 2020-001408-41, registered 21st April 2020, and DRKS: No. DRKS00021238, registered 22nd April 2020). Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.
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Affiliation(s)
- Jonathan Rilinger
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany. .,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Duerschmied
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Supady
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dawid L Staudacher
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tobias Wengenmayer
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Bemtgen X, Heidt T, Zotzmann V, Rilinger J, Wengenmayer T, Biever PM, von zur Mühlen C, Benk C, Bode C, Staudacher DL. Venoarterial extracorporeal membrane oxygenation decannulation using the novel Manta vascular closure device. European Heart Journal: Acute Cardiovascular Care 2020; 9:342-347. [DOI: 10.1177/2048872620918707] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Aims: Removal of large calibre arterial sheaths, as employed in venoarterial extracorporeal membrane oxygenation, is still associated with a high risk for vascular access site complications. In this study, we investigated the large bore Manta closure device as an option for venoarterial extracorporeal membrane oxygenation decannulation. Methods and results: Sixteen patients weaned from venoarterial extracorporeal membrane oxygenation between January–June 2019 were prospectively included in a registry (eight during extracorporeal cardiopulmonary resuscitation, seven with severe cardiogenic shock and one patient with fulminant pulmonary embolism). All patients had an arterial sheath removed at bedside using the Manta device achieving rapid haemostasis without clinically relevant complications afterwards. A computed tomography angiography was available for 11 patients (68.8%) and reassessed with regards to relevant pathologies at the closure device. Average intraluminal area was 40.4 mm2 (12.2–76.3 mm2) at the closure site. All devices but one were correctly deployed. Three patients (27.3%) had a visible thrombus at the closure device resulting in a >60% stenosis, two of which had a puncture site distal of the femoral artery bifurcation. Conclusion: Decannulation from venoarterial extracorporeal membrane oxygenation using the Manta closure device is a viable approach for rapid haemostasis, but is also associated with a significant risk of thrombotic vessel stenosis. These preliminary findings indicate that puncture in near proximity or distal to the femoral bifurcation might identify patients at risk and further studies are needed.
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Affiliation(s)
- Xavier Bemtgen
- Department of Cardiology and Angiology I, University Heart Center Freiburg – Bad Krozingen - University of Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Germany
| | - Timo Heidt
- Department of Cardiology and Angiology I, University Heart Center Freiburg – Bad Krozingen - University of Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Germany
| | - Viviane Zotzmann
- Department of Cardiology and Angiology I, University Heart Center Freiburg – Bad Krozingen - University of Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Germany
| | - Jonathan Rilinger
- Department of Cardiology and Angiology I, University Heart Center Freiburg – Bad Krozingen - University of Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Germany
| | - Tobias Wengenmayer
- Department of Cardiology and Angiology I, University Heart Center Freiburg – Bad Krozingen - University of Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Germany
| | - Paul M Biever
- Department of Cardiology and Angiology I, University Heart Center Freiburg – Bad Krozingen - University of Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Germany
| | - Constantin von zur Mühlen
- Department of Cardiology and Angiology I, University Heart Center Freiburg – Bad Krozingen - University of Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Germany
| | - Christoph Benk
- Faculty of Medicine, University of Freiburg, Germany
- Department of Cardiovascular Surgery, University Heart Center Freiburg – Bad Krozingen - University of Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, University Heart Center Freiburg – Bad Krozingen - University of Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Germany
| | - Dawid L Staudacher
- Department of Cardiology and Angiology I, University Heart Center Freiburg – Bad Krozingen - University of Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Germany
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Zotzmann V, Rilinger J, Lang CN, Duerschmied D, Benk C, Bode C, Wengenmayer T, Staudacher DL. Early full-body computed tomography in patients after extracorporeal cardiopulmonary resuscitation (eCPR). Resuscitation 2019; 146:149-154. [PMID: 31811881 DOI: 10.1016/j.resuscitation.2019.11.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/19/2019] [Accepted: 11/27/2019] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Initiation of venoarterial extracorporeal membrane oxygenation (ECMO) under ongoing cardiopulmonary resuscitation (eCPR) in patients with refractory cardiac arrest may improve otherwise deleterious outcome. In general, the duration of mechanical resuscitation from collapse to ECMO ranges from 40 to 70 min. CPR-related injuries are reported frequently in non-eCPR patients. We wanted to quantify CPR-related injuries in eCPR patients. METHODS All eCPR patients cannulated at a tertiary referral medical center between October 2010 and October 2017 were included in a retrospective registry study. A full-body CT scan was performed within the first 24 h after eCPR. RESULTS A total of 103 patients (mean age 58.8 ± 16.7 years, CPR duration 61.7 ± 31.9 min, and hospital survival 13.6 %) underwent eCPR and immediate full-body computed tomography (CT). Full-body CT detected the cause for collapse in 16.5% of patients. Average number of pathologies detected per CT scan was 6.5 ± 3.3 findings per patient, of which 2.6 ± 1.5 findings were retrospectively considered of clinical relevance for subsequent treatment. Most frequent findings were multiple rib or sternal fractures (65.5%), pneumo- or hemothorax (32.3%) and pulmonary infiltrates (91.3%). Intracranial bleedings and cerebral edema were frequent (10.7% and 26.2%). A total of 20 patients (19.4%) had findings in whole-body CT that were considered to be so severe that further treatment was considered futile and therapy was subsequently discontinued. Most findings were associated with poor outcome with the exception of rib fractures, bleedings and abdominal trauma, which might have been caused by vigorous resuscitation efforts and were associated with favorable outcome. CONCLUSION A full-body CT scan performed after eCPR revealed substantial clinically significant findings. Therefore, it might be reasonable to routinely perform a full-body CT in all eCPR patients.
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Affiliation(s)
- Viviane Zotzmann
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Jonathan Rilinger
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Corinna Nadine Lang
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Daniel Duerschmied
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Christoph Benk
- Department of Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Tobias Wengenmayer
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Dawid L Staudacher
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Rilinger J, Staudacher DL, Rieg S, Duerschmied D, Bode C, Wengenmayer T. Extracorporeal membrane oxygenation in Pneumocystis jirovecii pneumonia: outcome in HIV and non-HIV patients. Crit Care 2019; 23:356. [PMID: 31727133 PMCID: PMC6854795 DOI: 10.1186/s13054-019-2661-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/24/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Jonathan Rilinger
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany. .,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr 55, 79106, Freiburg, Germany.
| | - Dawid L Staudacher
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr 55, 79106, Freiburg, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Duerschmied
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr 55, 79106, Freiburg, Germany
| | - Christoph Bode
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr 55, 79106, Freiburg, Germany
| | - Tobias Wengenmayer
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetterstr 55, 79106, Freiburg, Germany
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Zotzmann V, Rilinger J, Lang CN, Kaier K, Benk C, Duerschmied D, Biever PM, Bode C, Wengenmayer T, Staudacher DL. Epinephrine, inodilator, or no inotrope in venoarterial extracorporeal membrane oxygenation implantation: a single-center experience. Crit Care 2019; 23:320. [PMID: 31533785 PMCID: PMC6751670 DOI: 10.1186/s13054-019-2605-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/10/2019] [Indexed: 11/25/2022]
Abstract
Background Venoarterial extracorporeal membrane oxygenation (VA-ECMO) can be a rescue therapy for patients in cardiogenic shock or in refractory cardiac arrest. After cannulation, vasoplegia and cardiac depression are frequent. In literature, there are conflicting data on inotropic therapy in these patients. Methods Analysis of a retrospective registry of all patients treated with VA-ECMO in a university hospital center between October 2010 and December 2018 for cardiogenic shock or extracorporeal cardiopulmonary resuscitation (eCPR) with a focus on individual early inotropic therapy. Results A total of 231 patients (age 58.6 ± 14.3, 29.9% female, 58% eCPR, in-house survival 43.7%) were analyzed. Of these, 41.6% received no inotrope therapy within the first 24 h (survival 47.9%), 29.0% received an inodilator (survival 52.2%), and 29.0% received epinephrine (survival 25.0%). Survival of patients with epinephrine was significantly worse compared to other patient groups when evaluating 30-day survival (p = 0.034/p = 0.005) and cumulative incidence of in-hospital death (p = 0.001). In a multivariate logistic regression analysis, treatment with epinephrine was associated with mortality in the whole cohort (OR 0.38, p = 0.011) as well as after propensity score matching (OR 0.24, p = 0.037). We found no significant differences between patients with inodilator treatment and those without. Conclusion Early epinephrine therapy within the first 24 h after cannulation for VA-ECMO was associated with poor survival compared to patients with or without any inodilator therapy. Until randomized data are available, epinephrine should be avoided in patients on VA-ECMO.
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Affiliation(s)
- Viviane Zotzmann
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany. .,Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care) Medical Center, University of Freiburg, Freiburg, Germany.
| | - Jonathan Rilinger
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany.,Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care) Medical Center, University of Freiburg, Freiburg, Germany
| | - Corinna N Lang
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany.,Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care) Medical Center, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Faculty of Medicine, Institute for Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany
| | - Christoph Benk
- Faculty of Medicine, Department of Cardiovascular Surgery, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - Daniel Duerschmied
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany.,Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care) Medical Center, University of Freiburg, Freiburg, Germany
| | - Paul M Biever
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany.,Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care) Medical Center, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany.,Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care) Medical Center, University of Freiburg, Freiburg, Germany
| | - Tobias Wengenmayer
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany.,Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care) Medical Center, University of Freiburg, Freiburg, Germany
| | - Dawid L Staudacher
- Faculty of Medicine, Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany.,Faculty of Medicine, Department of Medicine III (Interdisciplinary Medical Intensive Care) Medical Center, University of Freiburg, Freiburg, Germany
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Rilinger J, Heilmann C, Beitinger U, Olivier CB, Diehl P, Beyersdorf F, Siepe M. Moderate ischemic mitral regurgitation: coronary artery bypass grafting with versus without simultaneous treatment of the mitral valve. J Cardiovasc Surg (Torino) 2018. [PMID: 29532654 DOI: 10.23736/s0021-9509.18.10413-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Ischemic mitral regurgitation (IMR) is a frequent complication of coronary artery heart disease and is associated with increased mortality. Controversies exists whether patients with moderate IMR may benefit from a combined procedure with coronary artery bypass grafting (CABG) and treatment of mitral regurgitation. METHODS 451 patients with moderate IMR (grade 2) receiving either CABG alone (CABG only) or additional mitral valve repair or replacement (CABG+MV) were included in this observational single-centre study. Patients were matched according to the number of bypass grafts, preoperative NYHA functional class and age. In total, 42 patients (21 CABG only, 21 CABG+MV) were analysed. RESULTS The mean follow-up was 4.3±1.9 years. CABG alone reduced the IMR grade to 1.2±0.5, whereas the combined procedure resulted in a decrease to 0.6±0.7 (P=0.039). NYHA functional class was reduced from grade 2.8±0.6 to 1.6±0.5 (CABG only) and 2.0±1.1 (CABG+MV, P=0.55). Three- and five-year survival rates were 71% and 53% in the CABG only group compared to 60% both after 3 and 5 years in the CABG+MV group (P=0.89). CONCLUSIONS In this observational study, combined CABG and surgical treatment of moderate IMR was associated with a more effective reduction of IMR than CABG alone. No statistically significant differences in survival or NYHA functional class were observed. Further studies will need to investigate the value of additional mitral valve surgery in moderate IMR.
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Affiliation(s)
- Jonathan Rilinger
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany -
| | | | - Ulrich Beitinger
- Department of Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph B Olivier
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp Diehl
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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