1
|
Durães-Campos I, Costa C, Ferreira AR, Basílio C, Torrella P, Neves A, Lebreiro AM, Pestana G, Adão L, Pinheiro-Torres J, Solla-Buceta M, Riera J, Chico-Carballas JI, Gaião S, Paiva JA, Roncon-Albuquerque R. ECMO for drug-refractory electrical storm without a reversible trigger: a retrospective multicentric observational study. ESC Heart Fail 2024. [PMID: 38605602 DOI: 10.1002/ehf2.14756] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/21/2024] [Accepted: 02/29/2024] [Indexed: 04/13/2024] Open
Abstract
AIMS Drug-refractory electrical storm (ES) is a life-threatening medical emergency. We describe the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in drug-refractory ES without a reversible trigger, for which specific guideline recommendations are still lacking. METHODS AND RESULTS Retrospective observational study in four Iberian centres on the indications, treatment, complications, and outcome of drug-refractory ES not associated with acute coronary syndromes, decompensated heart failure, drug toxicity, electrolyte disturbances, endocrine emergencies, concomitant acute illness with fever, or poor compliance with anti-arrhythmic drugs, requiring VA-ECMO for circulatory support. Thirty-four (6%) out of 552 patients with VA-ECMO for cardiogenic shock were included [71% men; 57 (44-62) years], 65% underwent cardiopulmonary resuscitation before VA-ECMO implantation, and 26% during cannulation. Left ventricular unloading during VA-ECMO was used in 8 (24%) patients: 3 (9%) with intraaortic balloon pump, 3 (9%) with LV vent, and 2 (6%) with Impella. Thirty (88%) had structural heart disease and 8 (24%) had an implantable cardioverter-defibrillator. The drug-refractory ES was mostly due to monomorphic ventricular tachycardia (VT) and ventricular fibrillation (VF) (59%), isolated monomorphic VT (26%), polymorphic VT (9%), or VF (6%). Thirty-one (91%) required deep sedation, 44% overdrive pacing, 36% catheter ablation, and 26% acute autonomic modulation. The main complications were nosocomial infection (47%), bleeding (24%), and limb ischaemia (21%). Eighteen (53%) were weaned from VA-ECMO, and 29% had heart transplantation. Twenty-seven (79%) survived to hospital discharge (48 (33-82) days). Non-survivors were older [62 (58-67) vs. 54 (43-58); P < 0.01] and had a higher first rhythm disorder-to-ECMO interval [0 (0-2) vs. 2 (1-11) days; P = 0.02]. Seven (20%) had rehospitalization during follow-up [29 (12-48) months], with ES recurrence in 6%. CONCLUSIONS VA-ECMO bridged drug-refractory ES without a reversible trigger with a high success rate. This required prolonged hospital stays and coordination between the ECMO centre, the electrophysiology laboratory, and the heart transplant programme.
Collapse
Affiliation(s)
- Isabel Durães-Campos
- Department of Emergency and Intensive Care Medicine, São João University Hospital Center, Porto, Portugal
| | - Catarina Costa
- Department of Cardiology, São João University Hospital Center, Porto, Portugal
| | - Ana Rita Ferreira
- Department of Emergency and Intensive Care Medicine, São João University Hospital Center, Porto, Portugal
| | - Carla Basílio
- Department of Emergency and Intensive Care Medicine, São João University Hospital Center, Porto, Portugal
| | - Pau Torrella
- Department of Intensive Care, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Aida Neves
- Department of Emergency and Intensive Care Medicine, São João University Hospital Center, Porto, Portugal
| | | | - Gonçalo Pestana
- Department of Cardiology, São João University Hospital Center, Porto, Portugal
| | - Luís Adão
- Department of Cardiology, São João University Hospital Center, Porto, Portugal
| | - José Pinheiro-Torres
- Department of Cardiac Surgery, São João University Hospital Center, Porto, Portugal
| | - Miguel Solla-Buceta
- Intensive Care Unit, Hospital Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Jordi Riera
- Department of Intensive Care, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Sérgio Gaião
- Department of Emergency and Intensive Care Medicine, São João University Hospital Center, Porto, Portugal
| | - José Artur Paiva
- Department of Emergency and Intensive Care Medicine, São João University Hospital Center, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Roberto Roncon-Albuquerque
- Department of Emergency and Intensive Care Medicine, São João University Hospital Center, Porto, Portugal
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
2
|
Roncon-Albuquerque R, Gaião S, Vasques-Nóvoa F, Basílio C, Ferreira AR, Touceda-Bravo A, Pimentel R, Vaz A, Silva S, Castro G, Veiga T, Martins H, Dias F, Pereira C, Marto G, Coimbra I, Chico-Carballas JI, Figueiredo P, Paiva JA. Authors reply in response to a letter on "Standardized approach for extubation during extracorporeal membrane oxygenation in severe acute respiratory distress syndrome: a prospective observational study". Ann Intensive Care 2023; 13:120. [PMID: 38041789 PMCID: PMC10693533 DOI: 10.1186/s13613-023-01215-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 12/03/2023] Open
Affiliation(s)
- Roberto Roncon-Albuquerque
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal.
- Department of Surgery and Physiology, UnIC@RISE, Faculty of Medicine of the University of Porto, Porto, Portugal.
| | - Sérgio Gaião
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Francisco Vasques-Nóvoa
- Department of Surgery and Physiology, UnIC@RISE, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Internal Medicine, São João University Hospital Centre, Porto, Portugal
| | - Carla Basílio
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal
| | - Ana Rita Ferreira
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal
| | | | - Rodrigo Pimentel
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal
| | - Ana Vaz
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal
| | - Sofia Silva
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal
| | - Guiomar Castro
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal
| | - Tiago Veiga
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal
| | - Hélio Martins
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal
| | - Francisco Dias
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal
| | - Catarina Pereira
- Department of Internal Medicine, São João University Hospital Centre, Porto, Portugal
| | - Gonçalo Marto
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal
| | - Isabel Coimbra
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal
| | | | - Paulo Figueiredo
- Department of Infectious Diseases, São João University Hospital Centre, Porto, Portugal
| | - José Artur Paiva
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
3
|
Roncon-Albuquerque R, Gaião S, Vasques-Nóvoa F, Basílio C, Ferreira AR, Touceda-Bravo A, Pimentel R, Vaz A, Silva S, Castro G, Veiga T, Martins H, Dias F, Pereira C, Marto G, Coimbra I, Chico-Carballas JI, Figueiredo P, Paiva JA. Standardized approach for extubation during extracorporeal membrane oxygenation in severe acute respiratory distress syndrome: a prospective observational study. Ann Intensive Care 2023; 13:86. [PMID: 37723384 PMCID: PMC10506998 DOI: 10.1186/s13613-023-01185-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/04/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Extubation during extracorporeal oxygenation (ECMO) in severe acute respiratory distress syndrome (ARDS) has not been well studied. Despite the potential benefits of this strategy, weaning from ECMO before liberation from invasive mechanical ventilation remains the most frequent approach. Our aim was to evaluate the safety and feasibility of a standardized approach for extubation during ECMO in patients with severe ARDS. RESULTS We conducted a prospective observational study to assess the safety and feasibility of a standardized approach for extubation during ECMO in severe ARDS among 254 adult patients across 4 intensive care units (ICU) from 2 tertiary ECMO centers over 6 years. This consisted of a daily assessment of clinical and gas exchange criteria based on an Extracorporeal Life Support Organization guideline, with extubation during ECMO after validation by a dedicated intensive care medicine specialist. Fifty-four (21%) patients were extubated during ECMO, 167 (66%) did not reach the clinical criteria, and in 33 (13%) patients, gas exchange precluded extubation during ECMO. At ECMO initiation, there were fewer extrapulmonary organ dysfunctions (lower SOFA score [OR, 0.88; 95% CI, 0.79-0.98; P = .02] with similar PaO2/FiO2) when compared with patients not extubated during ECMO. Extubation during ECMO associated with shorter duration of invasive mechanical ventilation (7 (4-18) vs. 32 (18-54) days; P < .01) and of ECMO (12 (7-25) vs. 19 (10-41) days; P = .01). This was accompanied by a lower incidence of hemorrhagic shock (2 vs. 11%; P = .05), but more cannula-associated deep vein thrombosis (49 vs. 31%; P = .02) and failed extubation (20 vs. 6%; P < .01). There were no increased major adverse events. Extubation during ECMO is associated with a lower risk of all-cause death, independently of measured confounding (adjusted logistic regression OR 0.23; 95% confidence interval 0.08-0.69, P = .008). CONCLUSIONS A standardized approach was safe and feasible allowing extubation during ECMO in 21% of patients with severe ARDS, selecting patients who will have a shorter duration of invasive mechanical ventilation, ECMO course, and ICU stay, as well as fewer infectious complications, and high hospital survival.
Collapse
Affiliation(s)
- Roberto Roncon-Albuquerque
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal.
| | - Sérgio Gaião
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Francisco Vasques-Nóvoa
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Internal Medicine, São João University Hospital Centre, Porto, Portugal
| | - Carla Basílio
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Ana Rita Ferreira
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | | | - Rodrigo Pimentel
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Ana Vaz
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Sofia Silva
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Guiomar Castro
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Tiago Veiga
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Hélio Martins
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Francisco Dias
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Catarina Pereira
- Department of Internal Medicine, São João University Hospital Centre, Porto, Portugal
| | - Gonçalo Marto
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Isabel Coimbra
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | | | - Paulo Figueiredo
- Department of Infectious Diseases, São João University Hospital Centre, Porto, Portugal
| | - José Artur Paiva
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
4
|
Chico-Carballas JI, Touceda-Bravo A, Freita-Ramos S, Mosquera-Rodriguez D, Gómez-Casal V, Piñon-Esteban M. The first year of experience with an extracorporeal resuscitation program for refractory in-hospital cardiac arrest. Med Intensiva 2021; 45:e7-e10. [PMID: 34563346 DOI: 10.1016/j.medine.2020.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/26/2020] [Indexed: 10/20/2022]
Affiliation(s)
- J I Chico-Carballas
- Hospital Álvaro Cunqueiro, Critical Care Department, Av/ clara campoamor 341, Vigo (pontevedra) 36312, Spain.
| | - A Touceda-Bravo
- Hospital Álvaro Cunqueiro, Critical Care Department, Av/ clara campoamor 341, Vigo (pontevedra) 36312, Spain
| | - S Freita-Ramos
- Hospital Álvaro Cunqueiro, Critical Care Department, Av/ clara campoamor 341, Vigo (pontevedra) 36312, Spain
| | - D Mosquera-Rodriguez
- Hospital Álvaro Cunqueiro, Critical Care Department, Av/ clara campoamor 341, Vigo (pontevedra) 36312, Spain
| | - V Gómez-Casal
- Hospital Álvaro Cunqueiro, Critical Care Department, Av/ clara campoamor 341, Vigo (pontevedra) 36312, Spain
| | - M Piñon-Esteban
- Hospital Álvaro Cunqueiro, Cardiothoracic Surgery Department, Av/ clara campoamor 341, Vigo (pontevedra) 36312, Spain
| |
Collapse
|
5
|
Chico-Carballas JI, Touceda-Bravo A, Freita-Ramos S, Mosquera-Rodriguez D, Gómez-Casal V, Piñon-Esteban M. The first year of experience with an extracorporeal resuscitation program for refractory in-hospital cardiac arrest. Med Intensiva 2020. [PMID: 32402529 DOI: 10.1016/j.medin.2020.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- J I Chico-Carballas
- Hospital Álvaro Cunqueiro, Critical Care Department, Av/ clara campoamor 341, Vigo (pontevedra) 36312, Spain.
| | - A Touceda-Bravo
- Hospital Álvaro Cunqueiro, Critical Care Department, Av/ clara campoamor 341, Vigo (pontevedra) 36312, Spain
| | - S Freita-Ramos
- Hospital Álvaro Cunqueiro, Critical Care Department, Av/ clara campoamor 341, Vigo (pontevedra) 36312, Spain
| | - D Mosquera-Rodriguez
- Hospital Álvaro Cunqueiro, Critical Care Department, Av/ clara campoamor 341, Vigo (pontevedra) 36312, Spain
| | - V Gómez-Casal
- Hospital Álvaro Cunqueiro, Critical Care Department, Av/ clara campoamor 341, Vigo (pontevedra) 36312, Spain
| | - M Piñon-Esteban
- Hospital Álvaro Cunqueiro, Cardiothoracic Surgery Department, Av/ clara campoamor 341, Vigo (pontevedra) 36312, Spain
| |
Collapse
|