Echocardiographic Prediction of Successful Weaning From Venoarterial Extracorporeal Membrane Oxygenation.
Background: Weaning from venoarterial extracorporeal membrane oxygenation (VA-ECMO) support fails in 30% to 70% of patients. Objective: To explore the utility of echocardiographic parameters in predicting successful disconnection from VA-ECMO. Methods: Patients receiving VA-ECMO in a referral hospit...
| Published in: | American Journal of Critical Care Vol. 31; no. 6; pp. 483 - 494 |
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| Main Authors: | , , , , , , , , |
| Format: | algorithm CEU pictorial research tables/charts Journal Article |
| Published: |
American Association of Critical-Care Nurses
Nov2022
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=159958271&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 159958271 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10623264 44L jtl: American Journal of Critical Care issn: 10623264 maglogo: N pubinfo: dt: Nov2022 vid: 31 iid: 6 pid: 2559 pub: American Association of Critical-Care Nurses place: Alisa Veijo, California artinfo: ui: 159958271 159958271 159958271 10.4037/ajcc2022588 159958271 ppf: 483 ppct: 11 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Echocardiographic Prediction of Successful Weaning From Venoarterial Extracorporeal Membrane Oxygenation. aug: au: Alonso-Fernandez-Gatta, Marta Merchan-Gomez, Soraya Gonzalez-Cebrian, Miryam Diego-Nieto, Alejandro Gonzalez-Martin, Javier Toranzo-Nieto, Ines Barrio, Alfredo Martin-Herrero, Francisco Sanchez, Pedro L. affil: Marta Alonso-Fernandez-Gatta is a cardiologist at University Hospital of Salamanca-Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain and takes part in the Centro de Investigación en Red de Enfermedades Cardio vasculares (CIBER-CV), Instituto de Salud Carlos III, Madrid, Spain sug: subj: Echocardiography Treatment Outcomes Evaluation Treatment Weaning Extracorporeal Membrane Oxygenation Human Education, Continuing (Credit) Kaplan-Meier Estimator Descriptive Statistics Ventricular Ejection Fraction Sensitivity and Specificity Patient Discharge Retrospective Design Spain Data Analysis Software Repeated Measures T-Tests Chi Square Test Mann-Whitney U Test Fisher's Exact Test Multivariate Analysis Logistic Regression Univariate Statistics ROC Curve Middle Age Aged Male Female Middle Aged: 45-64 years Aged: 65+ years Male Female ab: Background: Weaning from venoarterial extracorporeal membrane oxygenation (VA-ECMO) support fails in 30% to 70% of patients. Objective: To explore the utility of echocardiographic parameters in predicting successful disconnection from VA-ECMO. Methods: Patients receiving VA-ECMO in a referral hospital were included. The relationships between echocardiographic parameters during the weaning trial and weaning success (survival > 24 hours after VA-ECMO explant and no death from cardiogenic shock, heart failure, or cardiac arrest during the hospital stay) and survival were evaluated. Results: Of 85 patients included, 61% had successful weaning. Parameters significantly related to weaning success were higher left ventricular ejection fraction (LVEF; 40% in patients with weaning success vs 30% in patients with weaning failure, P =.01), left ventricular outflow tract velocity time integral (15 cm vs 11 cm, P =.01), aortic valve opening in every cycle (98% vs 91% of patients, P =.01), and normal qualitative right ventricular function (60% vs 42% of patients, P =.02). The LVEF remained as an independent predictor of weaning success (hazard ratio, 0.938; 95% CI, 0.888-0.991; P =.02). An LVEF >33.4% was the optimal cutoff value to discriminate patients with successful weaning (area under the curve, 0.808; sensitivity, 93%; specificity, 72%) and was related to higher survival at discharge (60% vs 20%, P <.001). Conclusion: Among weaning trial echocardiographic parameters, LVEF was the only independent predictor of successful VA-ECMO weaning. An LVEF >33.4% was the optimal cutoff value to discriminate patients with successful weaning and was related to final survival. pubtype: Academic Journal doctype: algorithm CEU pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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