Search

OBJECTIVES Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a rescue for refractory cardiac arrest, of which acute coronary syndrome is a common cause. Data on the coronary revascularization strategy in patients receiving ECPR remain limited. METHODS The ECPR databases from two referral hospitals were screened for patients who underwent emergent revascularization. The baseline characteristics were matched 1:1 using propensity score between patients who underwent coronary artery bypass grafting (CABG) and those who received percutaneous coronary intervention (PCI). Outcomes, including success rate of weaning from extracorporeal membrane oxygenation (ECMO), hospital survival, and midterm survival in hospital survivors, were compared between CABG and PCI. RESULTS After matching, most of the patients (95%) had triple vessel disease. Compared with PCI (n  = 40), emergent CABG (n  = 40) had better early outcomes, in terms of the rates of successful ECMO weaning (71.1% vs 48.7%, P  = 0.05) and hospital survival (56.4% versus 32.4%, P  = 0.04). After a mean follow-up of 2 years, both revascularization strategies were associated with favourable midterm survival among hospital survivors (75.3% after CABG vs 88.9% after PCI, P  = 0.49), with a trend towards fewer reinterventions in patients who underwent CABG (P  = 0.07). CONCLUSIONS In patients who received ECPR because of triple vessel disease, the hospital outcomes were better after emergent CABG than after PCI. More evidence is required to determine the optimal revascularization strategy for patients who receive ECPR. [ABSTRACT FROM AUTHOR]

Purpose Caseloads of extracorporeal cardiopulmonary resuscitation (ECPR) have increased considerably, and hospital mortality rates remain high and unpredictable. The present study evaluated the effects of the interplay between age and prolonged low-flow duration (LFD) on hospital survival rates in elderly patients to identify subgroups that can benefit from ECPR. Methods Adult patients who received ECPR in our institution (2006-2016) were classified into groups 1, 2, and 3 (18-65, 65-75, and > 75 years, respectively). Data regarding ECPR and adverse events during hospitalization were collected prospectively. The primary end point was favorable neurologic outcome (cerebral performance category 1 or 2) at hospital discharge. Results In total, 482 patients were divided into groups 1, 2, and 3 (70.5%, 19.3%, and 10.2%, respectively). LFDs were comparable among the groups (40.3, 41.0, and 44.3 min in groups 1, 2, and 3, P = 0.781, 0.231, and 0.382, respectively). Favorable neurologic outcome rates were nonsignificantly lower in group 3 than in the other groups (27.6%, 24.7%, and 18.4% for group 1, 2, and 3, respectively). Subgroup analysis revealed that the favorable neurologic outcome rates in group 1 were 36.7%, 25.4%, and 13.0% for LFDs of 60 min, respectively (P = 0.005); in group 2, they were 32.1%, 21.2%, and 23.1%, respectively (P = 0.548); in group 3 they were 25.0%, 20.8%, and 0.0%, respectively (P = 0.274). Conclusion On emergency consultation for ECPR, age and low-flow duration should be considered together to predict neurologic outcome., Author(s): Hsi-Yu Yu [sup.1], Chih-Hsien Wang [sup.1], Nai-Hsin Chi [sup.1], Shu-Chien Huang [sup.1], Heng-Wen Chou [sup.1], Nai-Kuan Chou [sup.1], Yih-Sharng Chen [sup.1] Author Affiliations: (1) 0000 0004 0572 7815, grid.412094.a, [...]

Background: Pulmonary artery (PA) cannulation is an effective extracorporeal life support (ECLS) management for left ventricular (LV) decompression or right ventricular (RV) support. This case series explores the results of PA cannulation during ECLS for acute cardiac failure. Methods: Patients receiving percutaneous PA cannulation between January 2017 and December 2020 in a single institution were retrospectively reviewed. Patients receiving PA cannulation by a surgical cutdown method were excluded. Based on the hemodynamic needs of the patients, percutaneous PA cannulation was applied with ECLS for LV unloading and/or RV support. The primary endpoint was the successful weaning from circulatory support. The secondary endpoints included 30‐day or in‐hospital mortality, significant periprocedural complications, and successful hospital discharge without major complications. Results: Fifteen patients (13 men, age range 11.2–70.8 years) presented acute heart failure and were initially managed by conventional ECLS mode. Percutaneous PA cannulation was performed for LV unloading in 13 patients (86.67%) and isolated RV circulatory support in two patients (13.33%). Weaning from circulatory support was achieved in 11 patients (73.33%). No significant periprocedural complication, including bleeding, infection, or vascular event requiring surgical exploration, was reported. The 30‐day or in‐hospital mortality rate was 33.33%. Eight cases (53.33%) were successfully discharged without major complications, including permanent stroke or the need for long‐term hemodialysis. Conclusions: PA cannulation, especially percutaneously performed, was effective and safe for LV unloading and/or RV support during ECLS. Further investigation is required to confirm the efficacy and safety of our approach and management in a larger patient population. [ABSTRACT FROM AUTHOR]

Background: Active bloodstream infection (BSI) is a contraindication for heart transplantation (HT). However, some critical patients with BSI may undergo HT as a life‐saving procedure. We aimed to investigate the impact of pre‐transplant BSI on the clinical outcomes after HT. Methods: We enrolled 511 consecutive patients who underwent HT between 1999 and 2019. Patients were divided into two groups based on the presence of BSI within 30 days preoperatively. Forty‐three patients (8.4%) with BSI who were clinically stable and had no metastatic infection were considered for HT on an individual basis. In‐hospital mortality, incidence of early postoperative BSI, length of postoperative hospital stays, and long‐term survival were compared between the groups. Logistic and Cox regression analyses were performed to identify risk factors for in‐hospital and 1‐year mortality. Results: Patients with pre‐transplant BSI had a high incidence of previous cardiopulmonary resuscitation, pre‐transplant ventilator use, mechanical circulatory support use, renal replacement therapy, United Network for Organ Sharing status 1A, and a prolonged preoperative hospital waiting period. The in‐hospital mortality rate was higher in patients with pre‐transplant BSI (21% vs. 12%, p =.081), and the mortality rate was very high (33.3%) for those with BSI 0–15 days before HT. In addition, patients with pre‐transplant BSI had a significantly longer postoperative hospital stay than patients in the control group. However, long‐term survival was similar in both groups. Conclusions: Although pre‐transplant BSI was associated with higher in‐hospital mortality and prolonged postoperative hospital stay, patients who survived the early period had a similar long‐term prognosis. [ABSTRACT FROM AUTHOR]