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2. A national multi centre pre-hospital ECPR stepped wedge study; design and rationale of the ON-SCENE study

Author

Ali, Samir, Moors, Xavier, van Schuppen, Hans, Mommers, Lars, Weelink, Ellen, Meuwese, Christiaan L., Kant, Merijn, van den Brule, Judith, Kraemer, Carlos Elzo, Vlaar, Alexander P. J., Akin, Sakir, Lansink-Hartgring, Annemiek Oude, Scholten, Erik, Otterspoor, Luuk, de Metz, Jesse, Delnoij, Thijs, van Lieshout, Esther M. M., Houmes, Robert-Jan, Hartog, Dennis den, Gommers, Diederik, and Dos Reis Miranda, Dinis

Published
2024
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6. The interaction of thrombocytopenia, hemorrhage, and platelet transfusion in venoarterial extracorporeal membrane oxygenation: a multicenter observational study

Author

Raasveld, Senta Jorinde, van den Oord, Claudia, Schenk, Jimmy, van den Bergh, Walter M., Oude Lansink - Hartgring, Annemieke, van der Velde, Franciska, Maas, Jacinta J., van de Berg, Pablo, Lorusso, Roberto, Delnoij, Thijs S. R., Dos Reis Miranda, Dinis, Scholten, Erik, Taccone, Fabio Silvio, Dauwe, Dieter F., De Troy, Erwin, Hermans, Greet, Pappalardo, Federico, Fominskiy, Evgeny, Ivancan, Višnja, Bojčić, Robert, de Metz, Jesse, van den Bogaard, Bas, Donker, Dirk W., Meuwese, Christiaan L., De Bakker, Martin, Reddi, Benjamin, Henriques, José P. S., Broman, Lars Mikael, Dongelmans, Dave A., and Vlaar, Alexander P. J.

Published
2023
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8. Low thyroid function is not associated with an accelerated deterioration in renal function

Author

Meuwese, Christiaan L, van Diepen, Merel, Cappola, Anne R, Sarnak, Mark J, Shlipak, Michael G, Bauer, Douglas C, Fried, Linda P, Iacoviello, Massimo, Vaes, Bert, Degryse, Jean, Khaw, Kay-Tee, Luben, Robert N, Åsvold, Bjørn O, Bjøro, Trine, Vatten, Lars J, de Craen, Anton JM, Trompet, Stella, Iervasi, Giorgio, Molinaro, Sabrina, Ceresini, Graziano, Ferrucci, Luigi, Dullaart, Robin PF, Bakker, Stephan JL, Jukema, J Wouter, Kearney, Patricia M, Stott, David J, Peeters, Robin P, Franco, Oscar H, Völzke, Henry, Walsh, John P, Bremner, Alexandra, Sgarbi, José A, Maciel, Rui MB, Imaizumi, Misa, Ohishi, Waka, Dekker, Friedo W, Rodondi, Nicolas, Gussekloo, Jacobijn, and Elzen, Wendy PJ den

Subjects
Clinical Research, Kidney Disease, Renal and urogenital, Metabolic and endocrine, Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Glomerular Filtration Rate, Humans, Incidence, Longitudinal Studies, Male, Meta-Analysis as Topic, Middle Aged, Netherlands, Prognosis, Renal Insufficiency, Chronic, Thyroid Diseases, Thyroid Function Tests, Thyroid Hormones, chronic renal failure, CKD, creatinine clearance, epidemiology, thyroid function, Thyroid Studies Collaboration, Clinical Sciences, Urology & Nephrology
Abstract

BackgroundChronic kidney disease (CKD) is frequently accompanied by thyroid hormone dysfunction. It is currently unclear whether these alterations are the cause or consequence of CKD. This study aimed at studying the effect of thyroid hormone alterations on renal function in cross-sectional and longitudinal analyses in individuals from all adult age groups.MethodsIndividual participant data (IPD) from 16 independent cohorts having measured thyroid stimulating hormone, free thyroxine levels and creatinine levels were included. Thyroid hormone status was defined using clinical cut-off values. Estimated glomerular filtration rates (eGFR) were calculated by means of the four-variable Modification of Diet in Renal Disease (MDRD) formula. For this IPD meta-analysis, eGFR at baseline and eGFR change during follow-up were computed by fitting linear regression models and linear mixed models in each cohort separately. Effect estimates were pooled using random effects models.ResultsA total of 72 856 individuals from 16 different cohorts were included. At baseline, individuals with overt hypothyroidism (n = 704) and subclinical hypothyroidism (n = 3356) had a average (95% confidence interval) -4.07 (-6.37 to -1.78) and -2.40 (-3.78 to -1.02) mL/min/1.73 m2 lower eGFR as compared with euthyroid subjects (n = 66 542). In (subclinical) hyperthyroid subjects (n = 2254), average eGFR was 3.01 (1.50-4.52) mL/min/1.73 m2 higher. During 329 713 patient years of follow-up, eGFR did not decline more rapidly in individuals with low thyroid function compared with individuals with normal thyroid function.ConclusionsLow thyroid function is not associated with a deterioration of renal function. The cross-sectional association may be explained by renal dysfunction causing thyroid hormone alterations.

Published
2019

9. Plasma Transfusion and Procoagulant Product Administration in Extracorporeal Membrane Oxygenation: A Secondary Analysis of an International Observational Study on Current Practices

Author

van Haeren, Maite M.T., Raasveld, Senta Jorinde, Karami, Mina, Miranda, Dinis Dos Reis, Mandigers, Loes, Dauwe, Dieter F., De Troy, Erwin, Pappalardo, Federico, Fominskiy, Evgeny, van den Bergh, Walter M., Oude Lansink-Hartgring, Annemieke, van der Velde, Franciska, Maas, Jacinta J., van de Berg, Pablo, de Haan, Maarten, Donker, Dirk W., Meuwese, Christiaan L., Taccone, Fabio Silvio, Peluso, Lorenzo, Lorusso, Roberto, Delnoij, Thijs S.R., Scholten, Erik, Overmars, Martijn, Ivancan, Višnja, Bojčić, Robert, de Metz, Jesse, van den Bogaard, Bas, de Bakker, Martin, Reddi, Benjamin, Hermans, Greet, Broman, Lars Mikael, Henriques, José P.S., Schenk, Jimmy, Vlaar, Alexander P.J., and Müller, Marcella C.A.

Published
2023
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12. Looking Back, Going Forward:Understanding Cardiac Pathophysiology from Pressure-Volume Loops

Author

Protti, Ilaria, van den Enden, Antoon, Van Mieghem, Nicolas M., Meuwese, Christiaan L., Meani, Paolo, Protti, Ilaria, van den Enden, Antoon, Van Mieghem, Nicolas M., Meuwese, Christiaan L., and Meani, Paolo

Abstract

Knowing cardiac physiology is essential for health care professionals working in the cardiovascular field. Pressure–volume loops (PVLs) offer a unique understanding of the myocardial working and have become pivotal in complex pathophysiological scenarios, such as profound cardiogenic shock or when mechanical circulatory supports are implemented. This review provides a comprehensive summary of the left and right ventricle physiology, based on the PVL interpretation.

Published
2024

13. ECPELLA as a bridge-to-decision in refractory cardiogenic shock: a single-centre experience

Author

Cardiologie, Team Medisch, Circulatory Health, Regenerative Medicine and Stem Cells, Gezonde Vaten, CTC, Medische Staf Intensive Care, Medische Staf Spoedeisende Hulp, Medische staf Anesthesiologie, Other research (not in main researchprogram), Balder, Jan Willem, Szymanski, Mariusz K., van Laake, Linda W., van der Harst, Pim, Meuwese, Christiaan L., Ramjankhan, Faiz Z., van der Meer, Manon G., Hermens, Jeannine A.J.M., Voskuil, Michiel, de Waal, Eric E.C., Donker, Dirk W., Oerlemans, Marish I.F.J., Kraaijeveld, Adriaan O., Cardiologie, Team Medisch, Circulatory Health, Regenerative Medicine and Stem Cells, Gezonde Vaten, CTC, Medische Staf Intensive Care, Medische Staf Spoedeisende Hulp, Medische staf Anesthesiologie, Other research (not in main researchprogram), Balder, Jan Willem, Szymanski, Mariusz K., van Laake, Linda W., van der Harst, Pim, Meuwese, Christiaan L., Ramjankhan, Faiz Z., van der Meer, Manon G., Hermens, Jeannine A.J.M., Voskuil, Michiel, de Waal, Eric E.C., Donker, Dirk W., Oerlemans, Marish I.F.J., and Kraaijeveld, Adriaan O.

Published
2024

14. The physiology of venoarterial extracorporeal membrane oxygenation -: A comprehensive clinical perspective

Author

Medische Staf Intensive Care, Sepsis and Inflammation, Infection & Immunity, Cardiologie, Other research (not in main researchprogram), Fresiello, Libera, Hermens, Jeannine A.J., Pladet, Lara, Meuwese, Christiaan L., Donker, Dirk W., Medische Staf Intensive Care, Sepsis and Inflammation, Infection & Immunity, Cardiologie, Other research (not in main researchprogram), Fresiello, Libera, Hermens, Jeannine A.J., Pladet, Lara, Meuwese, Christiaan L., and Donker, Dirk W.

Published
2024

15. Neuropsychiatric sequelae following extracorporeal membrane oxygenation in the intensive care unit

Author

Infection & Immunity, Sepsis and Inflammation, Epi Methoden Team 3, Medische Staf Intensive Care, Other research (not in main researchprogram), Pladet, Lara C A, Luijken, Kim, Donker, Dirk W, Cremer, Olaf L, Meuwese, Christiaan L, Infection & Immunity, Sepsis and Inflammation, Epi Methoden Team 3, Medische Staf Intensive Care, Other research (not in main researchprogram), Pladet, Lara C A, Luijken, Kim, Donker, Dirk W, Cremer, Olaf L, and Meuwese, Christiaan L

Published
2024

16. The physiology of venoarterial extracorporeal membrane oxygenation - A comprehensive clinical perspective

Author

Fresiello, Libera, Hermens, Jeannine A.J., Pladet, Lara, Meuwese, Christiaan L., Donker, Dirk W., Fresiello, Libera, Hermens, Jeannine A.J., Pladet, Lara, Meuwese, Christiaan L., and Donker, Dirk W.

Abstract

Venoarterial extracorporeal membrane oxygenation (VA ECMO) has become a standard of care for severe cardiogenic shock, refractory cardiac arrest and related impending multiorgan failure. The widespread clinical use of this complex temporary circulatory support modality is still contrasted by a lack of formal scientific evidence in the current literature. This might at least in part be attributable to VA ECMO related complications, which may significantly impact on clinical outcome. In order to limit adverse effects of VA ECMO as much as possible an indepth understanding of the complex physiology during extracorporeally supported cardiogenic shock states is critically important. This review covers all relevant physiological aspects of VA ECMO interacting with the human body in detail. This, to provide a solid basis for health care professionals involved in the daily management of patients supported with VA ECMO and suffering from cardiogenic shock or cardiac arrest and impending multiorgan failure for the best possible care.

Published
2024

17. Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest:an overview of current practice and evidence

Author

Ali, Samir, Meuwese, Christiaan L., Moors, Xavier J.R., Donker, Dirk W., van de Koolwijk, Anina F., van de Poll, Marcel C.G., Gommers, Diederik, Dos Reis Miranda, Dinis, Ali, Samir, Meuwese, Christiaan L., Moors, Xavier J.R., Donker, Dirk W., van de Koolwijk, Anina F., van de Poll, Marcel C.G., Gommers, Diederik, and Dos Reis Miranda, Dinis

Abstract

Cardiac arrest (CA) is a common and potentially avoidable cause of death, while constituting a substantial public health burden. Although survival rates for out-of-hospital cardiac arrest (OHCA) have improved in recent decades, the prognosis for refractory OHCA remains poor. The use of veno-arterial extracorporeal membrane oxygenation during cardiopulmonary resuscitation (ECPR) is increasingly being considered to support rescue measures when conventional cardiopulmonary resuscitation (CPR) fails. ECPR enables immediate haemodynamic and respiratory stabilisation of patients with CA who are refractory to conventional CPR and thereby reduces the low-flow time, promoting favourable neurological outcomes. In the case of refractory OHCA, multiple studies have shown beneficial effects in specific patient categories. However, ECPR might be more effective if it is implemented in the pre-hospital setting to reduce the low-flow time, thereby limiting permanent brain damage. The ongoing ON-SCENE trial might provide a definitive answer regarding the effectiveness of ECPR. The aim of this narrative review is to present the most recent literature available on ECPR and its current developments.

Published
2024

19. Outcomes of Extracorporeal Membrane Oxygenation in COVID-19–Induced Acute Respiratory Distress Syndrome: An Inverse Probability Weighted Analysis

Author

Raasveld, Senta Jorinde, Taccone, Fabio Silvio, Broman, Lars Mikael, Hermans, Greet, Meersseman, Philippe, Quintana Diaz, Manuel, Delnoij, Thijs S. R., van de Poll, Marcel, Gouvea Bogossian, Elisa, van Baarle, Floor L. F., Durak, Koray, Zayat, Rashad, Oude Lansink-Hartgring, Annemieke, Meuwese, Christiaan L., van der Heijden, Joris J., de Troy, Erwin, Dauwe, Dieter, Scholten, Erik, van der Velde, Franciska, Maas, Jacinta J., Dos Reis Miranda, Dinis, Kuijpers, Marijn, van den Brule, Judith, van den Bergh, Walter M., and Vlaar, Alexander P. J.

Published
2022
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24. Transfusion of red blood cells in venoarterial extracorporeal membrane oxygenation: A multicenter retrospective observational cohort study

Author

Raasveld, Senta Jorinde, primary, Karami, Mina, additional, Schenk, Jimmy, additional, Dos Reis Miranda, Dinis, additional, Mandigers, Loes, additional, Dauwe, Dieter F., additional, De Troy, Erwin, additional, Pappalardo, Federico, additional, Fominskiy, Evgeny, additional, van den Bergh, Walter M., additional, Oude Lansink‐Hartgring, Annemieke, additional, van der Velde, Franciska, additional, Maas, Jacinta J., additional, van de Berg, Pablo, additional, de Haan, Maarten, additional, Donker, Dirk W., additional, Meuwese, Christiaan L., additional, Taccone, Fabio Silvio, additional, Peluso, Lorenzo, additional, Lorusso, Roberto, additional, Delnoij, Thijs S. R., additional, Scholten, Erik, additional, Overmars, Martijn, additional, Ivančan, Višnja, additional, Bojčić, Robert, additional, de Metz, Jesse, additional, van den Bogaard, Bas, additional, de Bakker, Martin, additional, Reddi, Benjamin, additional, Hermans, Greet, additional, Broman, Lars Mikael, additional, Henriques, José P. S., additional, and Vlaar, Alexander P. J., additional

Published
2023
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27. Interrater agreement in classifying infections during extracorporeal membrane oxygenation

Author

Verkerk, Karlijn, Pladet, Lara C.A., Meuwese, Christiaan L., Donker, Dirk W., Derde, Lennie P.G., Cremer, Olaf L., Verkerk, Karlijn, Pladet, Lara C.A., Meuwese, Christiaan L., Donker, Dirk W., Derde, Lennie P.G., and Cremer, Olaf L.

Abstract

Infectious complications are common during extracorporeal membrane oxygenation (ECMO) and may negatively impact outcomes. However, there is considerable variation in the reported rates of incidence, which hampers the use of infections as a quality benchmark for ECMO centers. To assess the contributing role of poor interrater agreement, three independent raters reviewed medical records from all intensive care unit (ICU) patients who received ECMO for >24 h in our tertiary center between October 2019 and October 2021 for suspected episodes of infection, which were rated based on their date of onset and presumed site/diagnosis. To establish a gold standard, any discrepancies were resolved using an expert panel consisting of two intensivists/infectious disease specialists. During 83 ECMO-runs in 77 patients, we observed a total of 62 adjudicated infectious episodes (incidence rate 62, 95% CI: 48–80, per 1000 days at risk). Among 81 episodes suspected by at least one observer, 66 (81%) were identified by two, and only 44 (54%) by all three raters, resulting in Fleiss’ kappa of 0.10 (95% CI: 0.00–0.19; slight agreement). However, if raters concurred regarding infection onset, subsequent agreement on infection site was good (concordance 89%; kappa 0.85, 95% CI: 0.72–0.98; near perfect agreement). In conclusion, adjudication of infectious episodes during ECMO is associated with poor interrater agreement regarding occurrence—but not site—of infection. This finding might partially explain the significant disparities observed in reported infection rates during ECMO, emphasizing the need for caution when interpreting infection data in this particular population due to the potential for inherent measurement error.

Published
2023

28. Transfusion of red blood cells in venoarterial extracorporeal membrane oxygenation:A multicenter retrospective observational cohort study

Author

Raasveld, Senta Jorinde, Karami, Mina, Schenk, Jimmy, Dos Reis Miranda, Dinis, Mandigers, Loes, Dauwe, Dieter F., De Troy, Erwin, Pappalardo, Federico, Fominskiy, Evgeny, van den Bergh, Walter M., Oude Lansink-Hartgring, Annemieke, van der Velde, Franciska, Maas, Jacinta J., van de Berg, Pablo, de Haan, Maarten, Donker, Dirk W., Meuwese, Christiaan L., Taccone, Fabio Silvio, Peluso, Lorenzo, Lorusso, Roberto, Delnoij, Thijs S.R., Scholten, Erik, Overmars, Martijn, Ivančan, Višnja, Bojčić, Robert, de Metz, Jesse, van den Bogaard, Bas, de Bakker, Martin, Reddi, Benjamin, Hermans, Greet, Broman, Lars Mikael, Henriques, José P.S., Vlaar, Alexander P.J., Raasveld, Senta Jorinde, Karami, Mina, Schenk, Jimmy, Dos Reis Miranda, Dinis, Mandigers, Loes, Dauwe, Dieter F., De Troy, Erwin, Pappalardo, Federico, Fominskiy, Evgeny, van den Bergh, Walter M., Oude Lansink-Hartgring, Annemieke, van der Velde, Franciska, Maas, Jacinta J., van de Berg, Pablo, de Haan, Maarten, Donker, Dirk W., Meuwese, Christiaan L., Taccone, Fabio Silvio, Peluso, Lorenzo, Lorusso, Roberto, Delnoij, Thijs S.R., Scholten, Erik, Overmars, Martijn, Ivančan, Višnja, Bojčić, Robert, de Metz, Jesse, van den Bogaard, Bas, de Bakker, Martin, Reddi, Benjamin, Hermans, Greet, Broman, Lars Mikael, Henriques, José P.S., and Vlaar, Alexander P.J.

Abstract

Background: Evidence-based recommendations for transfusion in patients with venoarterial extracorporeal membrane oxygenation (VA ECMO) are scarce. The current literature is limited to single-center studies with small sample sizes, therefore complicating generalizability. This study aims to create an overview of red blood cell (RBC) transfusion in VA ECMO patients. Methods: This international mixed-method study combined a survey with a retrospective observational study in 16 centers. The survey inventoried local transfusion guidelines. Additionally, retrospective data of all adult patients with a VA ECMO run >24 h (January 2018 until July 2019) was collected of patient, ECMO, outcome, and daily transfusion parameters. All patients that received VA ECMO for primary cardiac support were included, including surgical (i.e., post-cardiotomy) and non-surgical (i.e., myocardial infarction) indications. The primary outcome was the number of RBC transfusions per day and in total. Univariable logistic regressions and a generalized linear mixed model (GLMM) were performed to assess factors associated with RBC transfusion. Results: Out of 419 patients, 374 (89%) received one or more RBC transfusions. During a median ECMO run of 5 days (1st–3rd quartile 3–8), patients received a median total of eight RBC units (1st–3rd quartile 3–17). A lower hemoglobin (Hb) prior to ECMO, longer ECMO-run duration, and hemorrhage were associated with RBC transfusion. After correcting for duration and hemorrhage using a GLMM, a different transfusion trend was found among the regimens. No unadjusted differences were found in overall survival between either transfusion status or the different regimens, which remained after adjustment for potential confounders. Conclusion: RBC transfusion in patients on VA ECMO is very common. The sum of RBC transfusions increases rapidly after ECMO initiation, and is dependent on the

Published
2023

29. Plasma Transfusion and Procoagulant Product Administration in Extracorporeal Membrane Oxygenation:A Secondary Analysis of an International Observational Study on Current Practices

Author

Van Haeren, Maite M.T., Raasveld, Senta Jorinde, Karami, Mina, Miranda, Dinis Dos Reis, Mandigers, Loes, Dauwe, Dieter F., De Troy, Erwin, Pappalardo, Federico, Fominskiy, Evgeny, Van Den Bergh, Walter M., Oude Lansink-Hartgring, Annemieke, Van Der Velde, Franciska, Maas, Jacinta J., Van De Berg, Pablo, De Haan, Maarten, Donker, Dirk W., Meuwese, Christiaan L., Taccone, Fabio Silvio, Peluso, Lorenzo, Lorusso, Roberto, Delnoij, Thijs S.R., Scholten, Erik, Overmars, Martijn, Ivancan, Višnja, Bojčić, Robert, De Metz, Jesse, Van Den Bogaard, Bas, De Bakker, Martin, Reddi, Benjamin, Hermans, Greet, Broman, Lars Mikael, Henriques, José P.S., Schenk, Jimmy, Vlaar, Alexander P.J., Müller, Marcella C.A., Van Haeren, Maite M.T., Raasveld, Senta Jorinde, Karami, Mina, Miranda, Dinis Dos Reis, Mandigers, Loes, Dauwe, Dieter F., De Troy, Erwin, Pappalardo, Federico, Fominskiy, Evgeny, Van Den Bergh, Walter M., Oude Lansink-Hartgring, Annemieke, Van Der Velde, Franciska, Maas, Jacinta J., Van De Berg, Pablo, De Haan, Maarten, Donker, Dirk W., Meuwese, Christiaan L., Taccone, Fabio Silvio, Peluso, Lorenzo, Lorusso, Roberto, Delnoij, Thijs S.R., Scholten, Erik, Overmars, Martijn, Ivancan, Višnja, Bojčić, Robert, De Metz, Jesse, Van Den Bogaard, Bas, De Bakker, Martin, Reddi, Benjamin, Hermans, Greet, Broman, Lars Mikael, Henriques, José P.S., Schenk, Jimmy, Vlaar, Alexander P.J., and Müller, Marcella C.A.

Abstract

OBJECTIVES: To achieve optimal hemostatic balance in patients on extracorporeal membrane oxygenation (ECMO), a liberal transfusion practice is currently applied despite clear evidence. We aimed to give an overview of the current use of plasma, fibrinogen concentrate, tranexamic acid (TXA), and prothrombin complex concentrate (PCC) in patients on ECMO.DESIGN: A prespecified subanalysis of a multicenter retrospective study. Venovenous (VV)-ECMO and venoarterial (VA)-ECMO are analyzed as separate populations, comparing patients with and without bleeding and with and without thrombotic complications. SETTING: Sixteen international ICUs.PATIENTS: Adult patients on VA-ECMO or VV-ECMO.INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 420 VA-ECMO patients, 59% (n = 247) received plasma, 20% (n = 82) received fibrinogen concentrate, 17% (n = 70) received TXA, and 7% of patients (n = 28) received PCC. Fifty percent of patients (n = 208) suffered bleeding complications and 27% (n = 112) suffered thrombotic complications. More patients with bleeding complications than patients without bleeding complications received plasma (77% vs. 41%, p < 0.001), fibrinogen concentrate (28% vs 11%, p < 0.001), and TXA (23% vs 10%, p < 0.001). More patients with than without thrombotic complications received TXA (24% vs 14%, p = 0.02, odds ratio 1.75) in VA-ECMO, where no difference was seen in VV-ECMO. Of 205 VV-ECMO patients, 40% (n = 81) received plasma, 6% (n = 12) fibrinogen concentrate, 7% (n = 14) TXA, and 5% (n = 10) PCC. Thirty-nine percent (n = 80) of VV-ECMO patients suffered bleeding complications and 23% (n = 48) of patients suffered thrombotic complications. More patients with than without bleeding complications received plasma (58% vs 28%, p < 0.001), fibrinogen concentrate (13% vs 2%, p < 0.01), and TXA (11% vs 2%, p < 0.01).

Published
2023

30. The interaction of thrombocytopenia, hemorrhage, and platelet transfusion in venoarterial extracorporeal membrane oxygenation:a multicenter observational study

Author

Raasveld, Senta Jorinde, van den Oord, Claudia, Schenk, Jimmy, van den Bergh, Walter M., Oude Lansink - Hartgring, Annemieke, van der Velde, Franciska, Maas, Jacinta J., van de Berg, Pablo, Lorusso, Roberto, Delnoij, Thijs S.R., Dos Reis Miranda, Dinis, Scholten, Erik, Taccone, Fabio Silvio, Dauwe, Dieter F., De Troy, Erwin, Hermans, Greet, Pappalardo, Federico, Fominskiy, Evgeny, Ivancan, Višnja, Bojčić, Robert, de Metz, Jesse, van den Bogaard, Bas, Donker, Dirk W., Meuwese, Christiaan L., De Bakker, Martin, Reddi, Benjamin, Henriques, José P.S., Broman, Lars Mikael, Dongelmans, Dave A., Vlaar, Alexander P.J., Raasveld, Senta Jorinde, van den Oord, Claudia, Schenk, Jimmy, van den Bergh, Walter M., Oude Lansink - Hartgring, Annemieke, van der Velde, Franciska, Maas, Jacinta J., van de Berg, Pablo, Lorusso, Roberto, Delnoij, Thijs S.R., Dos Reis Miranda, Dinis, Scholten, Erik, Taccone, Fabio Silvio, Dauwe, Dieter F., De Troy, Erwin, Hermans, Greet, Pappalardo, Federico, Fominskiy, Evgeny, Ivancan, Višnja, Bojčić, Robert, de Metz, Jesse, van den Bogaard, Bas, Donker, Dirk W., Meuwese, Christiaan L., De Bakker, Martin, Reddi, Benjamin, Henriques, José P.S., Broman, Lars Mikael, Dongelmans, Dave A., and Vlaar, Alexander P.J.

Abstract

Background: Thrombocytopenia, hemorrhage and platelet transfusion are common in patients supported with venoarterial extracorporeal membrane oxygenation (VA ECMO). However, current literature is limited to small single-center experiences with high degrees of heterogeneity. Therefore, we aimed to ascertain in a multicenter study the course and occurrence rate of thrombocytopenia, and to assess the association between thrombocytopenia, hemorrhage and platelet transfusion during VA ECMO. Methods: This was a sub-study of a multicenter (N = 16) study on transfusion practices in patients on VA ECMO, in which a retrospective cohort (Jan-2018–Jul-2019) focusing on platelets was selected. The primary outcome was thrombocytopenia during VA ECMO, defined as mild (100–150·109/L), moderate (50–100·109/L) and severe (< 50·109/L). Secondary outcomes included the occurrence rate of platelet transfusion, and the association between thrombocytopenia, hemorrhage and platelet transfusion, assessed through mixed-effect models.Results: Of the 419 patients included, median platelet count at admission was 179·109/L. During VA ECMO, almost all (N = 398, 95%) patients developed a thrombocytopenia, of which a significant part severe (N = 179, 45%). One or more platelet transfusions were administered in 226 patients (54%), whereas 207 patients (49%) suffered a hemorrhagic event during VA ECMO. In non-bleeding patients, still one in three patients received a platelet transfusion. The strongest association to receive a platelet transfusion was found in the presence of severe thrombocytopenia (adjusted OR 31.8, 95% CI 17.9–56.5). After including an interaction term of hemorrhage and thrombocytopenia, this even increased up to an OR of 110 (95% CI 34–360). Conclusions: Thrombocytopenia has a higher occurrence than is currently recognized. Severe thrombocytopenia is strongl

Published
2023

31. Clinical decision support for ExtraCorporeal Membrane Oxygenation:Will we fly by wire?

Author

Pladet, Lara, Luijken, Kim, Fresiello, Libera, Miranda, Dinis Dos Reis, Hermens, Jeannine A., Smeden, Maarten van, Cremer, Olaf, Donker, Dirk W., Meuwese, Christiaan L., Pladet, Lara, Luijken, Kim, Fresiello, Libera, Miranda, Dinis Dos Reis, Hermens, Jeannine A., Smeden, Maarten van, Cremer, Olaf, Donker, Dirk W., and Meuwese, Christiaan L.

Abstract

Prognostic modelling techniques have rapidly evolved over the past decade and may greatly benefit patients supported with ExtraCorporeal Membrane Oxygenation (ECMO). Epidemiological and computational physiological approaches aim to provide more accurate predictive assessments of ECMO-related risks and benefits. Implementation of these approaches may produce predictive tools that can improve complex clinical decisions surrounding ECMO allocation and management. This Review describes current applications of prognostic models and elaborates on upcoming directions for their clinical applicability in decision support tools directed at improved allocation and management of ECMO patients. The discussion of these new developments in the field will culminate in a futuristic perspective leaving ourselves and the readers wondering whether we may “fly ECMO by wire” someday.

Published
2023

32. Prognostic models for mortality risk in patients requiring ECMO

Author

Pladet, Lara C.A., Barten, Jaimie M.M., Vernooij, Lisette M., Kraemer, Carlos V.Elzo, Bunge, Jeroen J.H., Scholten, Erik, Montenij, Leon J., Kuijpers, Marijn, Donker, Dirk W., Cremer, Olaf L., Meuwese, Christiaan L., Pladet, Lara C.A., Barten, Jaimie M.M., Vernooij, Lisette M., Kraemer, Carlos V.Elzo, Bunge, Jeroen J.H., Scholten, Erik, Montenij, Leon J., Kuijpers, Marijn, Donker, Dirk W., Cremer, Olaf L., and Meuwese, Christiaan L.

Abstract

Purpose: To provide an overview and evaluate the performance of mortality prediction models for patients requiring extracorporeal membrane oxygenation (ECMO) support for refractory cardiocirculatory or respiratory failure. Methods: A systematic literature search was undertaken to identify studies developing and/or validating multivariable prediction models for all-cause mortality in adults requiring or receiving veno-arterial (V-A) or veno-venous (V-V) ECMO. Estimates of model performance (observed versus expected (O:E) ratio and c-statistic) were summarized using random effects models and sources of heterogeneity were explored by means of meta-regression. Risk of bias was assessed using the Prediction model Risk Of BiAS Tool (PROBAST). Results: Among 4905 articles screened, 96 studies described a total of 58 models and 225 external validations. Out of all 58 models which were specifically developed for ECMO patients, 14 (24%) were ever externally validated. Discriminatory ability of frequently validated models developed for ECMO patients (i.e., SAVE and RESP score) was moderate on average (pooled c-statistics between 0.66 and 0.70), and comparable to general intensive care population-based models (pooled c-statistics varying between 0.66 and 0.69 for the Simplified Acute Physiology Score II (SAPS II), Acute Physiology and Chronic Health Evaluation II (APACHE II) score and Sequential Organ Failure Assessment (SOFA) score). Nearly all models tended to underestimate mortality with a pooled O:E > 1. There was a wide variability in reported performance measures of external validations, reflecting a large between-study heterogeneity. Only 1 of the 58 models met the generally accepted Prediction model Risk Of BiAS Tool criteria of good quality. Importantly, all predicted outcomes were conditional on the fact that ECMO support had already been initiated, thereby reducing their applicability for patient selection in clinical practice. Conclusions: A large number of mo

Published
2023

34. Plasma Transfusion and Procoagulant Product Administration in Extracorporeal Membrane Oxygenation: A Secondary Analysis of an International Observational Study on Current Practices

Author

Medische Staf Intensive Care, Other research (not in main researchprogram), Van Haeren, Maite M.T., Raasveld, Senta Jorinde, Karami, Mina, Miranda, Dinis Dos Reis, Mandigers, Loes, Dauwe, Dieter F., De Troy, Erwin, Pappalardo, Federico, Fominskiy, Evgeny, Van Den Bergh, Walter M., Oude Lansink-Hartgring, Annemieke, Van Der Velde, Franciska, Maas, Jacinta J., Van De Berg, Pablo, De Haan, Maarten, Donker, Dirk W., Meuwese, Christiaan L., Taccone, Fabio Silvio, Peluso, Lorenzo, Lorusso, Roberto, Delnoij, Thijs S.R., Scholten, Erik, Overmars, Martijn, Ivancan, Višnja, Bojčić, Robert, De Metz, Jesse, Van Den Bogaard, Bas, De Bakker, Martin, Reddi, Benjamin, Hermans, Greet, Broman, Lars Mikael, Henriques, José P.S., Schenk, Jimmy, Vlaar, Alexander P.J., Müller, Marcella C.A., Medische Staf Intensive Care, Other research (not in main researchprogram), Van Haeren, Maite M.T., Raasveld, Senta Jorinde, Karami, Mina, Miranda, Dinis Dos Reis, Mandigers, Loes, Dauwe, Dieter F., De Troy, Erwin, Pappalardo, Federico, Fominskiy, Evgeny, Van Den Bergh, Walter M., Oude Lansink-Hartgring, Annemieke, Van Der Velde, Franciska, Maas, Jacinta J., Van De Berg, Pablo, De Haan, Maarten, Donker, Dirk W., Meuwese, Christiaan L., Taccone, Fabio Silvio, Peluso, Lorenzo, Lorusso, Roberto, Delnoij, Thijs S.R., Scholten, Erik, Overmars, Martijn, Ivancan, Višnja, Bojčić, Robert, De Metz, Jesse, Van Den Bogaard, Bas, De Bakker, Martin, Reddi, Benjamin, Hermans, Greet, Broman, Lars Mikael, Henriques, José P.S., Schenk, Jimmy, Vlaar, Alexander P.J., and Müller, Marcella C.A.

Published
2023

35. Transfusion of red blood cells in venoarterial extracorporeal membrane oxygenation: A multicenter retrospective observational cohort study

Author

Medische Staf Intensive Care, Other research (not in main researchprogram), Raasveld, Senta Jorinde, Karami, Mina, Schenk, Jimmy, Dos Reis Miranda, Dinis, Mandigers, Loes, Dauwe, Dieter F., De Troy, Erwin, Pappalardo, Federico, Fominskiy, Evgeny, van den Bergh, Walter M., Oude Lansink-Hartgring, Annemieke, van der Velde, Franciska, Maas, Jacinta J., van de Berg, Pablo, de Haan, Maarten, Donker, Dirk W., Meuwese, Christiaan L., Taccone, Fabio Silvio, Peluso, Lorenzo, Lorusso, Roberto, Delnoij, Thijs S.R., Scholten, Erik, Overmars, Martijn, Ivančan, Višnja, Bojčić, Robert, de Metz, Jesse, van den Bogaard, Bas, de Bakker, Martin, Reddi, Benjamin, Hermans, Greet, Broman, Lars Mikael, Henriques, José P.S., Vlaar, Alexander P.J., Medische Staf Intensive Care, Other research (not in main researchprogram), Raasveld, Senta Jorinde, Karami, Mina, Schenk, Jimmy, Dos Reis Miranda, Dinis, Mandigers, Loes, Dauwe, Dieter F., De Troy, Erwin, Pappalardo, Federico, Fominskiy, Evgeny, van den Bergh, Walter M., Oude Lansink-Hartgring, Annemieke, van der Velde, Franciska, Maas, Jacinta J., van de Berg, Pablo, de Haan, Maarten, Donker, Dirk W., Meuwese, Christiaan L., Taccone, Fabio Silvio, Peluso, Lorenzo, Lorusso, Roberto, Delnoij, Thijs S.R., Scholten, Erik, Overmars, Martijn, Ivančan, Višnja, Bojčić, Robert, de Metz, Jesse, van den Bogaard, Bas, de Bakker, Martin, Reddi, Benjamin, Hermans, Greet, Broman, Lars Mikael, Henriques, José P.S., and Vlaar, Alexander P.J.

Published
2023

36. Interrater agreement in classifying infections during extracorporeal membrane oxygenation

Author

Sepsis and Inflammation, Infection & Immunity, Medische Staf Intensive Care, Other research (not in main researchprogram), UMC Utrecht, Verkerk, Karlijn, Pladet, Lara C.A., Meuwese, Christiaan L., Donker, Dirk W., Derde, Lennie P.G., Cremer, Olaf L., Sepsis and Inflammation, Infection & Immunity, Medische Staf Intensive Care, Other research (not in main researchprogram), UMC Utrecht, Verkerk, Karlijn, Pladet, Lara C.A., Meuwese, Christiaan L., Donker, Dirk W., Derde, Lennie P.G., and Cremer, Olaf L.

Published
2023

37. The interaction of thrombocytopenia, hemorrhage, and platelet transfusion in venoarterial extracorporeal membrane oxygenation: a multicenter observational study

Author

Medische Staf Intensive Care, Other research (not in main researchprogram), Raasveld, Senta Jorinde, van den Oord, Claudia, Schenk, Jimmy, van den Bergh, Walter M., Oude Lansink - Hartgring, Annemieke, van der Velde, Franciska, Maas, Jacinta J., van de Berg, Pablo, Lorusso, Roberto, Delnoij, Thijs S.R., Dos Reis Miranda, Dinis, Scholten, Erik, Taccone, Fabio Silvio, Dauwe, Dieter F., De Troy, Erwin, Hermans, Greet, Pappalardo, Federico, Fominskiy, Evgeny, Ivancan, Višnja, Bojčić, Robert, de Metz, Jesse, van den Bogaard, Bas, Donker, Dirk W., Meuwese, Christiaan L., De Bakker, Martin, Reddi, Benjamin, Henriques, José P.S., Broman, Lars Mikael, Dongelmans, Dave A., Vlaar, Alexander P.J., Medische Staf Intensive Care, Other research (not in main researchprogram), Raasveld, Senta Jorinde, van den Oord, Claudia, Schenk, Jimmy, van den Bergh, Walter M., Oude Lansink - Hartgring, Annemieke, van der Velde, Franciska, Maas, Jacinta J., van de Berg, Pablo, Lorusso, Roberto, Delnoij, Thijs S.R., Dos Reis Miranda, Dinis, Scholten, Erik, Taccone, Fabio Silvio, Dauwe, Dieter F., De Troy, Erwin, Hermans, Greet, Pappalardo, Federico, Fominskiy, Evgeny, Ivancan, Višnja, Bojčić, Robert, de Metz, Jesse, van den Bogaard, Bas, Donker, Dirk W., Meuwese, Christiaan L., De Bakker, Martin, Reddi, Benjamin, Henriques, José P.S., Broman, Lars Mikael, Dongelmans, Dave A., and Vlaar, Alexander P.J.

Published
2023

38. Clinical decision support for ExtraCorporeal Membrane Oxygenation: Will we fly by wire?

Author

Sepsis and Inflammation, Infection & Immunity, Epi Methoden Team 3, Medische Staf Intensive Care, Other research (not in main researchprogram), Pladet, Lara, Luijken, Kim, Fresiello, Libera, Miranda, Dinis Dos Reis, Hermens, Jeannine A, Smeden, Maarten van, Cremer, Olaf, Donker, Dirk W, Meuwese, Christiaan L, Sepsis and Inflammation, Infection & Immunity, Epi Methoden Team 3, Medische Staf Intensive Care, Other research (not in main researchprogram), Pladet, Lara, Luijken, Kim, Fresiello, Libera, Miranda, Dinis Dos Reis, Hermens, Jeannine A, Smeden, Maarten van, Cremer, Olaf, Donker, Dirk W, and Meuwese, Christiaan L

Published
2023

39. Prognostic models for mortality risk in patients requiring ECMO

Author

Sepsis and Inflammation, Infection & Immunity, Onderzoek, Onderzoek Heart at Risk, Medische Staf Intensive Care, Other research (not in main researchprogram), Pladet, Lara C.A., Barten, Jaimie M.M., Vernooij, Lisette M., Kraemer, Carlos V.Elzo, Bunge, Jeroen J.H., Scholten, Erik, Montenij, Leon J., Kuijpers, Marijn, Donker, Dirk W., Cremer, Olaf L., Meuwese, Christiaan L., Sepsis and Inflammation, Infection & Immunity, Onderzoek, Onderzoek Heart at Risk, Medische Staf Intensive Care, Other research (not in main researchprogram), Pladet, Lara C.A., Barten, Jaimie M.M., Vernooij, Lisette M., Kraemer, Carlos V.Elzo, Bunge, Jeroen J.H., Scholten, Erik, Montenij, Leon J., Kuijpers, Marijn, Donker, Dirk W., Cremer, Olaf L., and Meuwese, Christiaan L.

Published
2023

40. On the quality of reporting quality of life after extracorporeal life support

Author

Sepsis and Inflammation, Infection & Immunity, Cardiologie, Medische Staf Intensive Care, Other research (not in main researchprogram), Pladet, Lara C.A., Meuwese, Christiaan L., Cremer, Olaf L., Donker, Dirk W., Sepsis and Inflammation, Infection & Immunity, Cardiologie, Medische Staf Intensive Care, Other research (not in main researchprogram), Pladet, Lara C.A., Meuwese, Christiaan L., Cremer, Olaf L., and Donker, Dirk W.

Published
2023

41. Patient-centered weaning from venoarterial extracorporeal membrane oxygenation: “A practice-oriented narrative review of literature”

Author

Medische Staf Intensive Care, CTC, Brain, Circulatory Health, Other research (not in main researchprogram), Hermens, Jeannine A.J., Meuwese, Christiaan L., Szymanski, Mariusz K., Gianoli, Monica, van Dijk, Diederik, Donker, Dirk W., Medische Staf Intensive Care, CTC, Brain, Circulatory Health, Other research (not in main researchprogram), Hermens, Jeannine A.J., Meuwese, Christiaan L., Szymanski, Mariusz K., Gianoli, Monica, van Dijk, Diederik, and Donker, Dirk W.

Published
2023

42. Patient-centered weaning from venoarterial extracorporeal membrane oxygenation: "A practice-oriented narrative review of literature".

Author

Hermens, Jeannine AJ, Meuwese, Christiaan L, Szymanski, Mariusz K, Gianoli, Monica, van Dijk, Diederik, and Donker, Dirk W

Subjects
*ECHOCARDIOGRAPHY, *LEFT heart ventricle, *RIGHT heart ventricle, *EXTRACORPOREAL membrane oxygenation, *PATIENT-centered care, *DOCUMENTATION, *VENTILATOR weaning, *ALGORITHMS
Abstract

Venoarterial extracorporeal membrane oxygenation (V-A ECMO) is increasingly used in cardiogenic shock for rapid stabilization and bridging towards recovery, long-term mechanical circulatory support or transplant. Although technological advances have instigated its widespread use, the complex, long-lasting ECMO care creates a significant strain on hospital staff and resources. Therefore, optimal clinical management including timely decisions on ECMO removal and further therapy are pivotal, yet require a well-structured weaning approach. Although dedicated guidelines are lacking, a variety of weaning protocols have distillated echocardiographic and hemodynamic predictors for successful weaning. Nevertheless, a strikingly high mortality up to 70% after initial successful weaning raises concerns about the validity of current weaning strategies. Here, we plead for a patient-tailored approach including a bailout strategy when weaning fails. This should account not only for left- but also right ventricular function and interdependence, as well as the temporal course of cardiac recovery in function of extracorporeal support. Patients with a high risk of weaning failure should be identified early, enabling timely transportation to an advanced heart failure center. This review summarizes predictors of successful weaning and discusses all relevant elements for a structured weaning approach with a central role for patient-specific clinical considerations and echocardiography. [ABSTRACT FROM AUTHOR]

Published
2023
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46. Propensity score-based analysis of long-term outcome of patients on HeartWare and HeartMate 3 left ventricular assist device support

Author

Numan, Lieke, Ramjankhan, Faiz Z, Oberski, Daniel L, Oerlemans, Martinus I F J, Aarts, Emmeke, Gianoli, Monica, Van Der Heijden, Joris J, De Jonge, Nicolaas, Van Der Kaaij, Niels P, Meuwese, Christiaan L, Mokhles, Mostafa M, Oppelaar, Anne-Marie, De Waal, Eric E C, Asselbergs, Folkert W, Van Laake, Linda W, Leerstoel Klugkist, Methodology and statistics for the behavioural and social sciences, Leerstoel Klugkist, Methodology and statistics for the behavioural and social sciences, and Cardiology

Subjects
lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, LVAD, Centrifugal continuous flow pump, medicine.medical_treatment, Left ventricular assist device, law.invention, Brain Ischemia, Randomized controlled trial, law, Mechanical circulatory support, Internal medicine, Original Research Articles, medicine, Humans, Original Research Article, Propensity Score, Retrospective Studies, Proportional hazards model, business.industry, Hazard ratio, medicine.disease, Confidence interval, MCS, Stroke, lcsh:RC666-701, Ventricular assist device, Heart failure, Propensity score matching, Cardiology, Heart-Assist Devices, business, Cardiology and Cardiovascular Medicine, Destination therapy
Abstract

Aims Left ventricular assist device therapy has become the cornerstone in the treatment of end‐stage heart failure and is increasingly used as destination therapy next to bridge to transplant or recovery. HeartMate 3 (HM3) and HeartWare (HVAD) are centrifugal continuous flow devices implanted intrapericardially and most commonly used worldwide. No randomized controlled trials have been performed yet. Analysis based on large registries may be considered as the best alternative but has the disadvantage of different standard of care between centres and missing data. Bias is introduced, because the decision which device to use was not random, even more so because many centres use only one type of left ventricular assist device. Therefore, we performed a propensity score (PS)‐based analysis of long‐term clinical outcome of patients that received HM3 or HVAD in a single centre. Methods and results Between December 2010 and December 2019, 100 patients received HVAD and 81 patients HM3 as primary implantation at the University Medical Centre Utrecht. We performed PS matching with an extensive set of covariates, resulting in 112 matched patients with a median follow‐up of 28 months. After PS matching, survival was not significantly different (P = 0.21) but was better for HM3. The cumulative incidences for haemorrhagic stroke (P = 0.01) and pump thrombosis (P = 0.02) were significantly higher for HVAD patients. The cumulative incidences for major bleeding, ischaemic stroke, right heart failure, and driveline infection were not different between the groups. We found no interaction between the surgeon who performed the implantation and survival (P = 0.59, P = 0.78, and P = 0.89). Sensitivity analysis was performed, by PS matching without patients on preoperative temporary support resulting in 74 matched patients. This also resulted in a non‐significant difference in survival (P = 0.07). The PS‐adjusted Cox regression showed a worse but non‐significant (P = 0.10) survival for HVAD patients with hazard ratio 1.71 (95% confidence interval 0.91–3.24). Conclusions Survival was not significantly different between both groups after PS matching, but was better for HM3, with a significantly lower incidence of haemorrhagic stroke and pump thrombosis for HM3. These results need to be interpreted carefully, because matching may have introduced greater imbalance on unmeasured covariates. A multicentre approach of carefully selected centres is recommended to enlarge the number of matched patients.

Published
2021

49. Outcomes of Extracorporeal Membrane Oxygenation in COVID-19-Induced Acute Respiratory Distress Syndrome:An Inverse Probability Weighted Analysis

Author

Raasveld, Senta Jorinde, Taccone, Fabio Silvio, Broman, Lars Mikael, Hermans, Greet, Meersseman, Philippe, Quintana Diaz, Manuel, Delnoij, Thijs S.R., Van De Poll, Marcel, Gouvea Bogossian, Elisa, Van Baarle, Floor L.F., Durak, Koray, Zayat, Rashad, Oude Lansink-Hartgring, Annemieke, Meuwese, Christiaan L., Van Der Heijden, Joris J., De Troy, Erwin, Dauwe, Dieter, Scholten, Erik, Van Der Velde, Franciska, Maas, Jacinta J., Dos Reis Miranda, Dinis, Kuijpers, Marijn, Van Den Brule, Judith, Van Den Bergh, Walter M., Vlaar, Alexander P.J., Raasveld, Senta Jorinde, Taccone, Fabio Silvio, Broman, Lars Mikael, Hermans, Greet, Meersseman, Philippe, Quintana Diaz, Manuel, Delnoij, Thijs S.R., Van De Poll, Marcel, Gouvea Bogossian, Elisa, Van Baarle, Floor L.F., Durak, Koray, Zayat, Rashad, Oude Lansink-Hartgring, Annemieke, Meuwese, Christiaan L., Van Der Heijden, Joris J., De Troy, Erwin, Dauwe, Dieter, Scholten, Erik, Van Der Velde, Franciska, Maas, Jacinta J., Dos Reis Miranda, Dinis, Kuijpers, Marijn, Van Den Brule, Judith, Van Den Bergh, Walter M., and Vlaar, Alexander P.J.

Abstract

IMPORTANCE: Although venovenous extracorporeal membrane oxygenation (VV ECMO) has been used in case of COVID-19 induced acute respiratory distress syndrome (ARDS), outcomes and criteria for its application should be evaluated. OBJECTIVES: To describe patient characteristics and outcomes in patients receiving VV ECMO due to COVID-19-induced ARDS and to assess the possible impact of COVID-19 on mortality. DESIGN, SETTING AND PARTICIPANTS: Multicenter retrospective study in 15 ICUs worldwide. All adult patients (> 18 yr) were included if they received VV ECMO with ARDS as main indication. Two groups were created: a COVID-19 cohort from March 2020 to December 2020 and a "control" non-COVID ARDS cohort from January 2018 to July 2019. MAIN OUTCOMES AND MEASURES: Collected data consisted of patient demographics, baseline variables, ECMO characteristics, and patient outcomes. The primary outcome was 60-day mortality. Secondary outcomes included patient characteristics, COVID-19-related therapies before and during ECMO and complication rate. To assess the influence of COVID-19 on mortality, inverse probability weighted (IPW) analyses were used to correct for predefined confounding variables. RESULTS: A total of 193 patients with COVID-19 received VV ECMO. The main indication for VV ECMO consisted of refractory hypoxemia, either isolated or combined with refractory hypercapnia. Complications with the highest occurrence rate included hemorrhage, an additional infectious event or acute kidney injury. Mortality was 35% and 45% at 28 and 60 days, respectively. Those mortality rates did not differ between the first and second waves of COVID-19 in 2020. Furthermore, 60-day mortality was equal between patients with COVID-19 and non-COVID-19-associated ARDS receiving VV ECMO (hazard ratio 60-d mortality, 1.27; 95% CI, 0.82-1.98; p = 0.30). CONCLUSIONS AND RELEVANCE: Mortality for patients with COVID-19 who received VV ECMO was similar to that reported in other COVID-19 cohorts

Published
2022

50. RBC Transfusion in Venovenous Extracorporeal Membrane Oxygenation:A Multicenter Cohort Study

Author

Raasveld, Senta Jorinde, Karami, Mina, van den Bergh, Walter M., Lansink-Hartgring, Annemieke Oude, van der Velde, Franciska, Maas, Jacinta J., van de Berg, Pablo, de Haan, Maarten, Lorusso, Roberto, Delnoij, Thijs S.R., Dos Reis Miranda, Dinis, Mandigers, Loes, Scholten, Erik, Overmars, Martijn, Taccone, Fabio Silvio, Brasseur, Alexandre, Dauwe, Dieter F., de Troy, Erwin, Hermans, Greet, Meersseman, Philippe, Pappalardo, Federico, Fominskiy, Evgeny, Ivancan, Višnja, Bojčić, Robert, de Metz, Jesse, van den Bogaard, Bas, Donker, Dirk W., Meuwese, Christiaan L., de Bakker, Martin, Reddi, Benjamin, de Bruin, Sanne, Lagrand, Wim K., Henriques, José P.S., Broman, Lars M., Vlaar, Alexander P.J., Raasveld, Senta Jorinde, Karami, Mina, van den Bergh, Walter M., Lansink-Hartgring, Annemieke Oude, van der Velde, Franciska, Maas, Jacinta J., van de Berg, Pablo, de Haan, Maarten, Lorusso, Roberto, Delnoij, Thijs S.R., Dos Reis Miranda, Dinis, Mandigers, Loes, Scholten, Erik, Overmars, Martijn, Taccone, Fabio Silvio, Brasseur, Alexandre, Dauwe, Dieter F., de Troy, Erwin, Hermans, Greet, Meersseman, Philippe, Pappalardo, Federico, Fominskiy, Evgeny, Ivancan, Višnja, Bojčić, Robert, de Metz, Jesse, van den Bogaard, Bas, Donker, Dirk W., Meuwese, Christiaan L., de Bakker, Martin, Reddi, Benjamin, de Bruin, Sanne, Lagrand, Wim K., Henriques, José P.S., Broman, Lars M., and Vlaar, Alexander P.J.

Abstract

OBJECTIVES: In the general critical care patient population, restrictive transfusion regimen of RBCs has been shown to be safe and is yet implemented worldwide. However, in patients on venovenous extracorporeal membrane oxygenation, guidelines suggest liberal thresholds, and a clear overview of RBC transfusion practice is lacking. This study aims to create an overview of RBC transfusion in venovenous extracorporeal membrane oxygenation. DESIGN: Mixed method approach combining multicenter retrospective study and survey. SETTING: Sixteen ICUs worldwide. PATIENTS: Patients receiving venovenous extracorporeal membrane oxygenation between January 2018 and July 2019. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the proportion receiving RBC, the amount of RBC units given daily and in total. Furthermore, the course of hemoglobin over time during extracorporeal membrane oxygenation was assessed. Demographics, extracorporeal membrane oxygenation characteristics, and patient outcome were collected. Two-hundred eight patients received venovenous extracorporeal membrane oxygenation, 63% male, with an age of 55 years (45–62 yr), mainly for acute respiratory distress syndrome. Extracorporeal membrane oxygenation duration was 9 days (5–14 d). Prior to extracorporeal membrane oxygenation, hemoglobin was 10.8g/dL (8.9–13.0g/dL), decreasing to 8.7g/dL (7.7–9.8g/dL) during extracorporeal membrane oxygenation. Nadir hemoglobin was lower on days when a transfusion was administered (8.1g/dL [7.4–9.3g/dL]). A vast majority of 88% patients received greater than or equal to 1 RBC transfusion, consisting of 1.6 U (1.3–2.3 U) on transfusion days. This high transfusion occurrence rate was also found in nonbleeding patients (81%). Patients with a liberal transfusion threshold (hemoglobin > 9g/dL) received more RBC in total per transfusion day and extracorporeal membrane oxygenation day. No differences in survival, hemorrhagic and thrombotic complication rates

Published
2022

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