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3. PERSUADE Survey—PERioperative AnestheSia and Intensive Care Management of Left VentricUlar Assist DevicE Implantation in Europe and the United States

Author

Alfirevic, Andrej, Anton, James M., Antoniou, Theofani, Auci, Elisabetta, Badakhsh, Orode, Banks, Dalia A., Barrio, Jose M., Bartels, Karsten, Belli, Erol V., Bermede, Onat, Bettex, Dominique, Biedermann, Sébastien, Boelsen, Jonas, Boisen, Michael L., Book, Malte, Bottiger, Brandi A., Bouchez, Stefaan, Bräuer, Anselm, Brodt, Jessica L, Chaudhry, Sunit-Preet, Conlin, Frederick T., Cormican, Daniel S., Cristinar, Mircea, Curtis, Michael S., Dalia, Adam A., D'Avino, Emilio, Durand, Michel, Eberle, Balthasar, Emmert, Daniel A., Erb, Joachim M., Falterman, Jason, Forner, Anna Flo, Gatha, Nehal M., Gaudard, Philippe, Giebler, Antasia, Gliga, Louise A., Guarracino, Fabio, Gürcü, Mustafa E., Hans, Gregory A., Hanson, Ross S., Heringlake, Matthias, Hilberath, Jan N., Hommel, Matthias, Huhn, Ragnar, Iyer, Manoj H., Jacquet, Luc M., Karadeniz, Ümit, Kertai, Miklos D., Martin, Archer Kilbourne, Kolarczyk, Lavinia M., Koller, Tobias, Kurian, Dinesh J., Kornfield, Zev N., Koster, Andreas, Kranke, Peter, Krauss, Bernadette, Kudsioglu, Turkan, Kwak, Jenny, Lachauer, Steffen, Lagier, David, Lango, Romuald, Liang, Hong, Lilie, Craig J., Logeman, Elisabeth Angelique, Magunia, Harry, Mahmoud, Saifeldin, Makar, Moody, Markovic, Dejan, Mathis, Michael R., Mattei, Mathieu, Mazzeffi, Michael A., McCabe, Melissa D., Meers, J. Brad, Moitra, Vivek K., Møller-Sørensen, Hasse, Moravcova, Sarka, Muellejans, Bernd, Münch, Christopher M., Murray, Andrew W., Moncho, Azucena Pajares, Ngai, Jennie, Nielsen, Dorthe V., Ortoleva, Jamel P., Ouattara, Alexandre, Patel, Bhoumesh, Paul, Frank, Peng, Yong G., Pittarello, Demetrio, Prabhu, Mahesh, Rancati, Valentina, Rex, Steffen, Riha, Hynek, Robitaille, Mark J., Blanco, Yiliam Rodriguez, Rovira, Irene, Ruusalepp, Arno, Samalavicius, Robertas, Saatee, Siavosh, Sauer, William J., Scheiermann, Patrick, Schlesinger, Rachel E., Schroeder, Andrew M., Schroeder, Sarah E., Shih, Henry, Slaughter, Mark S., Sostaric, Maja, Šribar, Andrej, Svalebjørg, Morten, Székely, Andrea, Szentgyorgyi, Lajos, ter Horst, Maarten, Tschernko, Edda M., Twite, Mark, Ulrichs, Christoph, van der Maaten, Joost M.A.A., van der Ploeg, Nathalie, Vilela, Hugo P., von Homeyer, Peter, Wagner, Nana-Maria, Weiner, Menachem M., Wunder, Christian, Zink, Wolfgang, Kummerow, Maren, von Dossow, Vera, Pasero, Daniela, Martinez Lopez de Arroyabe, Blanca, Abrams, Benjamin, Kowalsky, Markus, Wilkey, Barbara J., Subramanian, Kathirvel, Martin, Archer K., Marczin, Nandor, and de Waal, Eric E.C.

Published
2024
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6. International consensus recommendations for anesthetic and intensive care management of lung transplantation. An EACTAIC, SCA, ISHLT, ESOT, ESTS, and AST approved document

Author

Burrell, Aidan, Carmona, Paula, Greenhalgh, Donna, Höchter, Dominik, Kachulis, Bessie, King, Christopher S., Licker, Marc J., McIlroy, David R., Nair, Priya, Pasero, Daniela, Pilcher, David, Rex, Steffen, Royston, David, Slinger, Peter, Valenza, Franco, Walker, Chris, Arcadipane, Antonio, Bastien, Oliver, Bekkers, Joseph A., Bettex, Dominique, Caliandro, Francesca, Checco, Erika Dal, Davis, Robert Duane, Dellgren, Göran, Espinoza, Andreas, Felten, Marie Louise, Feltracco, Paolo, Fischler, Marc, Fitzgerald, Linda J, Forner, Ana Flo, Fragata, Isabel, Román, Ana González, Harris, Paul, Hommel, Matthias, Lees, Nicholas J., Guen, Morgan Le, Leone, Marc, Lepoivre, Thierry, Marcucci, Carlo, Martelli, Sabina, Michel-Cherqui, Mireille, Molitoris, Ulrich, Montravers, Philippe, Mosca, Roberto, Parizkova, Barbora, Prabhu, Mahesh, Pugliese, Francesco, Raman, Sanjeev M., Ramos, Cristina, Ranieri, Vito Marco, Real, Maria I., Ricksten, Sven-Erik, Roman, Ana Gonzalez, Rozec, Bertrand, Sale, Shiva M., Sanchez, Juan F., Schwarzenberger, Johanna, Turan, Sema, Valchanov, Kamen, Valentine, Vincent G., von Homeyer, Peter, Vuylsteke, Alain, Weig, Thomas, Zarragoikoetxea, Iratxe, Zenz, Sebastian, Falcoz, Pierre-Emmanuel, Inci, Ilhan, Roscoe, Andrew, Senturk, Mert, Marczin, Nandor, de Waal, Eric E.C., Hopkins, Peter M.A., Mulligan, Michael S., Simon, Andre, Shaw, Andrew D., Van Raemdonck, Dirk, Neyrinck, Arne, Gries, Cynthia J., Algotsson, Lars, Szegedi, Laszlo, and von Dossow, Vera

Published
2021
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8. Can perioperative pCO2 gaps predict complications in patients undergoing major elective abdominal surgery randomized to goal-directed therapy or standard care? A secondary analysis

Author

Medische staf Anesthesiologie, Circulatory Health, Medische Staf Spoedeisende Hulp, de Keijzer, Ilonka N., Kaufmann, Thomas, de Waal, Eric E.C., Frank, Michael, de Korte-de Boer, Dianne, Montenij, Leonard M., Buhre, Wolfgang, Scheeren, Thomas W.L., Medische staf Anesthesiologie, Circulatory Health, Medische Staf Spoedeisende Hulp, de Keijzer, Ilonka N., Kaufmann, Thomas, de Waal, Eric E.C., Frank, Michael, de Korte-de Boer, Dianne, Montenij, Leonard M., Buhre, Wolfgang, and Scheeren, Thomas W.L.

Published
2024

9. PERSUADE Survey—PERioperative AnestheSia and Intensive Care Management of Left VentricUlar Assist DevicE Implantation in Europe and the United States

Author

Circulatory Health, Medische Staf Spoedeisende Hulp, Poli INT, Medische staf Anesthesiologie, Kummerow, Maren, von Dossow, Vera, Pasero, Daniela, Martinez Lopez de Arroyabe, Blanca, Abrams, Benjamin, Kowalsky, Markus, Wilkey, Barbara J., Subramanian, Kathirvel, Martin, Archer K., Marczin, Nandor, de Waal, Eric E.C., EACTAIC Transplant and VAD Subcommittee, SATA, and writing group, Circulatory Health, Medische Staf Spoedeisende Hulp, Poli INT, Medische staf Anesthesiologie, Kummerow, Maren, von Dossow, Vera, Pasero, Daniela, Martinez Lopez de Arroyabe, Blanca, Abrams, Benjamin, Kowalsky, Markus, Wilkey, Barbara J., Subramanian, Kathirvel, Martin, Archer K., Marczin, Nandor, de Waal, Eric E.C., and EACTAIC Transplant and VAD Subcommittee, SATA, and writing group

Published
2024

10. FLAVOUR Study: FLow profiles And postoperative VasOplegia after continUous-flow left ventriculaR assist device implantation

Author

AIOS Anesthesiologie, Cardiologie, Onderzoek Precision medicine, CTC, Circulatory Health, Team Medisch, Regenerative Medicine and Stem Cells, Medische Staf Spoedeisende Hulp, Kersten, Bas J., Numan, Lieke, van der Schoot, Marnix M., de Jong, Michel, Ramjankhan, Faiz, Aarts, Emmeke, Oerlemans, Marish I.F.J., van Laake, Linda W., de Waal, Eric E.C., AIOS Anesthesiologie, Cardiologie, Onderzoek Precision medicine, CTC, Circulatory Health, Team Medisch, Regenerative Medicine and Stem Cells, Medische Staf Spoedeisende Hulp, Kersten, Bas J., Numan, Lieke, van der Schoot, Marnix M., de Jong, Michel, Ramjankhan, Faiz, Aarts, Emmeke, Oerlemans, Marish I.F.J., van Laake, Linda W., and de Waal, Eric E.C.

Published
2024

11. Can the values of the venous-to-arterial pCO2 difference (pCO2 gap) be negative? A response.

Author

AIOS Anesthesiologie, Medische staf Anesthesiologie, Circulatory Health, de Keijzer, Ilonka N., Kaufmann, Thomas, de Waal, Eric E.C., Frank, Michael, de Korte-de Boer, Dianne, Montenij, Leonard M., Buhre, Wolfgang F.F.A., Scheeren, Thomas W.L., AIOS Anesthesiologie, Medische staf Anesthesiologie, Circulatory Health, de Keijzer, Ilonka N., Kaufmann, Thomas, de Waal, Eric E.C., Frank, Michael, de Korte-de Boer, Dianne, Montenij, Leonard M., Buhre, Wolfgang F.F.A., and Scheeren, Thomas W.L.

Published
2024

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

Author

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., 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.

Abstract

Background: In refractory cardiogenic shock, temporary mechanical support (tMCS) may be crucial for maintaining tissue perfusion and oxygen delivery. tMCS can serve as a bridge-to-decision to assess eligibility for left ventricular assist device (LVAD) implantation or heart transplantation, or as a bridge-to-recovery. ECPELLA is a novel tMCS configuration combining venoarterial extracorporeal membrane oxygenation with Impella. The present study presents the clinical parameters, outcomes, and complications of patients supported with ECPELLA. Methods: All patients supported with ECPELLA at University Medical Centre Utrecht between December 2020 and August 2023 were included. The primary outcome was 30-day mortality, and secondary outcomes were LVAD implantation/heart transplantation and safety outcomes. Results: Twenty patients with an average age of 51 years, and of whom 70% were males, were included. Causes of cardiogenic shock were acute heart failure (due to acute coronary syndrome, myocarditis, or after cardiac surgery) or chronic heart failure, respectively 70 and 30% of cases. The median duration of ECPELLA support was 164 h (interquartile range 98–210). In 50% of cases, a permanent LVAD was implanted. Cardiac recovery within 30 days was seen in 30% of cases and 30-day mortality rate was 20%. ECPELLA support was associated with major bleeding (40%), haemolysis (25%), vascular complications (30%), kidney failure requiring replacement therapy (50%), and Impella failure requiring extraction (15%). Conclusion: ECPELLA can be successfully used as a bridge to LVAD implantation or as a bridge-to-recovery in patients with refractory cardiogenic shock. Despite a significant number of complications, 30-day mortality was lower than observed in previous cohorts.

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. PERSUADE Survey – PERioperative AnestheSia and Intensive Care Management of Left VentricUlar Assist DevicE Implantation in Europe and the United States of America.

Author

Kummerow, Maren, primary, von Dossow, Vera, additional, Pasero, Daniela, additional, de Arroyabe, Blanca Martinez Lopez, additional, Abrams, Benjamin, additional, Kowalsky, Markus, additional, Wilkey, Barbara J., additional, Subramanian, Kathirvel, additional, Martin, Archer K., additional, Marczin, Nandor, additional, and de Waal, Eric E.C., additional

Published
2023
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15. Can perioperative pCO2 gaps predict complications in patients undergoing major elective abdominal surgery randomized to goal-directed therapy or standard care? A secondary analysis.

Author

de Keijzer, Ilonka N., Kaufmann, Thomas, de Waal, Eric E.C., Frank, Michael, de Korte-de Boer, Dianne, Montenij, Leonard M., Buhre, Wolfgang, and Scheeren, Thomas W.L.

Abstract

The difference between venous and arterial carbon dioxide pressure (pCO2 gap), has been used as a diagnostic and prognostic tool. We aimed to assess whether perioperative pCO2 gaps can predict postoperative complications. This was a secondary analysis of a multicenter RCT comparing goal-directed therapy (GDT) to standard care in which 464 patients undergoing high-risk elective abdominal surgery were included. Arterial and central venous blood samples were simultaneously obtained at four time points: after induction, at the end of surgery, at PACU/ICU admission, and PACU/ICU discharge. Complications within the first 30 days after surgery were recorded. Similar pCO2 gaps were found in patients with and without complications, except for the pCO2 gap at the end of surgery, which was higher in patients with complications (6.0 mmHg [5.0–8.0] vs. 6.0 mmHg [4.1–7.5], p = 0.005). The area under receiver operating characteristics curves for predicting complications from pCO2 gaps at all time points were between 0.5 and 0.6. A weak correlation between ScvO2 and pCO2 gaps was found for all timepoints (ρ was between − 0.40 and − 0.29 for all timepoints, p < 0.001). The pCO2 gap did not differ between GDT and standard care at any of the selected time points. In our study, pCO2 gap was a poor predictor of major postoperative complications at all selected time points. Our research does not support the use of pCO2 gap as a prognostic tool after high-risk abdominal surgery. pCO2 gaps were comparable between GDT and standard care. Clinical trial registration Netherlands Trial Registry NTR3380. [ABSTRACT FROM AUTHOR]

Published
2024
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16. PERSUADE Survey—PERioperative AnestheSia and Intensive Care Management of Left VentricUlar Assist DevicE Implantation in Europe and the United States.

Author

Kummerow, Maren, von Dossow, Vera, Pasero, Daniela, Martinez Lopez de Arroyabe, Blanca, Abrams, Benjamin, Kowalsky, Markus, Wilkey, Barbara J., Subramanian, Kathirvel, Martin, Archer K., Marczin, Nandor, and de Waal, Eric E.C.

Abstract

To comprehensively assess relevant institutional variations in anesthesia and intensive care management during left ventricular assist device (LVAD) implantation. The authors used a prospective data analysis. This was an online survey. Participants were from LVAD centers in Europe and the US. After investigating initial interest, 91 of 202 European and 93 of 195 US centers received a link to the survey targeting institutional organization and experience, perioperative hemodynamic monitoring, medical management, and postoperative intensive care aspects. The survey was completed by 73 (36.1%) European and 60 (30.8%) US centers. Although most LVAD implantations were performed in university hospitals (>5 years of experience), significant differences were observed in the composition of the preoperative multidisciplinary team and provision of intraoperative care. No significant differences in monitoring or induction agents were observed. Propofol was used more often for maintenance in Europe (p < 0.001). The choice for inotropes changed significantly from preoperatively (more levosimendan in Europe) to intraoperatively (more use of epinephrine in both Europe and the US). The use of quantitative methods for defining right ventricular (RV) function was reported more often from European centers than from US centers (p < 0.05). Temporary mechanical circulatory support for the treatment of RV failure was more often used in Europe. Nitric oxide appeared to play a major role only intraoperatively. There were no significant differences in early postoperative complications reported from European versus US centers. Although the perioperative practice of care for patients undergoing LVAD implantation differs in several aspects between Europe and the US, there were no perceived differences in early postoperative complications. [ABSTRACT FROM AUTHOR]

Published
2024
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18. Response to comments

Author

de Waal, Eric E.C., primary, Frank, Michael, additional, Scheeren, Thomas W.L., additional, Kaufmann, Thomas, additional, de Korte-de Boer, Dianne, additional, Cox, Boris, additional, van Kuijk, Sander M.J., additional, Montenij, Leon M., additional, and Buhre, Wolfgang, additional

Published
2022
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19. Can the values of the venous-to-arterial pCO2 difference (pCO2 gap) be negative? A response.

Author

de Keijzer, Ilonka N., Kaufmann, Thomas, de Waal, Eric E.C., Frank, Michael, de Korte-de Boer, Dianne, Montenij, Leonard M., Buhre, Wolfgang F.F.A., and Scheeren, Thomas W.L.

Abstract

The article responds to a comment made by Dr. Mallat regarding the values of the venous-to-arterial pCO2 difference (pCO2 gap) in a previous study. The authors acknowledge that negative pCO2 gap values are inappropriate and have removed them from their study. They have re-analyzed their data and found no significant changes to their main conclusions. The article includes a table presenting the pCO2 gap values in patients grouped by complications or treatment arm. The authors declare their competing interests and funding sources. [Extracted from the article]

Published
2024
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21. International consensus recommendations for anesthetic and intensive care management of lung transplantation. An EACTAIC, SCA, ISHLT, ESOT, ESTS, and AST approved document

Author

Marczin, Nandor, primary, de Waal, Eric E.C., additional, Hopkins, Peter M.A., additional, Mulligan, Michael S., additional, Simon, Andre, additional, Shaw, Andrew D., additional, Van Raemdonck, Dirk, additional, Neyrinck, Arne, additional, Gries, Cynthia J., additional, Algotsson, Lars, additional, Szegedi, Laszlo, additional, von Dossow, Vera, additional, Burrell, Aidan, additional, Carmona, Paula, additional, Greenhalgh, Donna, additional, Höchter, Dominik, additional, Kachulis, Bessie, additional, King, Christopher S., additional, Licker, Marc J., additional, McIlroy, David R., additional, Nair, Priya, additional, Pasero, Daniela, additional, Pilcher, David, additional, Rex, Steffen, additional, Royston, David, additional, Slinger, Peter, additional, Valenza, Franco, additional, Walker, Chris, additional, Arcadipane, Antonio, additional, Bastien, Oliver, additional, Bekkers, Joseph A., additional, Bettex, Dominique, additional, Caliandro, Francesca, additional, Checco, Erika Dal, additional, Davis, Robert Duane, additional, Dellgren, Göran, additional, Espinoza, Andreas, additional, Felten, Marie Louise, additional, Feltracco, Paolo, additional, Fischler, Marc, additional, Fitzgerald, Linda J, additional, Forner, Ana Flo, additional, Fragata, Isabel, additional, Román, Ana González, additional, Harris, Paul, additional, Hommel, Matthias, additional, Lees, Nicholas J., additional, Guen, Morgan Le, additional, Leone, Marc, additional, Lepoivre, Thierry, additional, Marcucci, Carlo, additional, Martelli, Sabina, additional, Michel-Cherqui, Mireille, additional, Molitoris, Ulrich, additional, Montravers, Philippe, additional, Mosca, Roberto, additional, Parizkova, Barbora, additional, Prabhu, Mahesh, additional, Pugliese, Francesco, additional, Raman, Sanjeev M., additional, Ramos, Cristina, additional, Ranieri, Vito Marco, additional, Real, Maria I., additional, Ricksten, Sven-Erik, additional, Roman, Ana Gonzalez, additional, Rozec, Bertrand, additional, Sale, Shiva M., additional, Sanchez, Juan F., additional, Schwarzenberger, Johanna, additional, Turan, Sema, additional, Valchanov, Kamen, additional, Valentine, Vincent G., additional, von Homeyer, Peter, additional, Vuylsteke, Alain, additional, Weig, Thomas, additional, Zarragoikoetxea, Iratxe, additional, Zenz, Sebastian, additional, Falcoz, Pierre-Emmanuel, additional, Inci, Ilhan, additional, Roscoe, Andrew, additional, and Senturk, Mert, additional

Published
2021
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22. Propensity score-based analysis of long-term outcome of patients on HeartWare and HeartMate 3 left ventricular assist device support

Author

Onderzoek Vrouw Hart & Vaatziekten, Onderzoek Precision medicine, CTC, Circulatory Health, Datascience, Team Medisch, Medische Staf Intensive Care, Medische staf Anesthesiologie, Regenerative Medicine and Stem Cells, 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., Onderzoek Vrouw Hart & Vaatziekten, Onderzoek Precision medicine, CTC, Circulatory Health, Datascience, Team Medisch, Medische Staf Intensive Care, Medische staf Anesthesiologie, Regenerative Medicine and Stem Cells, 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., and Van Laake, Linda W.

Published
2021

24. Propensity score‐based analysis of long‐term outcome of patients on HeartWare and HeartMate 3 left ventricular assist device support

Author

Numan, Lieke, primary, Ramjankhan, Faiz Z., additional, Oberski, Daniel L., additional, Oerlemans, Martinus I.F.J., additional, Aarts, Emmeke, additional, Gianoli, Monica, additional, Van Der Heijden, Joris J., additional, De Jonge, Nicolaas, additional, Van Der Kaaij, Niels P., additional, Meuwese, Christiaan L., additional, Mokhles, Mostafa M., additional, Oppelaar, Anne‐Marie, additional, De Waal, Eric E.C., additional, Asselbergs, Folkert W., additional, and Van Laake, Linda W., additional

Published
2021
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28. Effects of dobutamine and phenylephrine on cerebral perfusion in patients undergoing cerebral bypass surgery: a randomised crossover trial

Author

AIOS Anesthesiologie, Medische staf Anesthesiologie, Circulatory Health, ZL Cerebrovasculaire Ziekten Medisch, Brain, Neurologie, Management Vitale Functies, Akkermans, Annemarie, van Waes, Judith A.R., van Doormaal, Tristan P.C., de Waal, Eric E.C., Rinkel, Gabriël J.E., van der Zwan, Albert, Kalkman, Cor J., van Klei, Wilton A., AIOS Anesthesiologie, Medische staf Anesthesiologie, Circulatory Health, ZL Cerebrovasculaire Ziekten Medisch, Brain, Neurologie, Management Vitale Functies, Akkermans, Annemarie, van Waes, Judith A.R., van Doormaal, Tristan P.C., de Waal, Eric E.C., Rinkel, Gabriël J.E., van der Zwan, Albert, Kalkman, Cor J., and van Klei, Wilton A.

Published
2020

29. Vasoplegia after implantation of a continuous flow left ventricular assist device : Incidence, outcomes and predictors 11 Medical and Health Sciences 1103 Clinical Sciences

Author

De Waal, Eric E.C., Van Zaane, Bas, Van Der Schoot, Marnix M., Huisman, Albert, Ramjankhan, Faiz, Van Klei, Wilton A., and Marczin, Nandor

Subjects
Anesthesiology and Pain Medicine, Mechanical circulatory support, Cardiac Vasoplegia syndrome, Incidence, Morbidity, Mortality, Prediction, Outcome
Abstract

Background: Vasoplegia after routine cardiac surgery is associated with severe postoperative complications and increased mortality. It is also prevalent in patients undergoing implantation of pulsatile flow left ventricular assist devices (LVAD). However, less is known regarding vasoplegia after implantation of newer generations of continuous flow LVADs (cfLVAD). We aim to report the incidence, impact on outcome and predictors of vasoplegia in these patients. Methods: Adult patients scheduled for primary cfLVAD implantation were enrolled into a derivation cohort (n = 118, 2006-2013) and a temporal validation cohort (n = 73, 2014-2016). Vasoplegia was defined taking into consideration low mean arterial pressure and/or low systemic vascular resistance, preserved cardiac index and high vasopressor support. Vasoplegia was considered after bypass and the first 48 h of ICU stay lasting at least three consecutive hours. This concept of vasoplegia was compared to older definitions reported in the literature in terms of the incidence of postoperative vasoplegia and its association with adverse outcomes. Logistic regression was used to identify independent predictors. Their ability to discriminate patients with vasoplegia was quantified by the area under the receiver operating characteristic curve (AUC). Results: The incidence of vasoplegia was 33.1% using the unified definition of vasoplegia. Vasoplegia was associated with increased ICU length-of-stay (10.5 [6.9-20.8] vs 6.1 [4.6-10.4] p = 0.002), increased ICU-mortality (OR 5.8, 95% CI 1.9-18.2) and one-year-mortality (OR 3.9, 95% CI 1.5-10.2), and a higher incidence of renal failure (OR 4.3, 95% CI 1.8-10.4). Multivariable analysis identified previous cardiothoracic surgery, preoperative dopamine administration, preoperative bilirubin levels and preoperative creatinine clearance as independent preoperative predictors of vasoplegia. The resultant prediction model exhibited a good discriminative ability (AUC 0.80, 95% CI 0.71-0.89, p < 0.01). Temporal validation resulted in an AUC of 0.74 (95% CI 0.61-0.87, p < 0.01). Conclusions: In the era of the new generation of cfLVADs, vasoplegia remains a prevalent (33%) and critical condition with worse short-term outcomes and survival. We identified previous cardiothoracic surgery, preoperative treatment with dopamine, preoperative bilirubin levels and preoperative creatinine clearance as independent predictors.

Published
2018

30. Vasoplegia after implantation of a continuous flow left ventricular assist device: Incidence, outcomes and predictors 11 Medical and Health Sciences 1103 Clinical Sciences

Author

Medische staf Anesthesiologie, Circulatory Health, CDL Staf Patiëntenzorg KC, Other research (not in main researchprogram), CTC, Management Vitale Functies, De Waal, Eric E.C., Van Zaane, Bas, Van Der Schoot, Marnix M., Huisman, Albert, Ramjankhan, Faiz, Van Klei, Wilton A., Marczin, Nandor, Medische staf Anesthesiologie, Circulatory Health, CDL Staf Patiëntenzorg KC, Other research (not in main researchprogram), CTC, Management Vitale Functies, De Waal, Eric E.C., Van Zaane, Bas, Van Der Schoot, Marnix M., Huisman, Albert, Ramjankhan, Faiz, Van Klei, Wilton A., and Marczin, Nandor

Published
2018

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