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Hemodynamic Aspects of Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiac Support: A Worldwide Survey.

Authors :
Siriwardena M
Dozois M
Fan E
Billia F
Source :
ASAIO journal (American Society for Artificial Internal Organs : 1992) [ASAIO J] 2020 May; Vol. 66 (5), pp. 489-496.
Publication Year :
2020

Abstract

There is limited data available to guide management of patients supported with veno-arterial extracorporeal membrane oxygenation (VA-ECMO). An international cross-sectional survey of medical directors/program coordinators from Extracorporeal Life Support Organization centers was conducted. A hierarchical clustering on principle components was used. A total of 243 (55%) centers responded and were divided into three clusters: Cluster 1 (n = 102) had few high volumes and low specialized heart failure (HF) involvement; Cluster 2 (n = 75) had few high volumes and moderate HF involvement; Cluster 3 (n = 66) contained the majority of centers with >50 annual cases and high HF involvement. The most divergent responses were observed between Clusters 1 and 3 wherein Cluster 1 centers were less likely to change management based on pulse pressure (77% vs. 100%; p < 0.001) and would rather avoid inotropes to "rest the heart" (28%). Cluster 3 centers were more likely to perform daily echocardiograms (50% vs. 24%, p < 0.001), which were less likely to be exclusively performed by cardiologist (36% vs. 58%, p < 0.046) and base weaning on echocardiographic findings, when compared to Cluster 1 (3.97/5 vs. 3.56, p < 0.001). Responses were variable in management reflecting the lack of evidence for hemodynamic care for those supported with VA-ECMO.

Details

Language :
English
ISSN :
1538-943X
Volume :
66
Issue :
5
Database :
MEDLINE
Journal :
ASAIO journal (American Society for Artificial Internal Organs : 1992)
Publication Type :
Academic Journal
Accession number :
31192854
Full Text :
https://doi.org/10.1097/MAT.0000000000001024