PMID- 26452667
OWN - NLM
STAT- MEDLINE
DCOM- 20170413
LR  - 20170413
IS  - 2048-8734 (Electronic)
IS  - 2048-8726 (Linking)
VI  - 5
IP  - 7
DP  - 2016 Nov
TI  - Baseline MELD-XI score and outcome from veno-arterial extracorporeal membrane 
      oxygenation support for acute decompensated heart failure.
PG  - 82-88
LID - 10.1177/2048872615610865 [doi]
AB  - BACKGROUND: Acute decompensated heart failure is the most common acute heart 
      failure phenotype. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) 
      can provide bridging support for patients with acute decompensated heart failure 
      to transplantation. We studied the association between baseline (<6 months), 
      pre-ECMO (<24 h) parameters and outcome of VA-ECMO support in patients with 
      severe acute decompensated heart failure. METHODS: We included 26 consecutive 
      patients with acute decompensated heart failure (acute myocarditis, myocardial 
      infarction or post-cardiotomy shock were excluded) who were bridged with 
      peripheral VA-ECMO to transplantation. Data within six months (baseline) and 
      immediately pre-ECMO were collected. Model for end-stage liver disease (MELD) 
      with sodium (MELD-Na) and without international normalized ratio (MELD-XI) scores 
      were calculated. Outcome was defined as death at 30 days following VA-ECMO 
      support. RESULTS: Thirteen of the 26 patients died within 30 days of VA-ECMO 
      support. Univariate associations with 30-day mortality were baseline MELD-XI, 
      baseline sodium, creatinine, bilirubin, pre-ECMO alanine aminotransferase and 
      lactate. However, only baseline MELD-XI score (hazard ratio 2.678 (95% CI 
      1.085-6.607), p=0.033) was associated 30-day survival on logistic regression 
      analysis. Survivors demonstrated greater reduction in inotropic and vasoactive 
      drug support and improvement in alanine aminotransferase and lactate levels. 
      Using a threshold based on the median MELD-XI of 14.1, 30-day survival in 
      patients with a baseline MELD-XI ⩽ 14.1 was 69% compared with 31% in patients 
      with baseline MELD-XI > 14.1 ( p=0.046). CONCLUSION: Baseline MELD-XI score, but 
      not pre-ECMO parameters, is independently associated with outcomes from VA-ECMO 
      support in patients with acute decompensated heart failure.
FAU - Sern Lim, Hoong
AU  - Sern Lim H
AD  - University Hospital Birmingham NHS Foundation Trust, UK.
LA  - eng
PT  - Journal Article
DEP - 20160922
PL  - England
TA  - Eur Heart J Acute Cardiovasc Care
JT  - European heart journal. Acute cardiovascular care
JID - 101591369
SB  - IM
MH  - Adult
MH  - Extracorporeal Membrane Oxygenation/*methods/mortality
MH  - Female
MH  - Heart Failure/mortality/*therapy
MH  - Heart Transplantation/methods/mortality
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Heart failure
OT  - extracorporeal membrane oxygenation
EDAT- 2015/10/11 06:00
MHDA- 2017/04/14 06:00
CRDT- 2015/10/11 06:00
PHST- 2015/10/11 06:00 [pubmed]
PHST- 2017/04/14 06:00 [medline]
PHST- 2015/10/11 06:00 [entrez]
AID - 2048872615610865 [pii]
AID - 10.1177/2048872615610865 [doi]
PST - ppublish
SO  - Eur Heart J Acute Cardiovasc Care. 2016 Nov;5(7):82-88. doi: 
      10.1177/2048872615610865. Epub 2016 Sep 22.