PMID- 29916091 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20201001 IS - 2110-5820 (Print) IS - 2110-5820 (Electronic) IS - 2110-5820 (Linking) VI - 8 IP - 1 DP - 2018 Jun 19 TI - Vascular complications in adult postcardiotomy cardiogenic shock patients receiving venoarterial extracorporeal membrane oxygenation. PG - 72 LID - 10.1186/s13613-018-0417-3 [doi] LID - 72 AB - BACKGROUND: The rate, prognostic impacts, and predisposing factors of major vascular complications (MVCs) in patients underwent venoarterial extracorporeal membrane oxygenation (VA-ECMO) by surgical cut-down are poorly understood. The purpose of this study was to identify these parameters in adult VA-ECMO patients. METHODS: Adult postcardiotomy cardiogenic shock (PCS) patients receiving VA-ECMO by femoral surgical cut-down cannulation from January 2004 to December 2015 were enrolled in this study. Patients were separated into two groups depending on the presence of MVCs. Multivariate logistic regression was performed to identify factors independently associated with MVCs. RESULTS: Of 432 patients with PCS treated with VA-ECMO, 252 patients (58.3%) were weaned off VA-ECMO and 153 patients (35.4%) survived to discharge. MVCs were seen in 72 patients (16.7%), including bleeding or hematoma in the cannulation site (8.6%), limb ischemia requiring fasciotomy (8.6%), femoral artery embolism (0.7%), and retroperitoneal bleeding (0.7%). The rate of survival to discharge was 16.7 and 39.2% in patients with or without MVCs, respectively (p < 0.001). Obesity, concomitant with intra-aortic balloon pump (IABP), Sequential Organ Failure Assessment (SOFA) score at 24 h post-ECMO, and hemostasis disorder were shown to be associated with MVCs. MVCs were an independent risk factor for in-hospital mortality by multivariate analysis (odds ratio 3.91; 95% confidence interval, 1.67-9.14; p = 0.013). CONCLUSIONS: MVCs are common and associated with higher in-hospital mortality among adult PCS patients receiving peripheral VA-ECMO support. The obesity, concomitant with IABP, SOFA score at 24 h post-ECMO, and hemostasis disorder were independent risk factor of MVCs. FAU - Yang, Feng AU - Yang F AD - Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung, and Blood Vessels Diseases, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, 100029, China. FAU - Hou, Dengbang AU - Hou D AD - Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung, and Blood Vessels Diseases, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, 100029, China. FAU - Wang, Jinhong AU - Wang J AD - Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung, and Blood Vessels Diseases, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, 100029, China. FAU - Cui, Yongchao AU - Cui Y AD - Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung, and Blood Vessels Diseases, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, 100029, China. FAU - Wang, Xiaomeng AU - Wang X AD - Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung, and Blood Vessels Diseases, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, 100029, China. FAU - Xing, Zhichen AU - Xing Z AD - Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung, and Blood Vessels Diseases, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, 100029, China. FAU - Jiang, Chunjing AU - Jiang C AD - Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung, and Blood Vessels Diseases, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, 100029, China. FAU - Hao, Xing AU - Hao X AD - Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung, and Blood Vessels Diseases, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, 100029, China. FAU - Du, Zhongtao AU - Du Z AD - Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung, and Blood Vessels Diseases, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, 100029, China. FAU - Yang, Xiaofang AU - Yang X AD - Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung, and Blood Vessels Diseases, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, 100029, China. FAU - Jiang, Yu AU - Jiang Y AD - Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung, and Blood Vessels Diseases, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, 100029, China. FAU - Hou, Xiaotong AU - Hou X AD - Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung, and Blood Vessels Diseases, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, 100029, China. xt.hou@ccmu.edu.cn. LA - eng GR - No. PXM2016_014226_000023/Research Foundation of Beijing Lab for Cardiovascular Precision Medicine, Beijing, China/ GR - No. Z161100000516017 to X Hou/Grants from Beijing Municipal Commission/ PT - Journal Article DEP - 20180619 PL - Germany TA - Ann Intensive Care JT - Annals of intensive care JID - 101562873 PMC - PMC6006001 OTO - NOTNLM OT - Cannulation OT - Complications OT - Postcardiotomy cardiogenic shock OT - Survival OT - Venoarterial extracorporeal membrane oxygenation EDAT- 2018/06/20 06:00 MHDA- 2018/06/20 06:01 PMCR- 2018/06/19 CRDT- 2018/06/20 06:00 PHST- 2018/01/29 00:00 [received] PHST- 2018/06/11 00:00 [accepted] PHST- 2018/06/20 06:00 [entrez] PHST- 2018/06/20 06:00 [pubmed] PHST- 2018/06/20 06:01 [medline] PHST- 2018/06/19 00:00 [pmc-release] AID - 10.1186/s13613-018-0417-3 [pii] AID - 417 [pii] AID - 10.1186/s13613-018-0417-3 [doi] PST - epublish SO - Ann Intensive Care. 2018 Jun 19;8(1):72. doi: 10.1186/s13613-018-0417-3.