PMID- 34330572
OWN - NLM
STAT- MEDLINE
DCOM- 20220311
LR  - 20220311
IS  - 1532-8422 (Electronic)
IS  - 1053-0770 (Linking)
VI  - 36
IP  - 4
DP  - 2022 Apr
TI  - Precannulation International Normalized Ratio is Independently Associated With 
      Mortality in Veno-Arterial Extracorporeal Membrane Oxygenation.
PG  - 1092-1099
LID - S1053-0770(21)00579-6 [pii]
LID - 10.1053/j.jvca.2021.07.007 [doi]
AB  - OBJECTIVES: To explore whether precannulation international normalized ratio 
      (INR) is associated with in-hospital mortality in venoarterial extracorporeal 
      membrane oxygenation (VA-ECMO) patients. DESIGN: A retrospective, observational 
      cohort study. SETTING: A quaternary care academic medical center. PARTICIPANTS: 
      Patients with cardiogenic shock on VA-ECMO for >24 hours. INTERVENTIONS: None, 
      observational study. MEASUREMENTS AND MAIN RESULTS: A total of 188 patients who 
      were on VA-ECMO were included over three years. Patients were stratified into 
      three groups based on their pre-ECMO INR: INR <1.5, INR 1.5 to 1.8, and INR >1.8. 
      For all patients, demographics, comorbidities, and ECMO details were recorded. 
      The study's primary outcome was in-hospital mortality and secondary outcomes 
      included major bleeding, minor bleeding, allogeneic transfusion, ischemic stroke, 
      intracranial hemorrhage, acute renal failure, acute liver failure, 
      gastrointestinal bleeding, intensive care unit and hospital lengths of stay. A 
      multivariate logistic regression was used to determine whether precannulation INR 
      was associated independently with in-hospital mortality. In-hospital mortality 
      differed significantly by INR group (51.6% INR >1.8 v 42.3% INR 1.5-1.8 v 24.3% 
      INR <1.5; p = 0.004). In a multivariate logistic regression model, precannulation 
      INR >1.8 was associated independently with an increased odds of mortality (odds 
      ratio, 2.48; 95% confidence interval, 1.05-6.04) after controlling for sex, 
      Survival after VA- ECMO score, and ECMO indication. An INR within 1.5 to 1.8 did 
      not confer an increased mortality risk. CONCLUSIONS: An INR >1.8 before VA-ECMO 
      cannulation is associated independently with in-hospital mortality. 
      Precannulation INR should be considered by clinicians so that ECMO resources can 
      be better allocated and risks of organ failure and intracranial hemorrhage can be 
      better understood.
CI  - Copyright (c) 2021 Elsevier Inc. All rights reserved.
FAU - Plazak, Michael E
AU  - Plazak ME
AD  - Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD.
FAU - Grazioli, Alison
AU  - Grazioli A
AD  - Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
FAU - Powell, Elizabeth K
AU  - Powell EK
AD  - Department of Emergency Medicine, University of Maryland School of Medicine, 
      Baltimore, MD.
FAU - Menne, Ashley R
AU  - Menne AR
AD  - Department of Emergency Medicine, University of Maryland School of Medicine, 
      Baltimore, MD.
FAU - Bathula, Allison L
AU  - Bathula AL
AD  - Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD.
FAU - Madathil, Ronson J
AU  - Madathil RJ
AD  - Department of Cardiothoracic Surgery, University of Maryland School of Medicine, 
      Baltimore, MD.
FAU - Krause, Eric M
AU  - Krause EM
AD  - Department of Cardiothoracic Surgery, University of Maryland School of Medicine, 
      Baltimore, MD.
FAU - Deatrick, Kristopher B
AU  - Deatrick KB
AD  - Department of Cardiothoracic Surgery, University of Maryland School of Medicine, 
      Baltimore, MD.
FAU - Mazzeffi, Michael A
AU  - Mazzeffi MA
AD  - Department of Anesthesiology, University of Maryland School of Medicine, 
      Baltimore, MD. Electronic address: mmazzeff@hotmail.com.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20210708
PL  - United States
TA  - J Cardiothorac Vasc Anesth
JT  - Journal of cardiothoracic and vascular anesthesia
JID - 9110208
SB  - IM
MH  - *Extracorporeal Membrane Oxygenation
MH  - Hospital Mortality
MH  - Humans
MH  - International Normalized Ratio
MH  - Retrospective Studies
MH  - Shock, Cardiogenic
OTO - NOTNLM
OT  - ECMO
OT  - INR
OT  - cardiogenic shock
OT  - coagulation
EDAT- 2021/08/01 06:00
MHDA- 2022/03/12 06:00
CRDT- 2021/07/31 06:24
PHST- 2021/05/31 00:00 [received]
PHST- 2021/07/03 00:00 [revised]
PHST- 2021/07/05 00:00 [accepted]
PHST- 2021/08/01 06:00 [pubmed]
PHST- 2022/03/12 06:00 [medline]
PHST- 2021/07/31 06:24 [entrez]
AID - S1053-0770(21)00579-6 [pii]
AID - 10.1053/j.jvca.2021.07.007 [doi]
PST - ppublish
SO  - J Cardiothorac Vasc Anesth. 2022 Apr;36(4):1092-1099. doi: 
      10.1053/j.jvca.2021.07.007. Epub 2021 Jul 8.