PMID- 36036658
OWN - NLM
STAT- MEDLINE
DCOM- 20231030
LR  - 20231115
IS  - 1477-111X (Electronic)
IS  - 0267-6591 (Linking)
VI  - 38
IP  - 8
DP  - 2023 Nov
TI  - Pulse pressure within the first 2 days of veno-arterial extracorporeal membrane 
      oxygenation is predictive of death prior to hospital discharge, renal dysfunction 
      requiring dialysis and pulmonary oedema.
PG  - 1568-1576
LID - 10.1177/02676591221115935 [doi]
AB  - BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) flows are 
      titrated to achieve adequate perfusion while attempting to ideally maintain 
      arterial pulse pressure (PP). We assessed risk in patients with low PP defined as 
      <10 mmHg within the first 2 days of support. METHODS: Demographics, 
      haemodynamics, echocardiographic and radiological findings were recorded 
      retrospectively in cases conducted between 2014 and 2016. Outcomes were hospital 
      mortality, requirement for renal replacement therapy (RRT) and severe pulmonary 
      oedema (PO). RESULTS: Of 101 patients, 66.3% were male, mean age was 56 (range 
      18-71 years), mean duration of support was 6.3 days +/- 4.1 days, 37.6% died prior 
      to hospital discharge, 39.6% needed RRT and 11.9% had severe PO. Areas under the 
      receiver operating curves of PP at 48 h for hospital mortality, RRT and severe PO 
      were (respectively): 0.69 (95% CI 0.58-0.80, p = .001), 0.64 (95% CI 0.50-0.77, p 
      = .044), 0.69 (95% CI 0.55-0.82, p = .009). The odds ratio for mortality, RRT, 
      severe PO for those with low PP were (respectively) 2.8 (95% CI 1.01-7.5, p = 
      .04), 3.1 (95% CI 1.11-8.40, p = .026), 7.6 (95% CI 2.06-27.89, p = .001). 
      Central venous pressure, mean arterial pressure were not predictive. CONCLUSION: 
      PP during the first 2 days of support is predictive of clinically important 
      outcomes in patients supported with VA-ECMO.
FAU - Siriwardena, Maithri
AU  - Siriwardena M
AUID- ORCID: 0000-0001-9498-5573
AD  - Department of Intensive Care, St Vincent's Hospital, Sydney, Darlinghurst, NSW, 
      Australia.
FAU - Breeding, Jeff
AU  - Breeding J
AD  - Department of Intensive Care, St Vincent's Hospital, Sydney, Darlinghurst, NSW, 
      Australia.
FAU - Gopalakrishnan, Mani
AU  - Gopalakrishnan M
AD  - Department of Intensive Care, St Vincent's Hospital, Sydney, Darlinghurst, NSW, 
      Australia.
FAU - Jansz, Paul
AU  - Jansz P
AD  - Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, 
      Darlinghurst, NSW, Australia.
FAU - Granger, Emily K
AU  - Granger EK
AD  - Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, 
      Darlinghurst, NSW, Australia.
FAU - Jackson, Andrew
AU  - Jackson A
AD  - Department of Cardiac Anaesthesia, St Vincent's Hospital, Sydney, Darlinghurst, 
      NSW, Australia.
FAU - MacDonald, Peter S
AU  - MacDonald PS
AD  - Cardiac Failure and Transplantation, St Vincent's Hospital, Sydney, Darlinghurst, 
      NSW, Australia.
FAU - Lowe, David
AU  - Lowe D
AD  - Department of Intensive Care, St Vincent's Hospital, Sydney, Darlinghurst, NSW, 
      Australia.
FAU - Buscher, Hergen
AU  - Buscher H
AD  - Department of Intensive Care, St Vincent's Hospital, Sydney, Darlinghurst, NSW, 
      Australia.
AD  - University of New South Wales, Sydney, NSW, Australia.
AD  - Centre of Applied Medical Research, St Vincent's Hospital, Sydney, Darlinghurst, 
      NSW, Australia.
FAU - Nair, Priya
AU  - Nair P
AD  - Department of Intensive Care, St Vincent's Hospital, Sydney, Darlinghurst, NSW, 
      Australia.
LA  - eng
PT  - Journal Article
DEP - 20220829
PL  - England
TA  - Perfusion
JT  - Perfusion
JID - 8700166
SB  - IM
MH  - Humans
MH  - Male
MH  - Adolescent
MH  - Young Adult
MH  - Adult
MH  - Middle Aged
MH  - Aged
MH  - Female
MH  - Blood Pressure
MH  - *Extracorporeal Membrane Oxygenation/adverse effects
MH  - *Pulmonary Edema/etiology/therapy
MH  - Retrospective Studies
MH  - Patient Discharge
MH  - Renal Dialysis
MH  - *Kidney Diseases
MH  - Hospitals
OTO - NOTNLM
OT  - Extracorporeal membrane oxygenation
OT  - cardiorespiratory support
OT  - pulse pressure
COIS- Declaration of conflicting interestsThe author(s) declared no potential conflicts 
      of interest with respect to the research, authorship, and/or publication of this 
      article.
EDAT- 2022/08/30 06:00
MHDA- 2023/10/30 06:46
CRDT- 2022/08/29 09:23
PHST- 2023/10/30 06:46 [medline]
PHST- 2022/08/30 06:00 [pubmed]
PHST- 2022/08/29 09:23 [entrez]
AID - 10.1177/02676591221115935 [doi]
PST - ppublish
SO  - Perfusion. 2023 Nov;38(8):1568-1576. doi: 10.1177/02676591221115935. Epub 2022 
      Aug 29.