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  • 1
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    Online Resource
    Outcome after veno‐venous extracorporeal membrane oxygenation in elderly compared to younger patients: A 14‐year retrospective observational study
    Wiley ; 2023
    In:  Artificial Organs Vol. 47, No. 5 ( 2023-05), p. 882-890
    Details
    In: Artificial Organs, Wiley, Vol. 47, No. 5 ( 2023-05), p. 882-890
    Abstract: The outcome after veno‐venous extracorporeal membrane oxygenation in elderly patients is supposed to be unsatisfactory. Our primary aim was to determine the influence of advanced age on short‐ and long‐term outcomes; the secondary aim was to analyze risk factors for impaired outcomes. Methods Between January 2006 and June 2020, 755 patients received V‐V ECMO support at our department. Patients were grouped according to age (18–49.9, 50–59.9, 60–69.9, ≥70 years old), and then retrospectively analyzed for short‐ and long‐term outcomes. Risk factors for in‐hospital mortality and death during follow‐up were assessed using multivariate regression analysis. Results Duration of V‐V ECMO support was comparable between all groups median (8–10 days, p  = 0.256). Likewise, the weaning rate was comparable in all age groups 68.2%–76.5%; ( p  = 0.354), but in‐hospital mortality was significantly climbing with increasing age ( 〈 50 years 30.1%/ n  = 91 vs. 50–59.9 years 37.1%/ n  = 73, vs. 60–69.9 years 45.6%/ n  = 78 vs. ≥70 years 51.8%/ n  = 44; p   〈  0.001). Older age groups also showed significantly reduced cerebral performance category scores. The multivariate logistic analysis yielded age, acute and chronic hemodialysis, bilirubin on day 1 of support, malignancy, and primary lung disease as relevant risk factors for in‐hospital mortality. Age, coronary artery disease, presence of another primary lung disease, malignancy, and immunosuppression were risk factors for death during follow‐up. Conclusion In V‐V ECMO patients, advanced age is associated with more comorbidity, impaired short‐ and long‐term outcome, and worse neurological outcome.
    Type of Medium: Online Resource
    ISSN: 0160-564X , 1525-1594
    URL: Issue
    URL: Article
    DOI: 10.1111/aor.v47.5
    DOI: 10.1111/aor.14454
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2003825-2
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  • 2
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    Outcome after veno‐arterial extracorporeal membrane oxygenation in elderly patients: A 14‐year single‐center experience
    Wiley ; 2023
    In:  Artificial Organs Vol. 47, No. 4 ( 2023-04), p. 740-748
    Details
    In: Artificial Organs, Wiley, Vol. 47, No. 4 ( 2023-04), p. 740-748
    Abstract: Use of veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) in elderly patients is controversial because of presumed poor outcome. Our primary aim was to determine the influence of advanced age on short‐ and long‐term outcome; the secondary aim was to analyze risk factors for impaired outcome. Methods Between January 2006 and June 2020, 645 patients underwent VA‐ECMO implantation in our department. The patients were categorized into four groups: 〈 50, 50–59.9, 60–69.9 and ≥70 years old. Data were retrospectively analyzed for short‐ and long‐term outcome. Risk factors for in‐hospital mortality and mortality during follow‐up were assessed using multivariate regression analysis. Results VA‐ECMO support duration was comparable in all age groups (median 3 days). Weaning rates were 60.8%/ n  = 104 ( 〈 50 years), 51.4%/ n  = 90 (50–59.9 years), 58.8%/ n  = 107 (60–69.9), and 67.5%/ n  = 79 (≥70, p  = 0.048). Hospital mortality was highest in the patients aged 50–59.9 years (68%/ n  = 119), but not in the elderly patients (60–69.9, ≥70:62.1%/ n  = 113, 58,1%/ n  = 68). At discharge, the cerebral performance category scores were superior in the patients 〈 50 years. Multivariate logistic regression analysis revealed chronic kidney failure requiring hemodialysis, duration of cardiopulmonary resuscitation, and elevated blood lactate levels before VA‐ECMO, but not age as predictors of in‐hospital mortality. Cox's regression disclosed age as relevant risk factor for death during follow‐up. The patients' physical ability was comparable in all age groups. Conclusion VA‐ECMO support should not be declined in patients only because of advanced age. Mortality and neurological status at hospital discharge and during follow‐up were comparable in all age groups.
    Type of Medium: Online Resource
    ISSN: 0160-564X , 1525-1594
    URL: Issue
    URL: Article
    DOI: 10.1111/aor.v47.4
    DOI: 10.1111/aor.14452
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2003825-2
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  • 3
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    Neuron-specific enolase serum levels predict severe neuronal injury after extracorporeal life support in resuscitation†
    Oxford University Press (OUP) ; 2014
    In:  European Journal of Cardio-Thoracic Surgery Vol. 45, No. 3 ( 2014-3), p. 496-501
    Details
    In: European Journal of Cardio-Thoracic Surgery, Oxford University Press (OUP), Vol. 45, No. 3 ( 2014-3), p. 496-501
    Type of Medium: Online Resource
    ISSN: 1873-734X , 1010-7940
    URL: Article
    DOI: 10.1093/ejcts/ezt370
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2014
    detail.hit.zdb_id: 1500330-9
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  • 4
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    Omental Flap for Complex Sternal Wounds and Mediastinal Infection Following Cardiac Surgery
    Georg Thieme Verlag KG ; 2023
    In:  The Thoracic and Cardiovascular Surgeon Vol. 71, No. 01 ( 2023-01), p. 62-66
    Details
    In: The Thoracic and Cardiovascular Surgeon, Georg Thieme Verlag KG, Vol. 71, No. 01 ( 2023-01), p. 62-66
    Abstract: Introduction Omental flap (OF) is a traditional surgical option to counteract severe postcardiotomy mediastinal infection and to cover extensive sternal defects. We reviewed our experience with omental flap transfer (OFT) in various clinical circumstances, in which omentoplasty may be considered by cardiac surgeons. Methods Twenty-one patients, who underwent OFT from January 2012 to December 2021, were studied. The main indication was treatment of infected foreign material implants including vascular grafts and ventricular assist devices or prevention of its infection (16 patients). In five patients, an OFT was used to cure mediastinitis following deep sternal wound infection after median sternotomy. Results All patients had a high surgical risk with 3 ± 1.9 previous sternotomies and a mean Euro Score II of 55.0 ± 20.1. OF was successful in its prophylactic or therapeutic purpose in all patients, no complications related to the operative procedure were noted, that is, no early or late flap failure and no herniation of abdominal organs occurred. In-hospital mortality was six patients as three patients each died from multiple organ dysfunction syndrome and cerebral hemorrhage. All fifteen patients discharged demonstrated rapid recovery, complete wound healing without fistula, and no late gastrointestinal complications. The mean follow-up of 18 months was uneventful. Conclusion OFT seems to be an excellent solution for extensive mediastinal and deep sternal wound infections.
    Type of Medium: Online Resource
    ISSN: 0171-6425 , 1439-1902
    URL: Article
    DOI: 10.1055/s-0042-1757892
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2023
    detail.hit.zdb_id: 2056554-9
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  • 5
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    Online Resource
    Long-term survival and quality of life after extracorporeal life support: a 10-year report†
    Oxford University Press (OUP) ; 2017
    In:  European Journal of Cardio-Thoracic Surgery Vol. 52, No. 2 ( 2017-08), p. 241-247
    Details
    In: European Journal of Cardio-Thoracic Surgery, Oxford University Press (OUP), Vol. 52, No. 2 ( 2017-08), p. 241-247
    Type of Medium: Online Resource
    ISSN: 1010-7940 , 1873-734X
    URL: Article
    DOI: 10.1093/ejcts/ezx100
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2017
    detail.hit.zdb_id: 1500330-9
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  • 6
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    Extracorporeal Membrane Oxygenation for Massive Pulmonary Embolism as Bridge to Therapy
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  ASAIO Journal Vol. 66, No. 2 ( 2020-02), p. 146-152
    Details
    In: ASAIO Journal, Ovid Technologies (Wolters Kluwer Health), Vol. 66, No. 2 ( 2020-02), p. 146-152
    Abstract: Pulmonary Embolism (PE) is a common illness in western countries. The purpose of this study is to report the institutional experience with massive PE and Extracorporeal Membrane Oxygenation (ECMO) in inoperable patients on admission. A retrospective analysis using the institutional ECMO-registry including the time between 2006 and 2017 was performed. During the study period, 75 patients ( n = 46 patients venoarterial [VA], n = 29 patients venovenous [VV]) were placed on ECMO for massive PE. The primary support for massive PE consists of VA; however, VV support can be applied as well in selected cases as this work demonstrates. In the VA group, more patients (38 vs. 83%, P = 0.001) required mechanical resuscitation whereas in the VV group a more aggressive ventilation before support was noted ( e.g. minute ventilation: VA=8.8 ± 3.7 L/min, VV=11.5 ± 4.5 L/min, P = 0.01). Survival to discharge was similar in VV and VA patients (45 vs. 48%, P = 0.9). Patients who received additional therapeutic interventions after stabilization with ECMO – e.g. surgical thrombectomy – displayed a similar survival compared with those being only anticoagulated (44% vs. 49%, P = 0.40). ECMO is feasible for initial stabilization serving as a bridge to therapy in primarily inoperable patients with massive PE. The principal configuration of support is VA; however, VV can be applied as well in selected hemodynamically compromised cases under aggressive ventilation.
    Type of Medium: Online Resource
    ISSN: 1058-2916
    URL: Article
    DOI: 10.1097/MAT.0000000000000953
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2083312-X
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  • 7
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    Reliability of prognostic biomarkers after prehospital extracorporeal cardiopulmonary resuscitation with target temperature management
    Springer Science and Business Media LLC ; 2021
    In:  Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Vol. 29, No. 1 ( 2021-12)
    Details
    In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Springer Science and Business Media LLC, Vol. 29, No. 1 ( 2021-12)
    Abstract: Extracorporeal cardiopulmonary resuscitation (ECPR) performed at the emergency scene in out-of-hospital cardiac arrest (OHCA) can minimize low-flow time. Target temperature management (TTM) after cardiac arrest can improve neurological outcome. A combination of ECPR and TTM, both implemented as soon as possible on scene, appears to have promising results in OHCA. To date, it is still unknown whether the implementation of TTM and ECPR on scene affects the time course and value of neurological biomarkers. Methods 69 ECPR patients were examined in this study. Blood samples were collected between 1 and 72 h after ECPR and analyzed for S100, neuron-specific enolase (NSE), lactate, D-dimers and interleukin 6 (IL6). Cerebral performance category (CPC) scores were used to assess neurological outcome after ECPR upon hospital discharge. Resuscitation data were extracted from the Regensburg extracorporeal membrane oxygenation database and all data were analyzed by a statistician. The data were analyzed using non-parametric methods. Diagnostic accuracy of biomarkers was determined by area under the curve (AUC) analysis. Results were compared to the relevant literature. Results Non-hypoxic origin of cardiac arrest, manual chest compression until ECPR, a short low-flow time until ECPR initiation, low body mass index (BMI) and only a minimal need of extra-corporeal membrane oxygenation support were associated with a good neurological outcome after ECPR. Survivors with good neurological outcome had significantly lower lactate, IL6, D-dimer, and NSE values and demonstrated a rapid decrease in the initial S100 value compared to non-survivors. Conclusions A short low-flow time until ECPR initiation is important for a good neurological outcome. Hypoxia-induced cardiac arrest has a high mortality rate even when ECPR and TTM are performed at the emergency scene. ECPR patients with a higher BMI had a worse neurological outcome than patients with a normal BMI. The prognostic biomarkers S100, NSE, lactate, D-dimers and IL6 were reliable indicators of neurological outcome when ECPR and TTM were performed at the emergency scene.
    Type of Medium: Online Resource
    ISSN: 1757-7241
    URL: Article
    DOI: 10.1186/s13049-021-00961-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2455990-8
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  • 8
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    NSE serum levels in extracorporeal life support patients—Relevance for neurological outcome?
    Elsevier BV ; 2017
    In:  Resuscitation Vol. 121 ( 2017-12), p. 166-171
    Details
    In: Resuscitation, Elsevier BV, Vol. 121 ( 2017-12), p. 166-171
    Type of Medium: Online Resource
    ISSN: 0300-9572
    URL: Article
    DOI: 10.1016/j.resuscitation.2017.09.001
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2017
    detail.hit.zdb_id: 2010733-X
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  • 9
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    Increasing use of the Impella®-pump in severe cardiogenic shock: a word of caution
    Oxford University Press (OUP) ; 2020
    In:  Interactive CardioVascular and Thoracic Surgery Vol. 30, No. 5 ( 2020-05-01), p. 711-714
    Details
    In: Interactive CardioVascular and Thoracic Surgery, Oxford University Press (OUP), Vol. 30, No. 5 ( 2020-05-01), p. 711-714
    Abstract: Impella® pumps are increasingly utilized in patients in cardiogenic shock. We report on a case series where Impella support was insufficient, and a switch to venoarterial extracorporeal membrane oxygenation (VA ECMO) became necessary. ECMO patients with previous Impella devices were identified utilizing our institutional ECMO database. Since 2014, 10 patients with a mean age of 62 ± 3 years were identified. Despite correct placement of all Impella pumps, cardiogenic shock persisted with progressive multi-organ failure (Impella type 2.5/CP n = 6/4 patients). Femoro-femoral VA ECMO was implanted percutaneously on the contralateral side with the Impella initially left on standby but retracted into the descending aorta for transport reasons after a mean support time of 20 ± 8 h. All patients were able to unload their heart by left ventricular ejection with a blood pressure amplitude of 15 ± 3 mmHg on VA ECMO support. After VA ECMO implantation haemodynamic parameters improved significantly within 24 h of support (mean serum lactate levels decreased from 92 ± 17 to 44 ± 10 mg/dl, P = 0.031). Survival to hospital discharge was 70%. These data indicate that the Impella 2.5® and CP® might not be sufficient in profound cardiogenic shock. Comparative studies are necessary to specify which patient population benefits from which type of circulatory support.
    Type of Medium: Online Resource
    ISSN: 1569-9285
    URL: Article
    DOI: 10.1093/icvts/ivaa015
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2096257-5
    detail.hit.zdb_id: 3167862-2
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