Cargando…
Clinical course and prognostic factors of patients in severe accidental hypothermia with circulatory instability rewarmed with veno-arterial ECMO - an observational case series study
BACKGROUND: Recently, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has become the rewarming treatment of choice in hypothermic cardiac arrest. The detailed indications for extracorporeal rewarming in non-arrested, severely hypothermic patients with circulatory instability have not bee...
Autores principales: | , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5414327/ https://www.ncbi.nlm.nih.gov/pubmed/28464863 http://dx.doi.org/10.1186/s13049-017-0388-7 |
_version_ | 1783233352003747840 |
---|---|
author | Kosiński, Sylweriusz Darocha, Tomasz Jarosz, Anna Zeliaś, Aleksander Ziętkiewicz, Mirosław Podsiadło, Paweł Sanak, Tomasz Sałapa, Kinga Piątek, Jacek Konstany-Kalandyk, Janusz Gałązkowski, Robert Krawczyk, Paweł Krzych, Łukasz Drwiła, Rafał |
author_facet | Kosiński, Sylweriusz Darocha, Tomasz Jarosz, Anna Zeliaś, Aleksander Ziętkiewicz, Mirosław Podsiadło, Paweł Sanak, Tomasz Sałapa, Kinga Piątek, Jacek Konstany-Kalandyk, Janusz Gałązkowski, Robert Krawczyk, Paweł Krzych, Łukasz Drwiła, Rafał |
author_sort | Kosiński, Sylweriusz |
collection | PubMed |
description | BACKGROUND: Recently, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has become the rewarming treatment of choice in hypothermic cardiac arrest. The detailed indications for extracorporeal rewarming in non-arrested, severely hypothermic patients with circulatory instability have not been established yet. The primary purpose of the study was a preliminary analysis of all aspects of the treatment process, as well as initial identification of mortality risk factors within the group of severely hypothermic patients, treated with arteriovenous extracorporeal membrane oxygenation (VA-ECMO). The secondary aim of the study was to evaluate efficacy of VA-ECMO in initial 6-h period of treatment METHODS: From July 2013 to June 2016, thirty one hypothermic patients were accepted for extracorporeal rewarming at Severe Accidental Hypothermia Center, Cracow. Thirteen patients were identified with circulatory instability and were enrolled in the study. The evaluation took into account patients’ condition on admission, the course of therapy, and changes in laboratory and hemodynamic parameters. RESULTS: Nine out of 13 analyzed patients survived (69%). Patients who died were older, had lower both systolic and diastolic pressure, and had increased creatinine an potassium levels on admission. In surviving patients, arterial blood gases parameters (pH, BE, HCO(3)) and lactates would normalize more quickly. Their potassium level was lower on admission as well. The values of the core temperature on admission were comparable. Although normothermia was achieved in 92% of patients, none of them had been weaned-off VA-ECMO in the first 6 h of treatment. DISCUSSION AND CONCLUSIONS: In our preliminary study more pronounced markers of cardiocirculatory instability and organ hypoperfusion were observed in non-survivors. Future studies on indications to extracorporeal rewarming in severely hypothermic, non-arrested patients should focus on the extent of hemodynamic disturbances. Short term (<6 h) treatment in severe hypothermic, non-arrested patients seems to be not clinically appropriate. |
format | Online Article Text |
id | pubmed-5414327 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-54143272017-05-03 Clinical course and prognostic factors of patients in severe accidental hypothermia with circulatory instability rewarmed with veno-arterial ECMO - an observational case series study Kosiński, Sylweriusz Darocha, Tomasz Jarosz, Anna Zeliaś, Aleksander Ziętkiewicz, Mirosław Podsiadło, Paweł Sanak, Tomasz Sałapa, Kinga Piątek, Jacek Konstany-Kalandyk, Janusz Gałązkowski, Robert Krawczyk, Paweł Krzych, Łukasz Drwiła, Rafał Scand J Trauma Resusc Emerg Med Original Research BACKGROUND: Recently, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has become the rewarming treatment of choice in hypothermic cardiac arrest. The detailed indications for extracorporeal rewarming in non-arrested, severely hypothermic patients with circulatory instability have not been established yet. The primary purpose of the study was a preliminary analysis of all aspects of the treatment process, as well as initial identification of mortality risk factors within the group of severely hypothermic patients, treated with arteriovenous extracorporeal membrane oxygenation (VA-ECMO). The secondary aim of the study was to evaluate efficacy of VA-ECMO in initial 6-h period of treatment METHODS: From July 2013 to June 2016, thirty one hypothermic patients were accepted for extracorporeal rewarming at Severe Accidental Hypothermia Center, Cracow. Thirteen patients were identified with circulatory instability and were enrolled in the study. The evaluation took into account patients’ condition on admission, the course of therapy, and changes in laboratory and hemodynamic parameters. RESULTS: Nine out of 13 analyzed patients survived (69%). Patients who died were older, had lower both systolic and diastolic pressure, and had increased creatinine an potassium levels on admission. In surviving patients, arterial blood gases parameters (pH, BE, HCO(3)) and lactates would normalize more quickly. Their potassium level was lower on admission as well. The values of the core temperature on admission were comparable. Although normothermia was achieved in 92% of patients, none of them had been weaned-off VA-ECMO in the first 6 h of treatment. DISCUSSION AND CONCLUSIONS: In our preliminary study more pronounced markers of cardiocirculatory instability and organ hypoperfusion were observed in non-survivors. Future studies on indications to extracorporeal rewarming in severely hypothermic, non-arrested patients should focus on the extent of hemodynamic disturbances. Short term (<6 h) treatment in severe hypothermic, non-arrested patients seems to be not clinically appropriate. BioMed Central 2017-05-02 /pmc/articles/PMC5414327/ /pubmed/28464863 http://dx.doi.org/10.1186/s13049-017-0388-7 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Original Research Kosiński, Sylweriusz Darocha, Tomasz Jarosz, Anna Zeliaś, Aleksander Ziętkiewicz, Mirosław Podsiadło, Paweł Sanak, Tomasz Sałapa, Kinga Piątek, Jacek Konstany-Kalandyk, Janusz Gałązkowski, Robert Krawczyk, Paweł Krzych, Łukasz Drwiła, Rafał Clinical course and prognostic factors of patients in severe accidental hypothermia with circulatory instability rewarmed with veno-arterial ECMO - an observational case series study |
title | Clinical course and prognostic factors of patients in severe accidental hypothermia with circulatory instability rewarmed with veno-arterial ECMO - an observational case series study |
title_full | Clinical course and prognostic factors of patients in severe accidental hypothermia with circulatory instability rewarmed with veno-arterial ECMO - an observational case series study |
title_fullStr | Clinical course and prognostic factors of patients in severe accidental hypothermia with circulatory instability rewarmed with veno-arterial ECMO - an observational case series study |
title_full_unstemmed | Clinical course and prognostic factors of patients in severe accidental hypothermia with circulatory instability rewarmed with veno-arterial ECMO - an observational case series study |
title_short | Clinical course and prognostic factors of patients in severe accidental hypothermia with circulatory instability rewarmed with veno-arterial ECMO - an observational case series study |
title_sort | clinical course and prognostic factors of patients in severe accidental hypothermia with circulatory instability rewarmed with veno-arterial ecmo - an observational case series study |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5414327/ https://www.ncbi.nlm.nih.gov/pubmed/28464863 http://dx.doi.org/10.1186/s13049-017-0388-7 |
work_keys_str_mv | AT kosinskisylweriusz clinicalcourseandprognosticfactorsofpatientsinsevereaccidentalhypothermiawithcirculatoryinstabilityrewarmedwithvenoarterialecmoanobservationalcaseseriesstudy AT darochatomasz clinicalcourseandprognosticfactorsofpatientsinsevereaccidentalhypothermiawithcirculatoryinstabilityrewarmedwithvenoarterialecmoanobservationalcaseseriesstudy AT jaroszanna clinicalcourseandprognosticfactorsofpatientsinsevereaccidentalhypothermiawithcirculatoryinstabilityrewarmedwithvenoarterialecmoanobservationalcaseseriesstudy AT zeliasaleksander clinicalcourseandprognosticfactorsofpatientsinsevereaccidentalhypothermiawithcirculatoryinstabilityrewarmedwithvenoarterialecmoanobservationalcaseseriesstudy AT zietkiewiczmirosław clinicalcourseandprognosticfactorsofpatientsinsevereaccidentalhypothermiawithcirculatoryinstabilityrewarmedwithvenoarterialecmoanobservationalcaseseriesstudy AT podsiadłopaweł clinicalcourseandprognosticfactorsofpatientsinsevereaccidentalhypothermiawithcirculatoryinstabilityrewarmedwithvenoarterialecmoanobservationalcaseseriesstudy AT sanaktomasz clinicalcourseandprognosticfactorsofpatientsinsevereaccidentalhypothermiawithcirculatoryinstabilityrewarmedwithvenoarterialecmoanobservationalcaseseriesstudy AT sałapakinga clinicalcourseandprognosticfactorsofpatientsinsevereaccidentalhypothermiawithcirculatoryinstabilityrewarmedwithvenoarterialecmoanobservationalcaseseriesstudy AT piatekjacek clinicalcourseandprognosticfactorsofpatientsinsevereaccidentalhypothermiawithcirculatoryinstabilityrewarmedwithvenoarterialecmoanobservationalcaseseriesstudy AT konstanykalandykjanusz clinicalcourseandprognosticfactorsofpatientsinsevereaccidentalhypothermiawithcirculatoryinstabilityrewarmedwithvenoarterialecmoanobservationalcaseseriesstudy AT gałazkowskirobert clinicalcourseandprognosticfactorsofpatientsinsevereaccidentalhypothermiawithcirculatoryinstabilityrewarmedwithvenoarterialecmoanobservationalcaseseriesstudy AT krawczykpaweł clinicalcourseandprognosticfactorsofpatientsinsevereaccidentalhypothermiawithcirculatoryinstabilityrewarmedwithvenoarterialecmoanobservationalcaseseriesstudy AT krzychłukasz clinicalcourseandprognosticfactorsofpatientsinsevereaccidentalhypothermiawithcirculatoryinstabilityrewarmedwithvenoarterialecmoanobservationalcaseseriesstudy AT drwiłarafał clinicalcourseandprognosticfactorsofpatientsinsevereaccidentalhypothermiawithcirculatoryinstabilityrewarmedwithvenoarterialecmoanobservationalcaseseriesstudy |