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Conversion from Venovenous to Venoarterial Extracorporeal Membrane Oxygenation in Adults

No major study has been performed on the conversion from venovenous (VV) to venoarterial (VA) extracorporeal membrane oxygenation (ECMO) in adults. This single-center retrospective cohort study aimed to investigate the incidence, indication, and outcome in patients who converted from VV to VA ECMO....

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Autores principales: Falk, Lars, Fletcher-Sandersjöö, Alexander, Hultman, Jan, Broman, Lars Mikael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7999389/
https://www.ncbi.nlm.nih.gov/pubmed/33803411
http://dx.doi.org/10.3390/membranes11030188
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author Falk, Lars
Fletcher-Sandersjöö, Alexander
Hultman, Jan
Broman, Lars Mikael
author_facet Falk, Lars
Fletcher-Sandersjöö, Alexander
Hultman, Jan
Broman, Lars Mikael
author_sort Falk, Lars
collection PubMed
description No major study has been performed on the conversion from venovenous (VV) to venoarterial (VA) extracorporeal membrane oxygenation (ECMO) in adults. This single-center retrospective cohort study aimed to investigate the incidence, indication, and outcome in patients who converted from VV to VA ECMO. All adult patients (≥18 years) who commenced VV ECMO at our center between 2005 and 2018 were screened. Of 219 VV ECMO patients, 21% (n = 46) were converted to VA ECMO. The indications for conversion were right ventricular failure (RVF) (65%), cardiogenic shock (26%), and other (9%). In the converted patients, there was a significant increase in Sequential Organ Failure Assessment (SOFA) scores between admission 12 (9–13) and conversion 15 (13–17, p < 0.001). Compared to non-converted patients, converted patients also had a higher mortality rate (62% vs. 16%, p < 0.001) and a lower admission Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score (p < 0.001). Outcomes were especially unfavorable in those converted due to RVF. These results indicate that VA ECMO, as opposed to VV ECMO, should be considered as the first mode of choice in patients with respiratory failure and signs of circulatory impairment, especially in those with impaired RV function. For the remaining patients, Pre-admission RESP score, daily echocardiography, and SOFA score trajectories may help in the early identification of those where conversion from VV to VA ECMO is warranted. Multi-centric studies are warranted to validate these findings.
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spelling pubmed-79993892021-03-28 Conversion from Venovenous to Venoarterial Extracorporeal Membrane Oxygenation in Adults Falk, Lars Fletcher-Sandersjöö, Alexander Hultman, Jan Broman, Lars Mikael Membranes (Basel) Article No major study has been performed on the conversion from venovenous (VV) to venoarterial (VA) extracorporeal membrane oxygenation (ECMO) in adults. This single-center retrospective cohort study aimed to investigate the incidence, indication, and outcome in patients who converted from VV to VA ECMO. All adult patients (≥18 years) who commenced VV ECMO at our center between 2005 and 2018 were screened. Of 219 VV ECMO patients, 21% (n = 46) were converted to VA ECMO. The indications for conversion were right ventricular failure (RVF) (65%), cardiogenic shock (26%), and other (9%). In the converted patients, there was a significant increase in Sequential Organ Failure Assessment (SOFA) scores between admission 12 (9–13) and conversion 15 (13–17, p < 0.001). Compared to non-converted patients, converted patients also had a higher mortality rate (62% vs. 16%, p < 0.001) and a lower admission Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score (p < 0.001). Outcomes were especially unfavorable in those converted due to RVF. These results indicate that VA ECMO, as opposed to VV ECMO, should be considered as the first mode of choice in patients with respiratory failure and signs of circulatory impairment, especially in those with impaired RV function. For the remaining patients, Pre-admission RESP score, daily echocardiography, and SOFA score trajectories may help in the early identification of those where conversion from VV to VA ECMO is warranted. Multi-centric studies are warranted to validate these findings. MDPI 2021-03-09 /pmc/articles/PMC7999389/ /pubmed/33803411 http://dx.doi.org/10.3390/membranes11030188 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ).
spellingShingle Article
Falk, Lars
Fletcher-Sandersjöö, Alexander
Hultman, Jan
Broman, Lars Mikael
Conversion from Venovenous to Venoarterial Extracorporeal Membrane Oxygenation in Adults
title Conversion from Venovenous to Venoarterial Extracorporeal Membrane Oxygenation in Adults
title_full Conversion from Venovenous to Venoarterial Extracorporeal Membrane Oxygenation in Adults
title_fullStr Conversion from Venovenous to Venoarterial Extracorporeal Membrane Oxygenation in Adults
title_full_unstemmed Conversion from Venovenous to Venoarterial Extracorporeal Membrane Oxygenation in Adults
title_short Conversion from Venovenous to Venoarterial Extracorporeal Membrane Oxygenation in Adults
title_sort conversion from venovenous to venoarterial extracorporeal membrane oxygenation in adults
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7999389/
https://www.ncbi.nlm.nih.gov/pubmed/33803411
http://dx.doi.org/10.3390/membranes11030188
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