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Extracorporeal membrane oxygenation in patients with heart transplantation

A clinical prognosis analysis
  • Xiaozu LiaoEmail author
  • Zhou Cheng
  • Liqiang Wang
  • Binfei LiEmail author
  • Weizhao Huang
  • Hongyu Ye
  • Haiming Jiang
  • Zhanyuan Zhao
  • Yong Yuan
Original articles
  • 9 Downloads

Abstract

Background

Extracorporeal membrane oxygenation (ECMO) is indicated for bridging to heart transplantation, graft failure, and right heart failure after heart transplantation. This study explored risk factors affecting the clinical prognosis of cardiac transplantation patients treated with ECMO during the perioperative period.

Methods

Data on 28 heart transplantation patients with ECMO obtained from January 2012 to January 2018 in the People’s Hospital of Zhongshan City were retrospectively analyzed.

Results

A total of 25 patients (20 male and 5 female) were finally included. Heart transplantation was performed mainly due to cardiomyopathy (77.8%). Of the treated patients, 18 (72%) survived and were discharged, 4 were treated with cardiopulmonary resuscitation (CPR) before ECMO, and 3 died in hospital. There were no differences between the surviving and death group donors (N-terminal pro b‑type natriuretic peptide [NT-proBNP], creatine kinase-muscle/brain [CK-MB], warm ischemia time of donated heart, cold ischemia time of donated heart, total ischemia time of donated heart, and donor type). In univariate analysis, body mass index (BMI), length of stay in the intensive care unit (ICU), and CPR were relevant prognostic factors for heart transplantation patients with ECMO. Multi-factor logistic regression showed that CPR before ECMO (odds ratio, OR, 49.45; 95% confidence interval, CI, [1.37, 1781.6]; P= 0.033) is an independent risk factor influencing prognosis.

Conclusion

ECMO is an important life support method for patients before and after heart transplantation surgery. Obesity, poor preoperative cardiac function, and considerable intraoperative red blood cell transfusion may influence prognosis. Extracardiac compression before ECMO is an independent risk factor for prognosis.

Keywords

Shock, cardiogenic Obesity Cardiopulmonary resuscitation Body mass index Risk factors 

Abbreviations

ECMO

Extracorporeal membrane oxygenation

NT-proBNP

N-terminal pro b‑type natriuretic peptide

CK-MB

Creatine kinase-muscle/brain

Extrakorporale Membranoxygenierung bei Herztransplantation

Eine Analyse der klinischen Prognose

Zusammenfassung

Hintergrund

Die extrakorporale Membranoxygenierung (ECMO) ist für das Bridging bis zur Herztransplantation, bei Transplantatversagen und bei Rechtsherzinsuffizienz nach Herztransplantation indiziert. In der vorliegenden Studie wurden Risikofaktoren untersucht, die die klinische Prognose von Patienten mit Herztransplantation und mit ECMO in der perioperativen Phase beeinflussen.

Methoden

Daten von 28 Patienten mit Herztransplantation und ECMO aus dem Zeitraum Januar 2012 bis Januar 2018 im Volkskrankenhaus von Zhongshan wurden retrospektiv analysiert.

Ergebnisse

Insgesamt 25 Patienten (20 Männer und 5 Frauen) wurden letztlich eingeschlossen. Die Herztransplantation erfolgte hauptsächlich wegen einer Kardiomyopathie (77,8 %). Von den behandelten Patienten überlebten 18 (72 %) und wurden entlassen, 4 erhielten eine kardiopulmonale Reanimation (CPR) vor ECMO und 3 starben in der Klinik. Es fanden sich keine Unterschiede zwischen den Spendern in den Gruppen der Überlebenden und Verstorbenen (N-terminales pro-natriuretisches Peptid vom B‑Typ [NT-proBNP], Kreatinkinase vom Muscle/brain-Typ [CK-MB], Warme-Ischämie-Zeit des Spenderherzens, Kalte-Ischämie-Zeit des Spenderherzens, Gesamtischämiezeit des Spenderherzens und Spendertyp). In einer univariaten Analyse waren der Body-Mass-Index (BMI), die Dauer des Intensivaufenthalts und die CPR relevante Prognosefaktoren für Patienten mit Herztransplantation und ECMO. Eine multifaktorielle logistische Regression ergab, dass die CPR vor ECMO (Odds Ratio 49,45; 95%-Konfidenzintervall [1,37, 1781,6]; P = 0,033) ein unabhängiger Risikofaktor mit Einfluss auf die Prognose ist.

Schlussfolgerung

Die ECMO ist ein bedeutendes lebenserhaltendes Verfahren für Patienten vor und nach Herztransplantation. Adipositas, eine schlechte präoperative Herzfunktion und eine intraoperative Erythrozytentransfusion in großer Menge können die Prognose beeinflussen. Eine Herzdruckmassage vor ECMO ist ein unabhängiger Risikofaktor bezüglich der Prognose.

Schlüsselwörter

Kardiogener Schock Adipositas Kardiopulmonale Reanimation Body-Mass-Index Risikofaktoren 

Notes

Compliance with ethical guidelines

Conflict of interest

X. Liao, Z. Cheng, L. Wang, B. Li, W. Huang, H. Ye, H. Jiang, Z. Zhao and Y. Yuan declare that they have no competing interests.

Retrospective data collection was approved by the Institutional Review Board at Zhongshan Hospital affiliated to Sun Yat-Sen University. Written informed consent for publication was obtained from all participants.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • Xiaozu Liao
    • 1
    Email author
  • Zhou Cheng
    • 1
  • Liqiang Wang
    • 1
  • Binfei Li
    • 1
    Email author
  • Weizhao Huang
    • 2
  • Hongyu Ye
    • 2
  • Haiming Jiang
    • 2
  • Zhanyuan Zhao
    • 3
  • Yong Yuan
    • 4
  1. 1.Departments of AnesthesiologyZhongshan City People’s HospitalZhongshanChina
  2. 2.Departments of cardiac surgeryZhongshan City People’s HospitalZhongshanChina
  3. 3.Departments of Intensive Care UnitZhongshan City People’s HospitalZhongshanChina
  4. 4.Departments of CardiologyZhongshan City People’s HospitalZhongshanChina

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