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Outcome of Patients With Profound Cardiogenic Shock After Cardiopulmonary Resuscitation and Prompt Extracorporeal Membrane Oxygenation Support: A Single-Center Observational Study
Background: The in-hospital outcome of patients with profound cardiogenic shock (CS) undergoing extracorporeal membrane oxygenation (ECMO) and prognostic predictors were analyzed. Methods and Results: Between 2003 and 2010, 134 patients with profound CS undergoing 10-15min of cardiopulmonary cerebra...
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| Published in: | Circulation Journal 2012, Vol.76(6), pp.1385-1392 |
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| Main Authors: | , , , , , , , , , , , , , |
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| container_end_page | 1392 |
| container_issue | 6 |
| container_start_page | 1385 |
| container_title | Circulation Journal |
| container_volume | 76 |
| creator | Chung, Sheng-Ying Sheu, Jiunn-Jye Lin, Ying-Jui Sun, Cheuk-Kwan Chang, Li-Teh Chen, Yung-Lung Tsai, Tzu-Hsien Chen, Chien-Jen Yang, Cheng-Hsu Hang, Chi-Ling Leu, Steve Wu, Chiung-Jen Lee, Fan-Yen Yip, Hon-Kan |
| description | Background: The in-hospital outcome of patients with profound cardiogenic shock (CS) undergoing extracorporeal membrane oxygenation (ECMO) and prognostic predictors were analyzed. Methods and Results: Between 2003 and 2010, 134 patients with profound CS undergoing 10-15min of cardiopulmonary cerebral resuscitation (CPCR) and ECMO were prospectively recruited, including 27.6% (37) with ST-elevation myocardial infarction (STEMI), 11.9% (16) with non-STEMI, 22.4% (30) with post-surgery pump failure, 10.5% (14) with refractory congestive heart failure, 19.4% (26) with fulminant acute myocarditis, 2.2% (3) with pediatric congenital diaphragmatic hernia, and 6.0% (8) with percutaneous coronary intervention-related complications. The mean systolic pressure was 49.8mmHg and 91.8% of patients required ventilatory support prior to ECMO. The Post-ECMO Mean Acute Physiology and Chronic Health Evaluation (APACHE) II score and peak creatine kinase level were 26.2 and 5,311IU/L, respectively. In-hospital mortality was 57.5%. Sixty-eight patients (50.7%) were successfully weaned from ECMO and 57 (42.5%) were discharged alive. Univariate analysis identified the APACHE II score as the strongest predictor of in-hospital mortality (P |
| doi_str_mv | 10.1253/circj.CJ-11-1015 |
| format | article |
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Methods and Results: Between 2003 and 2010, 134 patients with profound CS undergoing 10-15min of cardiopulmonary cerebral resuscitation (CPCR) and ECMO were prospectively recruited, including 27.6% (37) with ST-elevation myocardial infarction (STEMI), 11.9% (16) with non-STEMI, 22.4% (30) with post-surgery pump failure, 10.5% (14) with refractory congestive heart failure, 19.4% (26) with fulminant acute myocarditis, 2.2% (3) with pediatric congenital diaphragmatic hernia, and 6.0% (8) with percutaneous coronary intervention-related complications. The mean systolic pressure was 49.8mmHg and 91.8% of patients required ventilatory support prior to ECMO. The Post-ECMO Mean Acute Physiology and Chronic Health Evaluation (APACHE) II score and peak creatine kinase level were 26.2 and 5,311IU/L, respectively. In-hospital mortality was 57.5%. Sixty-eight patients (50.7%) were successfully weaned from ECMO and 57 (42.5%) were discharged alive. Univariate analysis identified the APACHE II score as the strongest predictor of in-hospital mortality (P<0.0001) with respiratory failure, smoking, and male gender also related (all P<0.03). Multivariate analysis identified an APACHE II score ≥22 and successful ECMO weaning as the only independent predictor for in-hospital mortality and a determinant of survival, respectively (P=0.0003). Conclusions: Profound CS was associated with high mortality. Both successful weaning from ECMO and an APACHE II score might serve as outcome predictors for risk stratification. (Circ J 2012; 76: 1385-1392)</description><identifier>ISSN: 1346-9843</identifier><identifier>EISSN: 1347-4820</identifier><identifier>DOI: 10.1253/circj.CJ-11-1015</identifier><identifier>PMID: 22447007</identifier><language>eng</language><publisher>Japan: The Japanese Circulation Society</publisher><subject>Adult ; Aged ; APACHE ; Cardiopulmonary cerebral resuscitation ; Cardiopulmonary Resuscitation - adverse effects ; Cardiopulmonary Resuscitation - mortality ; Extracorporeal Membrane Oxygenation - adverse effects ; Extracorporeal Membrane Oxygenation - mortality ; Extracorporeal membrane oxygenation support ; Female ; Hospital Mortality ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Profound cardiogenic shock ; Prospective Studies ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Shock, Cardiogenic - diagnosis ; Shock, Cardiogenic - mortality ; Shock, Cardiogenic - therapy ; Survival Rate ; Taiwan ; Time Factors ; Treatment Outcome</subject><ispartof>Circulation Journal, 2012, Vol.76(6), pp.1385-1392</ispartof><rights>2012 THE JAPANESE CIRCULATION SOCIETY</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,783,787,4031,27935,27936,27937</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22447007$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chung, Sheng-Ying</creatorcontrib><creatorcontrib>Sheu, Jiunn-Jye</creatorcontrib><creatorcontrib>Lin, Ying-Jui</creatorcontrib><creatorcontrib>Sun, Cheuk-Kwan</creatorcontrib><creatorcontrib>Chang, Li-Teh</creatorcontrib><creatorcontrib>Chen, Yung-Lung</creatorcontrib><creatorcontrib>Tsai, Tzu-Hsien</creatorcontrib><creatorcontrib>Chen, Chien-Jen</creatorcontrib><creatorcontrib>Yang, Cheng-Hsu</creatorcontrib><creatorcontrib>Hang, Chi-Ling</creatorcontrib><creatorcontrib>Leu, Steve</creatorcontrib><creatorcontrib>Wu, Chiung-Jen</creatorcontrib><creatorcontrib>Lee, Fan-Yen</creatorcontrib><creatorcontrib>Yip, Hon-Kan</creatorcontrib><title>Outcome of Patients With Profound Cardiogenic Shock After Cardiopulmonary Resuscitation and Prompt Extracorporeal Membrane Oxygenation Support: A Single-Center Observational Study</title><title>Circulation Journal</title><addtitle>Circ J</addtitle><description>Background: The in-hospital outcome of patients with profound cardiogenic shock (CS) undergoing extracorporeal membrane oxygenation (ECMO) and prognostic predictors were analyzed. Methods and Results: Between 2003 and 2010, 134 patients with profound CS undergoing 10-15min of cardiopulmonary cerebral resuscitation (CPCR) and ECMO were prospectively recruited, including 27.6% (37) with ST-elevation myocardial infarction (STEMI), 11.9% (16) with non-STEMI, 22.4% (30) with post-surgery pump failure, 10.5% (14) with refractory congestive heart failure, 19.4% (26) with fulminant acute myocarditis, 2.2% (3) with pediatric congenital diaphragmatic hernia, and 6.0% (8) with percutaneous coronary intervention-related complications. The mean systolic pressure was 49.8mmHg and 91.8% of patients required ventilatory support prior to ECMO. The Post-ECMO Mean Acute Physiology and Chronic Health Evaluation (APACHE) II score and peak creatine kinase level were 26.2 and 5,311IU/L, respectively. In-hospital mortality was 57.5%. Sixty-eight patients (50.7%) were successfully weaned from ECMO and 57 (42.5%) were discharged alive. Univariate analysis identified the APACHE II score as the strongest predictor of in-hospital mortality (P<0.0001) with respiratory failure, smoking, and male gender also related (all P<0.03). Multivariate analysis identified an APACHE II score ≥22 and successful ECMO weaning as the only independent predictor for in-hospital mortality and a determinant of survival, respectively (P=0.0003). Conclusions: Profound CS was associated with high mortality. Both successful weaning from ECMO and an APACHE II score might serve as outcome predictors for risk stratification. (Circ J 2012; 76: 1385-1392)</description><subject>Adult</subject><subject>Aged</subject><subject>APACHE</subject><subject>Cardiopulmonary cerebral resuscitation</subject><subject>Cardiopulmonary Resuscitation - adverse effects</subject><subject>Cardiopulmonary Resuscitation - mortality</subject><subject>Extracorporeal Membrane Oxygenation - adverse effects</subject><subject>Extracorporeal Membrane Oxygenation - mortality</subject><subject>Extracorporeal membrane oxygenation support</subject><subject>Female</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Profound cardiogenic shock</subject><subject>Prospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Shock, Cardiogenic - diagnosis</subject><subject>Shock, Cardiogenic - mortality</subject><subject>Shock, Cardiogenic - therapy</subject><subject>Survival Rate</subject><subject>Taiwan</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1346-9843</issn><issn>1347-4820</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><recordid>eNpFkUtP3DAURq2qVXmUfVeVl92E-pXXEkXQgqgGlVYsLdu5ZjxN4tR2JPgT_GY8zBQ29pV97tG1P4Q-U3JKWcm_GRfM5rS7KigtKKHlO3RIuagL0TDy_qWuirYR_AAdxbghhLWkbD-iA8aEqAmpD9HTaknGj4C9xTcqOZhSxHcurfFN8NYvU487FXrn72FyBt-uvfmLz2yCsD-fl2H0kwqP-BfEJRqXssVPWOXOrBjnhM8fUlDGh9kHUAP-CaMOagK8enjM1h1-u8z5On1CH6waIpzs92P05-L8d_ejuF59v-zOrgvDeZuKClrTWGaYMKykFCquhTXQV5SrXBKty9raXguuTckF1QbqpqecadZTyig_Rl933jn4fwvEJEcXDQxDnssvUVLCWCNI25KMkh1qgo8xgJVzcGN-cIbkNgX5koLsriSlcptCbvmyty96hP614f-3Z-BiB2xiUvfwCqiQnBlgb6wrWW2XN_MbsFZBwsSfATpXoT8</recordid><startdate>2012</startdate><enddate>2012</enddate><creator>Chung, Sheng-Ying</creator><creator>Sheu, Jiunn-Jye</creator><creator>Lin, Ying-Jui</creator><creator>Sun, Cheuk-Kwan</creator><creator>Chang, Li-Teh</creator><creator>Chen, Yung-Lung</creator><creator>Tsai, Tzu-Hsien</creator><creator>Chen, Chien-Jen</creator><creator>Yang, Cheng-Hsu</creator><creator>Hang, Chi-Ling</creator><creator>Leu, Steve</creator><creator>Wu, Chiung-Jen</creator><creator>Lee, Fan-Yen</creator><creator>Yip, Hon-Kan</creator><general>The Japanese Circulation Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>2012</creationdate><title>Outcome of Patients With Profound Cardiogenic Shock After Cardiopulmonary Resuscitation and Prompt Extracorporeal Membrane Oxygenation Support</title><author>Chung, Sheng-Ying ; Sheu, Jiunn-Jye ; Lin, Ying-Jui ; Sun, Cheuk-Kwan ; Chang, Li-Teh ; Chen, Yung-Lung ; Tsai, Tzu-Hsien ; Chen, Chien-Jen ; Yang, Cheng-Hsu ; Hang, Chi-Ling ; Leu, Steve ; Wu, Chiung-Jen ; Lee, Fan-Yen ; Yip, Hon-Kan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c339t-6e9c8f2c24c2511e63b4fced613a3b40bb57ffdb43bc5341bce78d132b2d11213</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Aged</topic><topic>APACHE</topic><topic>Cardiopulmonary cerebral resuscitation</topic><topic>Cardiopulmonary Resuscitation - adverse effects</topic><topic>Cardiopulmonary Resuscitation - mortality</topic><topic>Extracorporeal Membrane Oxygenation - adverse effects</topic><topic>Extracorporeal Membrane Oxygenation - mortality</topic><topic>Extracorporeal membrane oxygenation support</topic><topic>Female</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Profound cardiogenic shock</topic><topic>Prospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Shock, Cardiogenic - diagnosis</topic><topic>Shock, Cardiogenic - mortality</topic><topic>Shock, Cardiogenic - therapy</topic><topic>Survival Rate</topic><topic>Taiwan</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chung, Sheng-Ying</creatorcontrib><creatorcontrib>Sheu, Jiunn-Jye</creatorcontrib><creatorcontrib>Lin, Ying-Jui</creatorcontrib><creatorcontrib>Sun, Cheuk-Kwan</creatorcontrib><creatorcontrib>Chang, Li-Teh</creatorcontrib><creatorcontrib>Chen, Yung-Lung</creatorcontrib><creatorcontrib>Tsai, Tzu-Hsien</creatorcontrib><creatorcontrib>Chen, Chien-Jen</creatorcontrib><creatorcontrib>Yang, Cheng-Hsu</creatorcontrib><creatorcontrib>Hang, Chi-Ling</creatorcontrib><creatorcontrib>Leu, Steve</creatorcontrib><creatorcontrib>Wu, Chiung-Jen</creatorcontrib><creatorcontrib>Lee, Fan-Yen</creatorcontrib><creatorcontrib>Yip, Hon-Kan</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation Journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chung, Sheng-Ying</au><au>Sheu, Jiunn-Jye</au><au>Lin, Ying-Jui</au><au>Sun, Cheuk-Kwan</au><au>Chang, Li-Teh</au><au>Chen, Yung-Lung</au><au>Tsai, Tzu-Hsien</au><au>Chen, Chien-Jen</au><au>Yang, Cheng-Hsu</au><au>Hang, Chi-Ling</au><au>Leu, Steve</au><au>Wu, Chiung-Jen</au><au>Lee, Fan-Yen</au><au>Yip, Hon-Kan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcome of Patients With Profound Cardiogenic Shock After Cardiopulmonary Resuscitation and Prompt Extracorporeal Membrane Oxygenation Support: A Single-Center Observational Study</atitle><jtitle>Circulation Journal</jtitle><addtitle>Circ J</addtitle><date>2012</date><risdate>2012</risdate><volume>76</volume><issue>6</issue><spage>1385</spage><epage>1392</epage><pages>1385-1392</pages><issn>1346-9843</issn><eissn>1347-4820</eissn><abstract>Background: The in-hospital outcome of patients with profound cardiogenic shock (CS) undergoing extracorporeal membrane oxygenation (ECMO) and prognostic predictors were analyzed. Methods and Results: Between 2003 and 2010, 134 patients with profound CS undergoing 10-15min of cardiopulmonary cerebral resuscitation (CPCR) and ECMO were prospectively recruited, including 27.6% (37) with ST-elevation myocardial infarction (STEMI), 11.9% (16) with non-STEMI, 22.4% (30) with post-surgery pump failure, 10.5% (14) with refractory congestive heart failure, 19.4% (26) with fulminant acute myocarditis, 2.2% (3) with pediatric congenital diaphragmatic hernia, and 6.0% (8) with percutaneous coronary intervention-related complications. The mean systolic pressure was 49.8mmHg and 91.8% of patients required ventilatory support prior to ECMO. The Post-ECMO Mean Acute Physiology and Chronic Health Evaluation (APACHE) II score and peak creatine kinase level were 26.2 and 5,311IU/L, respectively. In-hospital mortality was 57.5%. Sixty-eight patients (50.7%) were successfully weaned from ECMO and 57 (42.5%) were discharged alive. Univariate analysis identified the APACHE II score as the strongest predictor of in-hospital mortality (P<0.0001) with respiratory failure, smoking, and male gender also related (all P<0.03). Multivariate analysis identified an APACHE II score ≥22 and successful ECMO weaning as the only independent predictor for in-hospital mortality and a determinant of survival, respectively (P=0.0003). Conclusions: Profound CS was associated with high mortality. Both successful weaning from ECMO and an APACHE II score might serve as outcome predictors for risk stratification. (Circ J 2012; 76: 1385-1392)</abstract><cop>Japan</cop><pub>The Japanese Circulation Society</pub><pmid>22447007</pmid><doi>10.1253/circj.CJ-11-1015</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Circulation Journal, 2012, Vol.76(6), pp.1385-1392 |
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| subjects | Adult Aged APACHE Cardiopulmonary cerebral resuscitation Cardiopulmonary Resuscitation - adverse effects Cardiopulmonary Resuscitation - mortality Extracorporeal Membrane Oxygenation - adverse effects Extracorporeal Membrane Oxygenation - mortality Extracorporeal membrane oxygenation support Female Hospital Mortality Humans Logistic Models Male Middle Aged Multivariate Analysis Profound cardiogenic shock Prospective Studies Risk Assessment Risk Factors Severity of Illness Index Shock, Cardiogenic - diagnosis Shock, Cardiogenic - mortality Shock, Cardiogenic - therapy Survival Rate Taiwan Time Factors Treatment Outcome |
| title | Outcome of Patients With Profound Cardiogenic Shock After Cardiopulmonary Resuscitation and Prompt Extracorporeal Membrane Oxygenation Support: A Single-Center Observational Study |
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