Early fluid resuscitation and volume therapy in venoarterial extracorporeal membrane oxygenation
Purpose For circulatory support, venoarterial extracorporeal membrane oxygenation (VA-ECMO) is dependent on sufficient venous drainage ensured by fluid therapy. Volume overload however is linked to poor prognosis. This study therefore evaluates volume therapy in VA-ECMO. Material and methods We report data of a single center registry of all patients after VA-ECMO implantation treated between 2010 and 2015. Results A total of 195 patients were included in this registry with a medium age of 58.2 ± 1.1 years, 71.8% were male. A positive fluid balance was detected in 94.7% at day 1 (day 2: 93.7%, day 3: 92.6%). Consistently, survivors had a lower fluid balance when compared to non-survivors (P< .001). Three hours post-implantation, patients above the 75th percentile had a hazard ratio of 6.03 when compared to average survival (P< .05). AUC at that time point was 0.726 as calculated by ROC. Patients below the 50th percentile (fluid balance below 8500 mL after 24 hours) had the best prognosis after VA-ECMO implantation (P< .001). Conclusions Higher fluid balance was consistently linked to poor survival. We found no evidence to support a liberal fluid therapy in VA-ECMO patients, especially not the early after implantation. With a retrospective study, one cannot clarify if lower fluid balance might improve outcomes or represents a prognostic marker..
| Medienart: |
Artikel |
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| Erscheinungsjahr: |
2017 |
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| Erschienen: |
2017 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:37 |
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| Enthalten in: |
Journal of critical care - 37(2017), Seite 130-135 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Staudacher, Dawid L [VerfasserIn] |
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| Themen: |
Blood |
| doi: |
10.1016/j.jcrc.2016.09.017 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
OLC1991213239 |
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| 245 | 1 | 0 | |a Early fluid resuscitation and volume therapy in venoarterial extracorporeal membrane oxygenation |
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| 520 | |a Purpose For circulatory support, venoarterial extracorporeal membrane oxygenation (VA-ECMO) is dependent on sufficient venous drainage ensured by fluid therapy. Volume overload however is linked to poor prognosis. This study therefore evaluates volume therapy in VA-ECMO. Material and methods We report data of a single center registry of all patients after VA-ECMO implantation treated between 2010 and 2015. Results A total of 195 patients were included in this registry with a medium age of 58.2 ± 1.1 years, 71.8% were male. A positive fluid balance was detected in 94.7% at day 1 (day 2: 93.7%, day 3: 92.6%). Consistently, survivors had a lower fluid balance when compared to non-survivors (P< .001). Three hours post-implantation, patients above the 75th percentile had a hazard ratio of 6.03 when compared to average survival (P< .05). AUC at that time point was 0.726 as calculated by ROC. Patients below the 50th percentile (fluid balance below 8500 mL after 24 hours) had the best prognosis after VA-ECMO implantation (P< .001). Conclusions Higher fluid balance was consistently linked to poor survival. We found no evidence to support a liberal fluid therapy in VA-ECMO patients, especially not the early after implantation. With a retrospective study, one cannot clarify if lower fluid balance might improve outcomes or represents a prognostic marker. | ||
| 650 | 4 | |a Cardiopulmonary resuscitation--CPR | |
| 650 | 4 | |a Blood | |
| 650 | 4 | |a Sepsis | |
| 650 | 4 | |a Ventilation | |
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| 650 | 4 | |a Intensive care | |
| 650 | 4 | |a Edema | |
| 650 | 4 | |a Patients | |
| 650 | 4 | |a Medical prognosis | |
| 650 | 4 | |a Hospitals | |
| 650 | 4 | |a Fluid | |
| 700 | 1 | |a Gold, Wolfgang |4 oth | |
| 700 | 1 | |a Biever, Paul M |4 oth | |
| 700 | 1 | |a Bode, Christoph |4 oth | |
| 700 | 1 | |a Wengenmayer, Tobias |4 oth | |
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