Objectives: We observed early onset of severe respiratory failure (ESRF) after switching from veno-arterial extracorporeal membrane oxygenation (VA ECMO) to mechanical circulatory support (MCS), i.e. “bridge to bridge” strategy. The aim of our study was to analyse the frequency, impact on mortality and characteristics of patients presenting with ESFR after MCS implantation in bridge-to-bridge strategy. Methods: We retrospectively analysed data from 55 consecutive patients who underwent bridge-to-bridge strategy for refractory cardiogenic shock between January 2004 and March 2012 in our centre. ESRF was defined as acute respiratory syndrome with or without requirement for ECMO within 48 hours after MCS implantation. Results: ESRF was observed in 15/55 (27%) patients; 11 required veno-venous or VA ECMO and 4 were medically treated. Mean follow-up after MCS implantation was 450±728 days. Mortality after MCS implantation was increased among patients who developed ESRF (ESRF patients) compared with others (87% vs 53%, P=0.03). The rate of acute pulmonary oedema within seven days before MCS implantation was higher in ESRF patients (47% vs 8%, P=0.02), whereas spontaneous ventilation at the time of MCS implantation was lower in the ESRF group (0% vs 48%, P=0.01). The duration of VA ECMO and duration of mechanical ventilation before MCS implantation were not different between ESRF patients and others (respectively 11.2±7.4 vs 11.8 ±13.9 days, P=0.88 and 8.2±5.8 vs 7.0±11 days, P=0.7). Conclusions: Early severe respiratory failure after MCS implantation in bridge-to-bridge strategy is frequent and increases mortality. Mechanical ventilation and recent pulmonary oedema at the time of MCS implantation could predict early onset of severe respiratory failure after implantation.
Impact of early respiratory failure after mechanical circulatory support implantation in patients assisted by veno-arterial extracorporeal membrane oxygenation
POZZI, Matteo;
2012-01-01
Abstract
Objectives: We observed early onset of severe respiratory failure (ESRF) after switching from veno-arterial extracorporeal membrane oxygenation (VA ECMO) to mechanical circulatory support (MCS), i.e. “bridge to bridge” strategy. The aim of our study was to analyse the frequency, impact on mortality and characteristics of patients presenting with ESFR after MCS implantation in bridge-to-bridge strategy. Methods: We retrospectively analysed data from 55 consecutive patients who underwent bridge-to-bridge strategy for refractory cardiogenic shock between January 2004 and March 2012 in our centre. ESRF was defined as acute respiratory syndrome with or without requirement for ECMO within 48 hours after MCS implantation. Results: ESRF was observed in 15/55 (27%) patients; 11 required veno-venous or VA ECMO and 4 were medically treated. Mean follow-up after MCS implantation was 450±728 days. Mortality after MCS implantation was increased among patients who developed ESRF (ESRF patients) compared with others (87% vs 53%, P=0.03). The rate of acute pulmonary oedema within seven days before MCS implantation was higher in ESRF patients (47% vs 8%, P=0.02), whereas spontaneous ventilation at the time of MCS implantation was lower in the ESRF group (0% vs 48%, P=0.01). The duration of VA ECMO and duration of mechanical ventilation before MCS implantation were not different between ESRF patients and others (respectively 11.2±7.4 vs 11.8 ±13.9 days, P=0.88 and 8.2±5.8 vs 7.0±11 days, P=0.7). Conclusions: Early severe respiratory failure after MCS implantation in bridge-to-bridge strategy is frequent and increases mortality. Mechanical ventilation and recent pulmonary oedema at the time of MCS implantation could predict early onset of severe respiratory failure after implantation.
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