Extracorporeal membrane oxygenation for refractory cardiogenic shock

patient survival and health-related quality of life

Salla Jäämaa-Holmberg, Birgitta Salmela, Raili Suojaranta, Janne J. Jokinen, Karl B. Lemström, Jyri Lommi

Research output: Contribution to journalArticleScientificpeer-review

Abstract

OBJECTIVES Our goal was to study the outcome of patients with cardiogenic shock who were treated with venoarterial extracorporeal membrane oxygenation (VA ECMO), including the subsequent long-term health-related quality of life (HRQoL).

METHODS We conducted a retrospective study of 133 consecutive patients treated in a single centre from 2007 to 2016. The HRQoL was studied using the EuroQuol-5 dimensions-3 level questionnaire and the RAND 36-Item Short Form Health Survey at a minimum of 1year after VA ECMO.

RESULTS Of all patients, 66 (49.6%) were weaned from VA ECMO and 16 (12.0%) patients were bridged directly to a transplant, 15 (11.3%) to a ventricular assist device and 1 (0.8%) to a total artificial heart. Survival to discharge was 63.9% and to 1year, 60.9%. A higher in-hospital mortality rate was independently associated with lower HCO3 at VA ECMO implantation [odds ratio (OR) 1.2/decrease of 1mmol/l in HCO3 (95% confidence interval 1.1-1.3, P <0.001)] and with increased need of red blood cells transfused during intensive care [OR 1.9/unit of red blood cells needed/day (95% confidence interval 1.4-2.6, P <0.001)]. HRQoL measured with the EuroQuol-5 dimensions-3 level questionnaire was equal to the HRQoL of the general population. In the 36-Item Short Form questionnaire, patients reported better emotional well-being and equal energy, pain and general health perception compared to the general population. Limitations were experienced only in physical health. In total, 56% of the patients 60years had returned to work.

CONCLUSIONS VA ECMO can provide acceptable long-term survival with good HRQoL for selected patients with refractory cardiogenic shock. Timing of patient assessment and of VA ECMO implantation is essential because deeper acidosis is associated with a higher in-hospital mortality rate.

Original languageEnglish
JournalEuropean Journal of Cardio-Thoracic Surgery
Volume55
Issue number4
Pages (from-to)780-787
Number of pages8
ISSN1010-7940
DOIs
Publication statusPublished - Apr 2019
MoE publication typeA1 Journal article-refereed

Fields of Science

  • ADULTS
  • Cardiac arrest
  • Cardiogenic shock
  • Health-related quality of life
  • MORTALITY
  • OUTCOMES
  • SUPPORT
  • Survival
  • Venoarterial extracorporeal membrane oxygenation
  • 3126 Surgery, anesthesiology, intensive care, radiology

Cite this

@article{fa486f90186d4beaba060dc074dd233d,
title = "Extracorporeal membrane oxygenation for refractory cardiogenic shock: patient survival and health-related quality of life",
abstract = "OBJECTIVES Our goal was to study the outcome of patients with cardiogenic shock who were treated with venoarterial extracorporeal membrane oxygenation (VA ECMO), including the subsequent long-term health-related quality of life (HRQoL).METHODS We conducted a retrospective study of 133 consecutive patients treated in a single centre from 2007 to 2016. The HRQoL was studied using the EuroQuol-5 dimensions-3 level questionnaire and the RAND 36-Item Short Form Health Survey at a minimum of 1year after VA ECMO.RESULTS Of all patients, 66 (49.6{\%}) were weaned from VA ECMO and 16 (12.0{\%}) patients were bridged directly to a transplant, 15 (11.3{\%}) to a ventricular assist device and 1 (0.8{\%}) to a total artificial heart. Survival to discharge was 63.9{\%} and to 1year, 60.9{\%}. A higher in-hospital mortality rate was independently associated with lower HCO3 at VA ECMO implantation [odds ratio (OR) 1.2/decrease of 1mmol/l in HCO3 (95{\%} confidence interval 1.1-1.3, P <0.001)] and with increased need of red blood cells transfused during intensive care [OR 1.9/unit of red blood cells needed/day (95{\%} confidence interval 1.4-2.6, P <0.001)]. HRQoL measured with the EuroQuol-5 dimensions-3 level questionnaire was equal to the HRQoL of the general population. In the 36-Item Short Form questionnaire, patients reported better emotional well-being and equal energy, pain and general health perception compared to the general population. Limitations were experienced only in physical health. In total, 56{\%} of the patients 60years had returned to work.CONCLUSIONS VA ECMO can provide acceptable long-term survival with good HRQoL for selected patients with refractory cardiogenic shock. Timing of patient assessment and of VA ECMO implantation is essential because deeper acidosis is associated with a higher in-hospital mortality rate.",
keywords = "ADULTS, Cardiac arrest, Cardiogenic shock, Health-related quality of life, MORTALITY, OUTCOMES, SUPPORT, Survival, Venoarterial extracorporeal membrane oxygenation, 3126 Surgery, anesthesiology, intensive care, radiology",
author = "Salla J{\"a}{\"a}maa-Holmberg and Birgitta Salmela and Raili Suojaranta and Jokinen, {Janne J.} and Lemstr{\"o}m, {Karl B.} and Jyri Lommi",
year = "2019",
month = "4",
doi = "10.1093/ejcts/ezy374",
language = "English",
volume = "55",
pages = "780--787",
journal = "European Journal of Cardio-Thoracic Surgery",
issn = "1010-7940",
publisher = "Oxford University Press",
number = "4",

}

Extracorporeal membrane oxygenation for refractory cardiogenic shock : patient survival and health-related quality of life. / Jäämaa-Holmberg, Salla; Salmela, Birgitta; Suojaranta, Raili ; Jokinen, Janne J.; Lemström, Karl B.; Lommi, Jyri.

In: European Journal of Cardio-Thoracic Surgery, Vol. 55, No. 4, 04.2019, p. 780-787 .

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Extracorporeal membrane oxygenation for refractory cardiogenic shock

T2 - patient survival and health-related quality of life

AU - Jäämaa-Holmberg, Salla

AU - Salmela, Birgitta

AU - Suojaranta, Raili

AU - Jokinen, Janne J.

AU - Lemström, Karl B.

AU - Lommi, Jyri

PY - 2019/4

Y1 - 2019/4

N2 - OBJECTIVES Our goal was to study the outcome of patients with cardiogenic shock who were treated with venoarterial extracorporeal membrane oxygenation (VA ECMO), including the subsequent long-term health-related quality of life (HRQoL).METHODS We conducted a retrospective study of 133 consecutive patients treated in a single centre from 2007 to 2016. The HRQoL was studied using the EuroQuol-5 dimensions-3 level questionnaire and the RAND 36-Item Short Form Health Survey at a minimum of 1year after VA ECMO.RESULTS Of all patients, 66 (49.6%) were weaned from VA ECMO and 16 (12.0%) patients were bridged directly to a transplant, 15 (11.3%) to a ventricular assist device and 1 (0.8%) to a total artificial heart. Survival to discharge was 63.9% and to 1year, 60.9%. A higher in-hospital mortality rate was independently associated with lower HCO3 at VA ECMO implantation [odds ratio (OR) 1.2/decrease of 1mmol/l in HCO3 (95% confidence interval 1.1-1.3, P <0.001)] and with increased need of red blood cells transfused during intensive care [OR 1.9/unit of red blood cells needed/day (95% confidence interval 1.4-2.6, P <0.001)]. HRQoL measured with the EuroQuol-5 dimensions-3 level questionnaire was equal to the HRQoL of the general population. In the 36-Item Short Form questionnaire, patients reported better emotional well-being and equal energy, pain and general health perception compared to the general population. Limitations were experienced only in physical health. In total, 56% of the patients 60years had returned to work.CONCLUSIONS VA ECMO can provide acceptable long-term survival with good HRQoL for selected patients with refractory cardiogenic shock. Timing of patient assessment and of VA ECMO implantation is essential because deeper acidosis is associated with a higher in-hospital mortality rate.

AB - OBJECTIVES Our goal was to study the outcome of patients with cardiogenic shock who were treated with venoarterial extracorporeal membrane oxygenation (VA ECMO), including the subsequent long-term health-related quality of life (HRQoL).METHODS We conducted a retrospective study of 133 consecutive patients treated in a single centre from 2007 to 2016. The HRQoL was studied using the EuroQuol-5 dimensions-3 level questionnaire and the RAND 36-Item Short Form Health Survey at a minimum of 1year after VA ECMO.RESULTS Of all patients, 66 (49.6%) were weaned from VA ECMO and 16 (12.0%) patients were bridged directly to a transplant, 15 (11.3%) to a ventricular assist device and 1 (0.8%) to a total artificial heart. Survival to discharge was 63.9% and to 1year, 60.9%. A higher in-hospital mortality rate was independently associated with lower HCO3 at VA ECMO implantation [odds ratio (OR) 1.2/decrease of 1mmol/l in HCO3 (95% confidence interval 1.1-1.3, P <0.001)] and with increased need of red blood cells transfused during intensive care [OR 1.9/unit of red blood cells needed/day (95% confidence interval 1.4-2.6, P <0.001)]. HRQoL measured with the EuroQuol-5 dimensions-3 level questionnaire was equal to the HRQoL of the general population. In the 36-Item Short Form questionnaire, patients reported better emotional well-being and equal energy, pain and general health perception compared to the general population. Limitations were experienced only in physical health. In total, 56% of the patients 60years had returned to work.CONCLUSIONS VA ECMO can provide acceptable long-term survival with good HRQoL for selected patients with refractory cardiogenic shock. Timing of patient assessment and of VA ECMO implantation is essential because deeper acidosis is associated with a higher in-hospital mortality rate.

KW - ADULTS

KW - Cardiac arrest

KW - Cardiogenic shock

KW - Health-related quality of life

KW - MORTALITY

KW - OUTCOMES

KW - SUPPORT

KW - Survival

KW - Venoarterial extracorporeal membrane oxygenation

KW - 3126 Surgery, anesthesiology, intensive care, radiology

U2 - 10.1093/ejcts/ezy374

DO - 10.1093/ejcts/ezy374

M3 - Article

VL - 55

SP - 780

EP - 787

JO - European Journal of Cardio-Thoracic Surgery

JF - European Journal of Cardio-Thoracic Surgery

SN - 1010-7940

IS - 4

ER -