Pulse pressure within the first 2 days of veno-arterial extracorporeal membrane oxygenation is predictive of death prior to hospital discharge, renal dysfunction requiring dialysis and pulmonary oedema.

Siriwardena, M; Breeding, J; Gopalakrishnan, M; Jansz, P; Granger, EK; Jackson, A; MacDonald, PS; Lowe, D; Buscher, H; Nair, P

Pulse pressure within the first 2 days of veno-arterial extracorporeal membrane oxygenation is predictive of death prior to hospital discharge, renal dysfunction requiring dialysis and pulmonary oedema.

Siriwardena, M Breeding, J Gopalakrishnan, M Jansz, P Granger, EK Jackson, A MacDonald, PS Lowe, D Buscher, H Nair, P

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Publisher:: SAGE Publications
Publication Type:: Journal Article
Citation:: Perfusion, 2023, 38, (8), pp. 1568-1576
Issue Date:: 2023-11

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Field	Value	Language
dc.contributor.author	Siriwardena, M
dc.contributor.author	Breeding, J
dc.contributor.author	Gopalakrishnan, M
dc.contributor.author	Jansz, P
dc.contributor.author	Granger, EK
dc.contributor.author	Jackson, A
dc.contributor.author	MacDonald, PS
dc.contributor.author	Lowe, D
dc.contributor.author	Buscher, H
dc.contributor.author	Nair, P
dc.date.accessioned	2024-04-09T22:35:48Z
dc.date.available	2024-04-09T22:35:48Z
dc.date.issued	2023-11
dc.identifier.citation	Perfusion, 2023, 38, (8), pp. 1568-1576
dc.identifier.issn	0267-6591
dc.identifier.issn	1477-111X
dc.identifier.uri	http://hdl.handle.net/10453/177629
dc.description.abstract	BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) flows are titrated to achieve adequate perfusion while attempting to ideally maintain arterial pulse pressure (PP). We assessed risk in patients with low PP defined as <10 mmHg within the first 2 days of support. METHODS: Demographics, haemodynamics, echocardiographic and radiological findings were recorded retrospectively in cases conducted between 2014 and 2016. Outcomes were hospital mortality, requirement for renal replacement therapy (RRT) and severe pulmonary oedema (PO). RESULTS: Of 101 patients, 66.3% were male, mean age was 56 (range 18-71 years), mean duration of support was 6.3 days ± 4.1 days, 37.6% died prior to hospital discharge, 39.6% needed RRT and 11.9% had severe PO. Areas under the receiver operating curves of PP at 48 h for hospital mortality, RRT and severe PO were (respectively): 0.69 (95% CI 0.58-0.80, p = .001), 0.64 (95% CI 0.50-0.77, p = .044), 0.69 (95% CI 0.55-0.82, p = .009). The odds ratio for mortality, RRT, severe PO for those with low PP were (respectively) 2.8 (95% CI 1.01-7.5, p = .04), 3.1 (95% CI 1.11-8.40, p = .026), 7.6 (95% CI 2.06-27.89, p = .001). Central venous pressure, mean arterial pressure were not predictive. CONCLUSION: PP during the first 2 days of support is predictive of clinically important outcomes in patients supported with VA-ECMO.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	SAGE Publications
dc.relation.ispartof	Perfusion
dc.relation.isbasedon	10.1177/02676591221115935
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1102 Cardiorespiratory Medicine and Haematology
dc.subject.classification	3201 Cardiovascular medicine and haematology
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Adolescent
dc.subject.mesh	Young Adult
dc.subject.mesh	Adult
dc.subject.mesh	Middle Aged
dc.subject.mesh	Aged
dc.subject.mesh	Female
dc.subject.mesh	Blood Pressure
dc.subject.mesh	Extracorporeal Membrane Oxygenation
dc.subject.mesh	Pulmonary Edema
dc.subject.mesh	Retrospective Studies
dc.subject.mesh	Patient Discharge
dc.subject.mesh	Renal Dialysis
dc.subject.mesh	Kidney Diseases
dc.subject.mesh	Hospitals
dc.subject.mesh	Humans
dc.subject.mesh	Pulmonary Edema
dc.subject.mesh	Kidney Diseases
dc.subject.mesh	Patient Discharge
dc.subject.mesh	Renal Dialysis
dc.subject.mesh	Extracorporeal Membrane Oxygenation
dc.subject.mesh	Retrospective Studies
dc.subject.mesh	Blood Pressure
dc.subject.mesh	Adolescent
dc.subject.mesh	Adult
dc.subject.mesh	Aged
dc.subject.mesh	Middle Aged
dc.subject.mesh	Hospitals
dc.subject.mesh	Female
dc.subject.mesh	Male
dc.subject.mesh	Young Adult
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Adolescent
dc.subject.mesh	Young Adult
dc.subject.mesh	Adult
dc.subject.mesh	Middle Aged
dc.subject.mesh	Aged
dc.subject.mesh	Female
dc.subject.mesh	Blood Pressure
dc.subject.mesh	Extracorporeal Membrane Oxygenation
dc.subject.mesh	Pulmonary Edema
dc.subject.mesh	Retrospective Studies
dc.subject.mesh	Patient Discharge
dc.subject.mesh	Renal Dialysis
dc.subject.mesh	Kidney Diseases
dc.subject.mesh	Hospitals
dc.title	Pulse pressure within the first 2 days of veno-arterial extracorporeal membrane oxygenation is predictive of death prior to hospital discharge, renal dysfunction requiring dialysis and pulmonary oedema.
dc.type	Journal Article
utslib.citation.volume	38
utslib.location.activity	England
utslib.for	1102 Cardiorespiratory Medicine and Haematology
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Health
utslib.copyright.status	closed_access	*
dc.date.updated	2024-04-09T22:35:47Z
pubs.issue	8
pubs.publication-status	Published
pubs.volume	38
utslib.citation.issue	8

Abstract:

BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) flows are titrated to achieve adequate perfusion while attempting to ideally maintain arterial pulse pressure (PP). We assessed risk in patients with low PP defined as <10 mmHg within the first 2 days of support. METHODS: Demographics, haemodynamics, echocardiographic and radiological findings were recorded retrospectively in cases conducted between 2014 and 2016. Outcomes were hospital mortality, requirement for renal replacement therapy (RRT) and severe pulmonary oedema (PO). RESULTS: Of 101 patients, 66.3% were male, mean age was 56 (range 18-71 years), mean duration of support was 6.3 days ± 4.1 days, 37.6% died prior to hospital discharge, 39.6% needed RRT and 11.9% had severe PO. Areas under the receiver operating curves of PP at 48 h for hospital mortality, RRT and severe PO were (respectively): 0.69 (95% CI 0.58-0.80, p = .001), 0.64 (95% CI 0.50-0.77, p = .044), 0.69 (95% CI 0.55-0.82, p = .009). The odds ratio for mortality, RRT, severe PO for those with low PP were (respectively) 2.8 (95% CI 1.01-7.5, p = .04), 3.1 (95% CI 1.11-8.40, p = .026), 7.6 (95% CI 2.06-27.89, p = .001). Central venous pressure, mean arterial pressure were not predictive. CONCLUSION: PP during the first 2 days of support is predictive of clinically important outcomes in patients supported with VA-ECMO.

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http://hdl.handle.net/10453/177629