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Acute lung injury after mechanical circulatory support implantation in patients on extracorporeal life support: an unrecognized problem.
Eur J Cardiothorac Surg. 2013 Sep; 44(3):544-9; discussion 549-50.EJ

Abstract

OBJECTIVES

We observed early acute lung injury (ALI) after a switch from veno-arterial extracorporeal life support (VA-ECLS) to long-term mechanical circulatory support (MCS). The aim of our study was to analyse the frequency, impact on mortality and characteristics of patients presenting ALI after MCS implantation in the bridge-to-bridge (BTB) strategy.

METHODS

We retrospectively analysed data from 55 consecutive cardiogenic shock patients who underwent a BTB strategy between January 2004 and March 2012 in our centre. ALI was defined as severe acute respiratory failure (PaO2/FiO2 <200) with or without need for iterative VA-ECLS or veno-venous (VV)-exracorporeal membrane oxygenation (ECMO) occurring within 48 h of MCS implantation.

RESULTS

ALI was observed in 15 of 55 (27%) patients. Eleven patients required VV-ECMO or VA-ECLS and 4 were treated medically. The median (interquartile range) duration of support under a long-term device was 47.5 (168.8) days. Mortality while on long-term support was significantly higher in patients who developed ALI (13 of 15, 87%) than in those who did not (21 of 40, 53%; P = 0.03). Hazard ratio for death while on support in patients who developed ALI when compared with those who did not was 3.390 (95% confidence interval, 1.636-7.026, P = 0.001). Univariate risk factors for postimplant ALI included: signs of pulmonary oedema while under extracorporeal life support (ECLS) during the week preceding long-term device implantation; mechanical ventilation, the incomplete recovery of renal and hepatic functions and the number of red blood cell units transfused at the time of long-term device implantation, and use of pulsatile, biventricular support.

CONCLUSIONS

Implantation of a long-term MCS device in patients on ECLS can result in severe ALI, which is associated with ominous outcomes. Various preimplant risk factors for ALI have been identified and might allow devising strategies to prevent this complication.

Authors+Show Affiliations

Assistance Publique-Hôpitaux de Paris, Department of Cardiac and Thoracic Surgery, Cardiologic Institute, Hôpital La Pitié-Salpêtrière, Paris, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23477925

Citation

Boulate, David, et al. "Acute Lung Injury After Mechanical Circulatory Support Implantation in Patients On Extracorporeal Life Support: an Unrecognized Problem." European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, vol. 44, no. 3, 2013, pp. 544-9; discussion 549-50.
Boulate D, Luyt CE, Pozzi M, et al. Acute lung injury after mechanical circulatory support implantation in patients on extracorporeal life support: an unrecognized problem. Eur J Cardiothorac Surg. 2013;44(3):544-9; discussion 549-50.
Boulate, D., Luyt, C. E., Pozzi, M., Niculescu, M., Combes, A., Leprince, P., & Kirsch, M. (2013). Acute lung injury after mechanical circulatory support implantation in patients on extracorporeal life support: an unrecognized problem. European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, 44(3), 544-9; discussion 549-50. https://doi.org/10.1093/ejcts/ezt125
Boulate D, et al. Acute Lung Injury After Mechanical Circulatory Support Implantation in Patients On Extracorporeal Life Support: an Unrecognized Problem. Eur J Cardiothorac Surg. 2013;44(3):544-9; discussion 549-50. PubMed PMID: 23477925.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute lung injury after mechanical circulatory support implantation in patients on extracorporeal life support: an unrecognized problem. AU - Boulate,David, AU - Luyt,Charles-Edouard, AU - Pozzi,Matteo, AU - Niculescu,Michaela, AU - Combes,Alain, AU - Leprince,Pascal, AU - Kirsch,Matthias, Y1 - 2013/03/10/ PY - 2013/3/13/entrez PY - 2013/3/13/pubmed PY - 2014/5/10/medline KW - Acute lung injury KW - Bridge to bridge KW - Cardiogenic shock KW - Extracorporeal life support KW - Extracorporeal membrane oxygenation KW - Mechanical circulatory support SP - 544-9; discussion 549-50 JF - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JO - Eur J Cardiothorac Surg VL - 44 IS - 3 N2 - OBJECTIVES: We observed early acute lung injury (ALI) after a switch from veno-arterial extracorporeal life support (VA-ECLS) to long-term mechanical circulatory support (MCS). The aim of our study was to analyse the frequency, impact on mortality and characteristics of patients presenting ALI after MCS implantation in the bridge-to-bridge (BTB) strategy. METHODS: We retrospectively analysed data from 55 consecutive cardiogenic shock patients who underwent a BTB strategy between January 2004 and March 2012 in our centre. ALI was defined as severe acute respiratory failure (PaO2/FiO2 <200) with or without need for iterative VA-ECLS or veno-venous (VV)-exracorporeal membrane oxygenation (ECMO) occurring within 48 h of MCS implantation. RESULTS: ALI was observed in 15 of 55 (27%) patients. Eleven patients required VV-ECMO or VA-ECLS and 4 were treated medically. The median (interquartile range) duration of support under a long-term device was 47.5 (168.8) days. Mortality while on long-term support was significantly higher in patients who developed ALI (13 of 15, 87%) than in those who did not (21 of 40, 53%; P = 0.03). Hazard ratio for death while on support in patients who developed ALI when compared with those who did not was 3.390 (95% confidence interval, 1.636-7.026, P = 0.001). Univariate risk factors for postimplant ALI included: signs of pulmonary oedema while under extracorporeal life support (ECLS) during the week preceding long-term device implantation; mechanical ventilation, the incomplete recovery of renal and hepatic functions and the number of red blood cell units transfused at the time of long-term device implantation, and use of pulsatile, biventricular support. CONCLUSIONS: Implantation of a long-term MCS device in patients on ECLS can result in severe ALI, which is associated with ominous outcomes. Various preimplant risk factors for ALI have been identified and might allow devising strategies to prevent this complication. SN - 1873-734X UR - https://www.unboundmedicine.com/medline/citation/23477925/Acute_lung_injury_after_mechanical_circulatory_support_implantation_in_patients_on_extracorporeal_life_support:_an_unrecognized_problem_ L2 - https://academic.oup.com/ejcts/article-lookup/doi/10.1093/ejcts/ezt125 DB - PRIME DP - Unbound Medicine ER -