Top

Published in:

01-08-2013 | Original: Postoperative Critical Care

Long-term mortality in patients with chronic obstructive pulmonary disease following extracorporeal membrane oxygenation for cardiac assist after cardiovascular surgery

Authors: Klaus Distelmaier, Alexander Niessner, Dominik Haider, Irene M. Lang, Gottfried Heinz, Gerald Maurer, Herbert Koinig, Barbara Steinlechner, Georg Goliasch

Published in: Intensive Care Medicine | Issue 8/2013

Abstract

Purpose

Information on predisposing risk factors influencing long-term survival after extracorporeal membrane oxygenation (ECMO) support remains scarce. In critically ill patients chronic obstructive pulmonary disease (COPD) is an independent risk factor for mortality and morbidity. We assessed the influence of COPD on cardiovascular and all-cause mortality in patients undergoing ECMO therapy.

Methods

We prospectively included 191 patients undergoing veno-arterial ECMO therapy following cardiovascular surgery at a university-affiliated tertiary care center into our registry.

Results

The median follow-up time was 51 months (IQR 34–71 months) corresponding to 4,197 overall months of follow-up. A total of 125 patients (65 %) died; 88 % of deaths were due to cardiovascular causes. Long-term survival was decreased in patients with COPD after 1 year (23 % vs. 44 %) and after 6 years (14 % vs. 35 %) compared to patients without COPD. COPD was independently associated with all-cause mortality with a hazard ratio of 4.22 (95 % CI 1.04–17.11, p = 0.04) and cardiovascular mortality with a hazard ratio of 5.87 (95 % CI 1.41–24.47, p = 0.02).

Conclusions

We identified COPD as a strong and independent predictor of long-term all-cause mortality and cardiovascular mortality in patients undergoing ECMO therapy following cardiovascular surgery. The current study presents valuable information for a comprehensive decision-making process prior to ECMO implantation and helps to identify high-risk patients that may benefit from intensified treatment of co-morbidities and close check-ups after hospital discharge.

Available only for authorised users

Bartlett RH, Roloff DW, Custer JR, Younger JG, Hirschl RB (2000) Extracorporeal life support: the University of Michigan experience. JAMA 283:904–908PubMedCrossRef

Combes A, Leprince P, Luyt CE, Bonnet N, Trouillet JL, Leger P, Pavie A, Chastre J (2008) Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Crit Care Med 36:1404–1411PubMedCrossRef

Rastan AJ, Dege A, Mohr M, Doll N, Falk V, Walther T, Mohr FW (2010) Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. J Thorac Cardiovasc Surg 139:302–311, e1

Smedira NG, Blackstone EH (2001) Postcardiotomy mechanical support: risk factors and outcomes. Ann Thorac Surg 71:S60–S66 (discussion S82–65)PubMedCrossRef

Angouras DC, Anagnostopoulos CE, Chamogeorgakis TP, Rokkas CK, Swistel DG, Connery CP, Toumpoulis IK (2010) Postoperative and long-term outcome of patients with chronic obstructive pulmonary disease undergoing coronary artery bypass grafting. Ann Thorac Surg 89:1112–1118PubMedCrossRef

O’Boyle F, Mediratta N, Chalmers J, Al-Rawi O, Mohan K, Shaw M, Poullis M (2013) Long-term survival of patients with pulmonary disease undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg 43:697–703PubMedCrossRef

Rady MY, Ryan T (1999) Perioperative predictors of extubation failure and the effect on clinical outcome after cardiac surgery. Crit Care Med 27:340–347PubMedCrossRef

Samuels LE, Kaufman MS, Morris RJ, Promisloff R, Brockman SK (1998) Coronary artery bypass grafting in patients with COPD. Chest 113:878–882PubMedCrossRef

Funk GC, Bauer P, Burghuber OC, Fazekas A, Hartl S, Hochrieser H, Schmutz R, Metnitz P (2012) Prevalence and prognosis of chronic obstructive pulmonary disease in critically ill patients between 1998 and 2008. Eur Respir J 41:792–799PubMedCrossRef

10.

Sellares J, Ferrer M, Cano E, Loureiro H, Valencia M, Torres A (2011) Predictors of prolonged weaning and survival during ventilator weaning in a respiratory ICU. Intensive Care Med 37:775–784PubMedCrossRef

11.

Vestbo J, Hurd SS, Agusti AG, Jones PW, Vogelmeier C, Anzueto A, Barnes PJ, Fabbri LM, Martinez FJ, Nishimura M, Stockley RA, Sin DD, Rodriguez-Roisin R (2013) Global Strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease, GOLD executive summary. Am J Respir Crit Care Med 187:347–365PubMedCrossRef

12.

MacLaren G, Combes A, Bartlett RH (2012) Contemporary extracorporeal membrane oxygenation for adult respiratory failure: life support in the new era. Intensive Care Med 38:210–220PubMedCrossRef

13.

Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, Hibbert CL, Truesdale A, Clemens F, Cooper N, Firmin RK, Elbourne D (2009) Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 374:1351–1363PubMedCrossRef

14.

The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308

15.

Gattinoni L, Pesenti A, Mascheroni D, Marcolin R, Fumagalli R, Rossi F, Iapichino G, Romagnoli G, Uziel L, Agostoni A et al (1986) Low-frequency positive-pressure ventilation with extracorporeal CO₂ removal in severe acute respiratory failure. JAMA 256:881–886PubMedCrossRef

16.

Antonelli M, Bonten M, Cecconi M, Chastre J, Citerio G, Conti G, Curtis JR, Hedenstierna G, Joannidis M, Macrae D, Maggiore SM, Mancebo J, Mebazaa A, Preiser JC, Rocco P, Timsit JF, Wernerman J, Zhang H (2013) Year in review in Intensive Care Medicine 2012: III. Noninvasive ventilation, monitoring and patient-ventilator interactions, acute respiratory distress syndrome, sedation, paediatrics and miscellanea. Intensive Care Med 39:543–557PubMedCrossRef

17.

Aissaoui N, Luyt CE, Leprince P, Trouillet JL, Leger P, Pavie A, Diebold B, Chastre J, Combes A (2011) Predictors of successful extracorporeal membrane oxygenation (ECMO) weaning after assistance for refractory cardiogenic shock. Intensive Care Med 37:1738–1745PubMedCrossRef

18.

Roques F, Nashef SA, Michel P, Gauducheau E, de Vincentiis C, Baudet E, Cortina J, David M, Faichney A, Gabrielle F, Gams E, Harjula A, Jones MT, Pintor PP, Salamon R, Thulin L (1999) Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg 15:816–822 (discussion 822–813)PubMedCrossRef

19.

Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963PubMedCrossRef

20.

Grønnesby JK, Borgan O (1996) A method for checking regression models in survival analysis based on the risk score. Lifetime Data Anal 2:315–328PubMedCrossRef

21.

Nishiyama K, Morimoto T, Furukawa Y, Nakagawa Y, Ehara N, Taniguchi R, Ozasa N, Saito N, Hoshino K, Touma M, Tamura T, Haruna Y, Shizuta S, Doi T, Fukushima M, Kita T, Kimura T (2010) Chronic obstructive pulmonary disease–an independent risk factor for long-term cardiac and cardiovascular mortality in patients with ischemic heart disease. Int J Cardiol 143:178–183PubMedCrossRef

22.

Campo G, Guastaroba P, Marzocchi A, Santarelli A, Varani E, Vignali L, Sangiorgio P, Tondi S, Serenelli C, De Palma R, Saia F (2013) Impact of chronic obstructive pulmonary disease on long-term outcome after ST-segment elevation myocardial Infarction receiving primary percutaneous coronary intervention. Chest. doi:10.1378/chest.12-2313

23.

Engstrom G, Melander O, Hedblad B (2010) Population-based study of lung function and incidence of heart failure hospitalisations. Thorax 65:633–638PubMedCrossRef

24.

Sin DD, Wu L, Man SF (2005) The relationship between reduced lung function and cardiovascular mortality: a population-based study and a systematic review of the literature. Chest 127:1952–1959PubMedCrossRef

25.

Clarenbach CF, Senn O, Sievi NA, Camen G, van Gestel AJ, Rossi VA, Puhan MA, Thurnheer R, Russi EW, Kohler M (2013) Determinants of endothelial function in patients with COPD. Eur Respir J (in press)

26.

Farooq V, Serruys PW, Bourantas C, Vranckx P, Diletti R, Garcia Garcia HM, Holmes DR, Kappetein AP, Mack M, Feldman T, Morice MC, Colombo A, Morel MA, de Vries T, van Es GA, Steyerberg EW, Dawkins KD, Mohr FW, James S, Stahle E (2012) Incidence and multivariable correlates of long-term mortality in patients treated with surgical or percutaneous revascularization in the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) trial. Eur Heart J 33:3105–3113PubMedCrossRef

27.

Wu C, Camacho FT, Wechsler AS, Lahey S, Culliford AT, Jordan D, Gold JP, Higgins RS, Smith CR, Hannan EL (2012) Risk score for predicting long-term mortality after coronary artery bypass graft surgery. Circulation 125:2423–2430PubMedCrossRef

28.

Gupta H, Ramanan B, Gupta PK, Fang X, Polich A, Modrykamien A, Schuller D, Morrow LE (2013) Impact of chronic obstructive pulmonary disease on postoperative outcomes: results from a national database. Chest. doi:10.1378/chest.12-1499

29.

Bailey ML, Richter SM, Mullany DV, Tesar PJ, Fraser JF (2011) Risk factors and survival in patients with respiratory failure after cardiac operations. Ann Thorac Surg 92:1573–1579PubMedCrossRef

30.

Filsoufi F, Rahmanian PB, Castillo JG, Chikwe J, Adams DH (2008) Predictors and early and late outcomes of respiratory failure in contemporary cardiac surgery. Chest 133:713–721PubMedCrossRef

31.

Hein OV, Birnbaum J, Wernecke KD, Konertz W, Jain U, Spies C (2006) Three-year survival after four major post-cardiac operative complications. Crit Care Med 34:2729–2737PubMedCrossRef

32.

Peek GJ, Killer HM, Reeves R, Sosnowski AW, Firmin RK (2002) Early experience with a polymethyl pentene oxygenator for adult extracorporeal life support. ASAIO J 48:480–482PubMedCrossRef

33.

Khoshbin E, Dux AE, Killer H, Sosnowski AW, Firmin RK, Peek GJ (2007) A comparison of radiographic signs of pulmonary inflammation during ECMO between silicon and poly-methyl pentene oxygenators. Perfusion 22:15–21PubMedCrossRef

34.

Khoshbin E, Roberts N, Harvey C, Machin D, Killer H, Peek GJ, Sosnowski AW, Firmin RK (2005) Poly-methyl pentene oxygenators have improved gas exchange capability and reduced transfusion requirements in adult extracorporeal membrane oxygenation. ASAIO J 51:281–287PubMedCrossRef

35.

Chen YS, Lin JW, Yu HY, Ko WJ, Jerng JS, Chang WT, Chen WJ, Huang SC, Chi NH, Wang CH, Chen LC, Tsai PR, Wang SS, Hwang JJ, Lin FY (2008) Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. Lancet 372:554–561PubMedCrossRef

36.

Morris MC, Ittenbach RF, Godinez RI, Portnoy JD, Tabbutt S, Hanna BD, Hoffman TM, Gaynor JW, Connelly JT, Helfaer MA, Spray TL, Wernovsky G (2004) Risk factors for mortality in 137 pediatric cardiac intensive care unit patients managed with extracorporeal membrane oxygenation. Crit Care Med 32:1061–1069PubMedCrossRef

37.

Jan SL, Lin SJ, Fu YC, Chi CS, Wang CC, Wei HJ, Chang Y, Hwang B, Chen PY, Huang FL, Lin MC (2010) Extracorporeal life support for treatment of children with enterovirus 71 infection-related cardiopulmonary failure. Intensive Care Med 36:520–527PubMedCrossRef

38.

Schmidt M, Tachon G, Devilliers C, Muller G, Hekimian G, Brechot N, Merceron S, Luyt CE, Trouillet JL, Chastre J, Leprince P, Combes A (2013) Blood oxygenation and decarboxylation determinants during venovenous ECMO for respiratory failure in adults. Intensive Care Med 39:838–846

Title: Long-term mortality in patients with chronic obstructive pulmonary disease following extracorporeal membrane oxygenation for cardiac assist after cardiovascular surgery
Authors: Klaus Distelmaier
Alexander Niessner
Dominik Haider
Irene M. Lang
Gottfried Heinz
Gerald Maurer
Herbert Koinig
Barbara Steinlechner
Georg Goliasch
Publication date: 01-08-2013
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 8/2013
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-013-2931-y

At a glance: The STEP trials

Springer Medicine

Long-term mortality in patients with chronic obstructive pulmonary disease following extracorporeal membrane oxygenation for cardiac assist after cardiovascular surgery

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2013

Time to reach a new steady state after changes of positive end expiratory pressure

Epidemiology and outcome of thrombocytopenic patients in the intensive care unit: results of a prospective multicenter study

Reporting and handling missing values in clinical studies in intensive care units

Levosimendan for the treatment of subarachnoid hemorrhage-related cardiogenic shock

Neurally adjusted ventilatory assist: letting the respiratory center take over control of ventilation

The ECMOnet score: a useful tool not to be taken absolutely