Journal of cardiothoracic and vascular anesthesia · 2025
Unifying Weaning Success Criteria to Bridge the Extracorporeal Membrane Oxygenation Gap: Variations in Determinants Based on Definitions of Successful Weaning.
СтатьяНаблюдательное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Serizawa Hibiki, Suzuki Ginga, Nishioka Saria, Kobori Toshimitsu, Masuyama Yuka, Yamamoto Saki, Nakamichi Yoshimi, Honda Mitsuru, Sasaki Yosuke
Аннотация
OBJECTIVE: To investigate the factors contributing to the "ECMO gap," the discrepancy between successful weaning from venoarterial extracorporeal membrane oxygenation (VA-ECMO) and survival to hospital discharge, using different definitions of successful weaning.
DESIGN: Single-center retrospective observational study.
SETTING: A tertiary academic medical center intensive care unit.
PARTICIPANTS: Patients aged ≥18 years who underwent VA-ECMO between January 2018 and June 2023. Patients who died while on ECMO were excluded. Successful weaning from ECMO was defined using two criteria: survival for 48 hours (Definition 1) and independence from mechanical circulatory support (MCS) within 30 days (Definition 2).
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Multivariate logistic regression analysis was performed to identify factors associated with the ECMO gap for each definition, with Bayesian logistic regression conducted as a sensitivity analysis. Of the 130 ECMO patients, 110 were included in the analysis. Acute myocardial infarction and sepsis-induced cardiogenic shock (SICS) were associated with the ECMO gap under Definition 1. Under Definition 2, age (p = 0.04) was significantly associated with the ECMO gap," while SICS showed a trend toward significance (p = 0.06). Bayesian analysis supported the association between age (odds ratio [95% confidence interval]: 0.08 [0.01-0.16]) and the ECMO gap. SICS showed a possible association (odds ratio [95% confidence interval]: 3.15 [0.26-6.33]); however, the wide credible interval suggests caution in interpretation.
CONCLUSIONS: The factors associated with the ECMO gap vary depending on the definition of successful weaning from ECMO. Specifically, advanced age and sepsis (eg, SICS) may hinder long-term recovery and contribute to the ECMO gap. Standardizing the definition of successful ECMO weaning is essential to improving patient outcomes and refining treatment strategies.
DESIGN: Single-center retrospective observational study.
SETTING: A tertiary academic medical center intensive care unit.
PARTICIPANTS: Patients aged ≥18 years who underwent VA-ECMO between January 2018 and June 2023. Patients who died while on ECMO were excluded. Successful weaning from ECMO was defined using two criteria: survival for 48 hours (Definition 1) and independence from mechanical circulatory support (MCS) within 30 days (Definition 2).
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Multivariate logistic regression analysis was performed to identify factors associated with the ECMO gap for each definition, with Bayesian logistic regression conducted as a sensitivity analysis. Of the 130 ECMO patients, 110 were included in the analysis. Acute myocardial infarction and sepsis-induced cardiogenic shock (SICS) were associated with the ECMO gap under Definition 1. Under Definition 2, age (p = 0.04) was significantly associated with the ECMO gap," while SICS showed a trend toward significance (p = 0.06). Bayesian analysis supported the association between age (odds ratio [95% confidence interval]: 0.08 [0.01-0.16]) and the ECMO gap. SICS showed a possible association (odds ratio [95% confidence interval]: 3.15 [0.26-6.33]); however, the wide credible interval suggests caution in interpretation.
CONCLUSIONS: The factors associated with the ECMO gap vary depending on the definition of successful weaning from ECMO. Specifically, advanced age and sepsis (eg, SICS) may hinder long-term recovery and contribute to the ECMO gap. Standardizing the definition of successful ECMO weaning is essential to improving patient outcomes and refining treatment strategies.