Article ; Online: Definitions of major bleeding for predicting mortality in critically ill adult patients who survived 24 hours while supported with peripheral veno-arterial extracorporeal membrane oxygenation for cardiogenic shock: a comparative historical cohort study.
Canadian journal of anaesthesia = Journal canadien d'anesthesie
2024 Volume 71, Issue 4, Page(s) 523–534
Abstract: Purpose: The severity of bleeding events is heterogeneously defined during peripheral veno-arterial extracorporeal membrane oxygenation (pVA-ECMO). We studied three bleeding definitions in pVA-ECMO: the Extracorporeal Life Support Organization (ELSO)- ... ...
| Title translation | Définitions de l’hémorragie majeure pour prédire la mortalité chez la patientèle adulte gravement malade ayant survécu 24 heures sous oxygénation par membrane extracorporelle veino-artérielle périphérique pour un choc cardiogénique : une étude de cohorte historique comparative. |
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| Abstract | Purpose: The severity of bleeding events is heterogeneously defined during peripheral veno-arterial extracorporeal membrane oxygenation (pVA-ECMO). We studied three bleeding definitions in pVA-ECMO: the Extracorporeal Life Support Organization (ELSO)-serious bleeding, the Bleeding Academic Research Consortium (BARC), and the universal definition of postoperative bleeding (UPDB) classifications. Methods: We included consecutive adult patients supported by pVA-ECMO for refractory cardiogenic shock admitted to Lille academic hospitals between January 2013 and December 2019. We assessed the association of bleeding definitions with the primary endpoint of 28-day all-cause mortality with the use of multivariate models accounting for time-dependent and competing variables. We compared models' performances using the Harrell's C-Index and the Akaike information criteria. Results: Twenty-eight-day mortality occurred in 128/308 (42%) 308 patients. The ELSO-serious bleeding (hazard ratio [HR], 1.67; 95% confidence interval [CI], 1.09 to 2.56) and BARC ≥ type 2 (HR, 1.55; 95% CI, 1.01 to 2.37) were associated with 28-day mortality (Harrell's C-index, 0.69; 95% CI, 0.63 to 0.74 for both). Predictors of ELSO-serious bleeding were postcardiotomy, body mass index, baseline platelets count, fibrinogen, and hemoglobin levels. Conclusion: Extracorporeal Life Support Organization-serious bleeding and BARC ≥ type 2 are relevant definitions of major bleeding regarding their association with mortality in critically ill patients who survived the first 24 hr while supported with pVA-ECMO for cardiogenic shock. Study registration: CERAR (IRB 00010254-2022-050, Paris, France); first submitted on 18 April 2022. |
| MeSH term(s) | Adult ; Humans ; Shock, Cardiogenic/therapy ; Shock, Cardiogenic/etiology ; Extracorporeal Membrane Oxygenation ; Cohort Studies ; Critical Illness ; Hemorrhage ; Hospital Mortality ; Retrospective Studies |
| Language | English |
| Publishing date | 2024-03-04 |
| Publishing country | United States |
| Document type | Journal Article |
| ZDB-ID | 91002-8 |
| ISSN | 1496-8975 ; 0832-610X |
| ISSN (online) | 1496-8975 |
| ISSN | 0832-610X |
| DOI | 10.1007/s12630-024-02704-6 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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