Publications by authors named "Akram Zaaqoq"
Background: Critical care of patients on extracorporeal membrane oxygenation (ECMO) with acute brain injury (ABI) is notable for a lack of high-quality clinical evidence. Here, we offer guidelines for neurological care (neurological monitoring and management) of adults during and after ECMO support.
Methods: These guidelines are based on clinical practice consensus recommendations and scientific statements.
Article Synopsis
- This study investigates the relationship between mortality rates for patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) based on where in the hospital their cardiac arrest occurs, as well as the effect of moving patients for cannulation on their outcomes.
- The research analyzed data from 2,515 patients who experienced in-hospital cardiac arrest between 2020 and 2023 at hospitals reporting to the Extracorporeal Life Support Organization (ELSO).
- Results showed significantly higher odds of mortality for patients who had cardiac arrests in the ICU or acute care beds compared to those in the cardiac catheterization lab, while relocating patients for cannulation did not have a notable impact on survival rates.
Article Synopsis
- - The text discusses the lack of strong clinical evidence in the critical care of ECMO patients with acute brain injury (ABI) and presents guidelines for their neurological care.
- - Guidelines were developed using input from an international panel of 30 ECMO experts through a structured voting process, focusing on five key clinical areas.
- - The consensus emphasizes the importance of early detection and intervention for ABI in ECMO patients to improve health outcomes and outlines multiple recommendations to guide clinical practice and highlight research needs.
Article Synopsis
- - Low pulse pressure (PP) during venoarterial-extracorporeal membrane oxygenation (VA-ECMO) is linked to cardiac dysfunction and increased risk of acute brain injury (ABI), with a specific focus on central nervous system (CNS) issues.
- - An analysis of 9,807 patients showed that 15% had a low PP (≤10 mm Hg), and these patients experienced ABI more frequently (15% vs. 11%) compared to those with higher PP.
- - Low PP was independently associated with higher chances of CNS ischemia and brain death, highlighting the importance of monitoring pulse pressure in patients receiving peripheral VA-ECMO.
Article Synopsis
- Anemia is linked to an increased risk of cardiac arrest and stroke in COVID-19 patients, with a study analyzing the impact of hemoglobin levels at ICU admission on these outcomes.
- The retrospective study reviewed data from over 6,900 ICU patients across 370 international sites, measuring the incidence of stroke or cardiac arrest within 30 days of admission, with anemia classified into normal, mild, moderate, and severe categories.
- The results showed that as anemia severity increased, so did the risk of cardiac arrest or stroke, particularly noting that moderate/severe anemia raised the risk by 32% compared to those with normal hemoglobin levels.
Article Synopsis
- The study investigates the survival outcomes of adult COVID-19 patients on venovenous extracorporeal membrane oxygenation (VV-ECMO) across different regions and timeframes, analyzing data from 1060 patients in 351 institutions worldwide between January 2020 and December 2021.
- It found that the in-hospital mortality rate for the overall cohort was 47.12%, with notable differences in mortality trends among regions, especially a spike in deaths in North America and Europe during mid-2020, while Latin America maintained better survival rates for longer.
- The results suggest that various factors, including the timing of ECMO initiation and patient demographics, contribute to mortality variances, emphasizing the need for improved patient selection
Article Synopsis
- The study investigates how skin pigmentation affects the discrepancy between peripheral oxygen saturation (SpO) and arterial saturation of oxygen (SaO) in patients receiving venovenous-extracorporeal membrane oxygenation (VV-ECMO), particularly focusing on race/ethnicity impacts and occult hypoxemia, linked to higher in-hospital mortality.
- Data from over 13,000 patients showed that Black and Hispanic individuals experienced higher rates of occult hypoxemia compared to White patients, with significant statistical support for these findings.
- The research highlights the need for careful monitoring of SaO in conjunction with SpO during ECMO, especially for patients with darker skin pigmentation, due to the increased risks
Article Synopsis
- ECMO is utilized as a critical therapy for COVID-19 patients suffering from severe ARDS, but bleeding and thrombotic complications are significant issues during treatment.
- Data from a global study involving over 1,200 severe COVID-19 patients on ECMO indicates that 38% experienced coagulation issues, with 54% facing hemorrhagic complications and higher mortality rates among those with bleeding.
- The study suggests that while coagulation disorders are common and serious in these patients, the associated mortality risk may be lower than earlier reports from single-nation studies.
Article Synopsis
- Assessing a patient's functional status before cardiac surgery might help predict the need for postoperative veno-arterial ECMO and outcomes.
- A study of 83 patients showed no significant link between their premorbid functional status and mortality rates, but age was found to be a predictor of mortality.
- Further research is encouraged to evaluate different functional status markers and their effects on various outcomes post-surgery.
Limb ischaemia is a clinically relevant complication of venoarterial extracorporeal membrane oxygenation (VA ECMO) with femoral artery cannulation. No selective distal perfusion or other advanced techniques were used in the past to maintain adequate distal limb perfusion. A more recent trend is the shift from the reactive or emergency management to the pro-active or prophylactic placement of a distal perfusion cannula to avoid or reduce limb ischaemia-related complications.
View Article and Find Full Text PDFBackground: The efficacy of extracorporeal membrane oxygenation (ECMO) as a bridge to left ventricular assist device (LVAD) remains unclear, and recipients of the more contemporary HeartMate 3 (HM3) LVAD are not well represented in previous studies. We therefore undertook a multicenter, retrospective study of this population.
Methods And Results: INTERMACS 1 LVAD recipients from five U.
Background: Adult extracorporeal membrane oxygenation (ECMO) patients are at high risk for allogeneic blood transfusion. Few studies have characterized iatrogenic blood loss from phlebotomy in adult ECMO patients. We hypothesized that iatrogenic phlebotomy would be a significant source of blood loss during ECMO.
View Article and Find Full Text PDFObjectives: Chronic alcohol use is associated with chronic pain and increased opioid consumption. The association between chronic alcohol use and acute postoperative pain has been studied minimally. The authors' objective was to explore the association among preoperative alcohol use, postoperative pain, and opioid consumption after coronary artery bypass grafting (CABG).
View Article and Find Full Text PDFArticle Synopsis
- Acute kidney injury (AKI) is linked to higher in-hospital mortality for patients on veno-arterial ECMO, but the specific effects of KDIGO AKI stages have not been fully studied.
- A retrospective analysis of 179 patients revealed that as age increases, the odds of mortality within 30 days rise by 4%, and any presence of AKI increases mortality odds by 59%.
- Higher KDIGO stages of AKI are associated with increased mortality risk at 30 days, indicating that further research is necessary to confirm these preliminary findings.
Background: Low pulse pressure (PP) in venoarterial-extracorporeal membrane oxygenation (VA-ECMO) is a marker of cardiac dysfunction and has been associated with acute brain injury (ABI) as continuous-flow centrifugal pump may lead to endothelial dysregulation.
Methods: We retrospectively analyzed adults (≥18 years) on "peripheral" VA-ECMO support for cardiogenic shock in the Extracorporeal Life Support Organization Registry (1/2018-7/2023). Cubic splines were used to establish a threshold (PP≤10 mmHg at 24 hours of ECMO support) for "early low" PP.
Importance: Skin pigmentation influences peripheral oxygen saturation (SpO) measured by pulse oximetry compared to the arterial saturation of oxygen (SaO) measured via arterial blood gas analysis. However, data on SpO-SaO discrepancy are limited in venovenous-extracorporeal membrane oxygenation (VV-ECMO) patients.
Objective: To determine whether there is racial/ethnical discrepancy between SpO and SaO in patients receiving VV-ECMO.
Background: While venoarterial extracorporeal membrane oxygenation (V-A ECMO) provides lifesaving support for cardiopulmonary failure, complications may increase mortality, with few studies focusing on ischemic/hemorrhagic stroke. We aimed to determine the trends and associations of stroke incidence and mortality, and their risk factors, including the effects of annual case volumes of ECMO centers.
Methods: Retrospective analysis was performed on the Extracorporeal Life Support Organization (ELSO) registry, including adult V-A ECMO patients from 534 international centers between 2012 and 2021, excluding extracorporeal cardiopulmonary resuscitation.
The Extracorporeal Life Support Organization (ELSO) registry captures clinical data and outcomes on patients receiving extracorporeal membrane oxygenation (ECMO) support across the globe at participating centers. It provides a very unique opportunity to benchmark outcomes and analyze the clinical course to help identify ways of improving patient outcomes. In this review, we summarize select adult ECMO articles published using the ELSO registry over the past 5 years.
View Article and Find Full Text PDFRisk Factors for Stroke Development After Thoracic Aortic Surgery.
J Cardiothorac Vasc Anesth
December 2023
Objectives: Stroke after thoracic aortic surgery is a complication that is associated with poor outcomes. The aim is to characterize the intraoperative risk factors for stroke development.
Design: A retrospective analysis.
Article Synopsis
- A study analyzed data from 33,041 adult patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO) to understand stroke incidence and mortality trends between 2012-2021 at various centers.
- Results showed that ischemic stroke incidence increased significantly (by 21% per year) while hemorrhagic strokes remained stable; overall 90-day mortality decreased by 1.78% each year.
- Higher case volumes at ELSO centers were linked to increased stroke incidences but lower 90-day mortality rates, with the highest risk of death occurring in the initial days of VA-ECMO treatment.
Article Synopsis
- The study aimed to determine if fasciotomy, a surgical procedure, affected mortality rates in patients with acute compartment syndrome (ACS) undergoing extracorporeal cardiopulmonary resuscitation (ECPR).
- Out of 764 ECPR patients analyzed, 127 developed ACS, with 63% undergoing fasciotomy; the overall mortality rate for ACS patients was about 69%, showing no significant difference in mortality between those who did and did not receive fasciotomy.
- Factors such as body mass index (BMI) and blood pressure were linked to mortality risk, but fasciotomy itself was not proven to independently increase mortality; further research is needed to validate these results due to potential biases in the study's