Impact of Age-Adjusted Charlson Comorbidity on Hospital Survival and Short-Term Outcome of Patients with Extracorporeal Cardiopulmonary Resuscitation
Abstract
:1. Background
2. Methods
3. Results
4. Discussion
5. Limitations
6. Conclusions
Author Contributions
Funding
Conflicts of Interest
Appendix A
Absolute contraindication |
Age >90 |
End-stage malignancy (except reversible adverse reaction due to immuno- or chemotherapy treatment.) |
Long-term poor morbidity |
Acute intracranial hemorrhage |
Uncontrolled bleeding |
Prolonged CPR >90 min |
Do-not-resuscitation (DNR) prescription |
Relative contraindication |
Age 75–90 |
Sepsis |
Pre-existing multiple organ failure |
Prolonged CPR >60 min |
Unwitnessed arrest |
References
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Variables | All (461) | ACCI 0–3 (240) | ACCI 4–13 (221) | p (ACCI 0–3 vs. ACCI 4–13) |
---|---|---|---|---|
Female gender | 105 (22.8%) | 55 (22.9%) | 50 (22.6%) | 0.941 |
Age (years) | 55.5 ± 15.3 | 45.8 ± 12.8 | 66.1 ± 9.96 | <0.001 |
<40 | 78 (16.9%) | 78 (32.5%) | 0 (0.0%) | <0.001 |
40–49 | 67 (14.5%) | 58 (24.2%) | 9 (4.1%) | |
50–59 | 120 (26.0%) | 77 (32.1%) | 43 (19.5%) | |
60–69 | 117 (25.4%) | 27 (11.3%) | 90 (40.7%) | |
70–79 | 60 (13.0%) | 0 (0.0%) | 60 (27.1%) | |
>80 | 19 (4.1%) | 0 (0.0%) | 19 (8.6%) | |
Diabetes mellitus | 177 (38.4%) | 44 (18.3%) | 133 (60.2%) | <0.001 |
Uncomplicated | 160 (34.7%) | 44 (18.3%) | 116 (52.5%) | <0.001 |
End-organ damage | 17 (3.7%) | 0 (0.0%) | 17 (7.7%) | <0.001 |
Liver disease, moderate | 9 (2.0%) | 0 (0.0%) | 9 (4.1%) | 0.002 |
AIDS | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0.376 |
CKD-4,5 | 68 (14.8%) | 6 (2.5%) | 62 (28.1%) | <0.001 |
Congestive heart failure | 103 (22.3%) | 29 (12.1%) | 74 (33.5%) | <0.001 |
Old myocardial infarct | 60 (13.0%) | 11 (4.6%) | 49 (22.1%) | <0.001 |
COPD | 9 (2.0%) | 0 (0.0%) | 9 (4.1%) | 0.002 |
Peripheral vascular disease | 27 (5.9%) | 0 (0.0%) | 27 (12.2%) | <0.001 |
Old CVA or TIA | 34 (7.4%) | 4 (1.7%) | 30 (13.6%) | <0.001 |
Dementia | 5 (1.1%) | 0 (0.0%) | 5 (2.3%) | 0.019 |
Hemiplegia | 5 (1.1%) | 0 (0.0%) | 5 (2.3%) | 0.019 |
Auto-immune connective disease | 3 (0.7%) | 3 (1.3%) | 0 (0.0%) | 0.090 |
Peptic ulcer disease | 19 (4.1%) | 3 (1.3%) | 16 (7.2%) | 0.001 |
Malignancy | 22 (4.8%) | 1 (0.4%) | 21 (9.5%) | <0.001 |
CCI | 1 (IQR: 0–2) | 0 (IQR: 0–1) | 2 (IQR: 1–4) | <0.001 |
ACCI | 3 (2–5) | 2 (IQR: 1–3) | 5 (IQR: 4–7) | <0.001 |
Main CPR causes | <0.001 | |||
ACS | 193 (41.9%) | 83 (34.6%) | 110 (49.8%) | 0.001 |
Chronic heart failure | 64 (13.9%) | 33 (13.8) | 31 (14.0%) | |
Septic shock | 33 (7.2%) | 18 (7.5%) | 15 (6.8%) | |
Post-cardiotomy | 31 (6.7%) | 13 (5.4%) | 18 (8.1%) | |
Pulmonary embolism | 25 (5.4%) | 12 (5.0%) | 13 (5.9%) | |
Acute myocarditis | 19 (4.1%) | 18 (7.5%) | 1 (0.5%) | |
Arrhythmia | 18 (3.9%) | 11 (4.6%) | 7 (3.2%) | |
Cardiac tamponade | 8 (1.7%) | 2 (0.8%) | 6 (2.7%) | |
Respiratory failure | 16 (3.5%) | 13 (5.4%) | 3 (1.4%) | |
Acute aortic dissection | 7 (1.5%) | 5 (2.1%) | 2(0.9%) | |
Hypovolemia | 12 (2.6%) | 9 (3.7%) | 3 (1.4%) | |
Acute rejection | 9 (2.0%) | 5 (2.1%) | 4 (1.8%) | |
Others | 26 (5.6%) | 18 (7.5%) | 8 (3.6%) | |
CPR duration before ECMO run (min) | 41.7 ± 23.2 | 42.1 ± 25.6 | 41.3 ± 20.7 | 0.754 |
OHCA | 89 (19.3%) | 59 (24.6%) | 30 (13.6%) | 0.003 |
Variables | All (461) | ACCI 0–3 (240) | ACCI 4–13 (221) | p |
---|---|---|---|---|
ECMO days | 4.79 ± 17.53 | 4.48 ± 6.10 | 5.13 ± 24.5 | 0.694 |
Ventilator days | 11.1 ± 19.30 | 11.6 ± 21.2 | 10.6 ± 17.1 | 0.547 |
ICU days | 12.7 ± 18.57 | 12.5 ± 18.5 | 13.0 ± 18.7 | 0.780 |
Hospitalization days | 22.0 ± 34.4 | 21.7 ± 36.1 | 22.2 ± 32.5 | 0.899 |
Mortality | 0.069 | |||
Die on ECMO | 256 (55.5%) | 136 (56.7%) | 120 (54.3%) | |
Weaned off ECMO and die | 67 (14.6%) | 27 (11.3%) | 40 (18.1%) | |
Hospital discharge | 138 (29.9%) | 77 (32.1%) | 61 (27.6%) | 0.294 |
Morbidity | ||||
Vascular complications | 31 (6.7%) | 16 (6.7%) | 15 (6.8%) | 0.959 |
Neurological complications | 193 (41.9%) | 101 (42.1%) | 92 (41.6%) | 0.921 |
New renal failure | 204 (44.3%) | 93 (38.7%) | 111 (50.2%) | 0.013 |
Variables | Univariate Analysis | p | Multivariate Analysis | p |
---|---|---|---|---|
Female gender | 0.81 (0.50–1.32) | 0.406 | - | - |
CCI | 0.93 (0.83–1.04) | 0.205 | - | - |
Age (+10 years) | 0.94 (0.82–1.07) | 0.353 | - | - |
ACCI | 0.95 (0.87–1.02) | 0.164 | - | - |
CPR causes | ||||
ACS | 1.41 (0.94–2.11) | 0.091 * | 1.31 (0.87–1.02) | 0.215 |
Chronic heart failure | 0.83 (0.46–1.50) | 0.526 | - | - |
Septic shock | 0.14 (0.03–0.59) | 0.007 * | 0.16 (0.04–0.70) | 0.014 |
Post-cardiotomy | 1.31 (0.61–2.82) | 0.486 | - | - |
Pulmonary embolism | 1.91 (0.85–4.32) | 0.120 | - | - |
Acute myocarditis | 1.76 (0.69–4.44) | 0.242 | - | - |
CPR-to-ECMO duration (+10 min) | 0.90 (0.82–1.00) | 0.044 * | 0.90 (0.81–1.00) | 0.043 |
OHCA | 1.41 (0.86–2.30) | 0.169 | - | - |
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Share and Cite
Tseng, L.-J.; Yu, H.-Y.; Wang, C.-H.; Chi, N.-H.; Huang, S.-C.; Chou, H.-W.; Shih, H.-C.; Chou, N.-K.; Chen, Y.-S. Impact of Age-Adjusted Charlson Comorbidity on Hospital Survival and Short-Term Outcome of Patients with Extracorporeal Cardiopulmonary Resuscitation. J. Clin. Med. 2018, 7, 313. https://doi.org/10.3390/jcm7100313
Tseng L-J, Yu H-Y, Wang C-H, Chi N-H, Huang S-C, Chou H-W, Shih H-C, Chou N-K, Chen Y-S. Impact of Age-Adjusted Charlson Comorbidity on Hospital Survival and Short-Term Outcome of Patients with Extracorporeal Cardiopulmonary Resuscitation. Journal of Clinical Medicine. 2018; 7(10):313. https://doi.org/10.3390/jcm7100313
Chicago/Turabian StyleTseng, Li-Jung, Hsi-Yu Yu, Chih-Hsien Wang, Nai-Hsin Chi, Shu-Chien Huang, Heng-Wen Chou, Hsin-Chin Shih, Nai-Kuan Chou, and Yih-Sharng Chen. 2018. "Impact of Age-Adjusted Charlson Comorbidity on Hospital Survival and Short-Term Outcome of Patients with Extracorporeal Cardiopulmonary Resuscitation" Journal of Clinical Medicine 7, no. 10: 313. https://doi.org/10.3390/jcm7100313