Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Hypoalbuminemia and Albumin Replacement during Extracorporeal Membrane Oxygenation in Patients with Cardiogenic Shock

  • Jae Beom Jeon (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Cho Hee Lee (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Yongwhan Lim (Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Min-Chul Kim (Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Hwa Jin Cho (Department of Pediatrics, Chonnam National University Children's Hospital, Chonnam National University Medical School) ;
  • Do Wan Kim (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Kyo Seon Lee (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • In Seok Jeong (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School)
  • Received : 2022.10.26
  • Accepted : 2023.01.31
  • Published : 2023.07.05
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Abstract

Background: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with cardiorespiratory failure. The serum albumin level is an important prognostic marker in critically ill patients. We evaluated the efficacy of using pre-ECMO serum albumin levels to predict 30-day mortality in patients with cardiogenic shock (CS) who underwent venoarterial (VA) ECMO. Methods: We reviewed the medical records of 114 adult patients who underwent VA-ECMO between March 2021 and September 2022. The patients were divided into survivors and non-survivors. Clinical data before and during ECMO were compared. Results: Patients' mean age was 67.8±13.6 years, and 36 (31.6%) were female. The proportion of survival to discharge was 48.6% (n=56). Cox regression analysis showed that the pre-ECMO albumin level independently predicted 30-day mortality (hazard ratio, 0.25; 95% confidence interval [CI], 0.11-0.59; p=0.002). The area under the receiver operating characteristic curve of albumin levels (pre-ECMO) was 0.73 (standard error [SE], 0.05; 95% CI, 0.63-0.81; p<0.001; cut-off value=3.4 g/dL). Kaplan-Meier survival analysis showed that the cumulative 30-day mortality was significantly higher in patients with a pre-ECMO albumin level ≤3.4 g/dL than in those with a level >3.4 g/dL (68.9% vs. 23.8%, p<0.001). As the adjusted amount of albumin infused increased, the possibility of 30-day mortality also increased (coefficient=0.140; SE, 0.037; p<0.001). Conclusion: Hypoalbuminemia during ECMO was associated with higher mortality, even with higher amounts of albumin replacement, in patients with CS who underwent VA-ECMO. Further studies are needed to predict the timing of albumin replacement during ECMO.

Keywords

Acknowledgement

This work was supported by grants B2021-0991 and BCRI22025 from the Chonnam National University Hospital Biomedical Research Institute.

References

  1. Mosier JM, Kelsey M, Raz Y, et al. Extracorporeal membrane oxygenation (ECMO) for critically ill adults in the emergency department: history, current applications, and future directions. Crit Care 2015;19:431. https://doi.org/10.1186/s13054-015-1155-7
  2. Oh TK, Song IA. Trend of extracorporeal membrane oxygenation support in patients with acute respiratory distress syndrome in South Korea. Sci Rep 2022;12:5225. https://doi.org/10.1038/s41598-022-09230-9
  3. Bartlett RH, Deatrick KB. Current and future status of extracorporeal life support for respiratory failure in adults. Curr Opin Crit Care 2016;22:80-5. https://doi.org/10.1097/MCC.0000000000000274
  4. Kim E, Sodirzhon-Ugli NY, Kim DW, et al. Prediction of 6-month mortality using pre-extracorporeal membrane oxygenation lactate in patients with acute coronary syndrome undergoing veno-arterial-extracorporeal membrane oxygenation. J Chest Surg 2022;55:143-50. https://doi.org/10.5090/jcs.21.127
  5. Malbrain ML, Langer T, Annane D, et al. Intravenous fluid therapy in the perioperative and critical care setting: executive summary of the International Fluid Academy (IFA). Ann Intensive Care 2020;10:64. https://doi.org/10.1186/s13613-020-00679-3
  6. Lee JJ, Kim JH. Plasma volume expanders: classification and characteristics of colloids. J Korean Med Assoc 2013;56:924-32. https://doi.org/10.5124/jkma.2013.56.10.924
  7. Jiang L, Jiang S, Zhang M, Zheng Z, Ma Y. Albumin versus other fluids for fluid resuscitation in patients with sepsis: a meta-analysis. PLoS One 2014;9:e114666. https://doi.org/10.1371/journal.pone.0114666
  8. Wengenmayer T, Schroth F, Biever PM, et al. Albumin fluid resuscitation in patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO) therapy is associated with improved survival. Intensive Care Med 2018;44:2312-4. https://doi.org/10.1007/s00134-018-5443-y
  9. Nicholson JP, Wolmarans MR, Park GR. The role of albumin in critical illness. Br J Anaesth 2000;85:599-610. https://doi.org/10.1093/bja/85.4.599
  10. Kim H, Paek JH, Song JH, et al. Permissive fluid volume in adult patients undergoing extracorporeal membrane oxygenation treatment. Crit Care 2018;22:270. https://doi.org/10.1186/s13054-018-2211-x
  11. Extracorporeal Life Support Organization (ELSO) general guidelines for all ECLS cases: ELSO guidelines for cardiopulmonary extracorporeal life support, version 1.4 [Internet]. ELSO; 2017 [cited 2022 Oct 20]. Available from: https://www.elso.org
  12. Adrie C, Adib-Conquy M, Laurent I, et al. Successful cardiopulmonary resuscitation after cardiac arrest as a "sepsis-like" syndrome. Circulation 2002;106:562-8. https://doi.org/10.1161/01.cir.0000023891.80661.ad
  13. Jellinge ME, Henriksen DP, Hallas P, Brabrand M. Hypoalbuminemia is a strong predictor of 30-day all-cause mortality in acutely admitted medical patients: a prospective, observational, cohort study. PLoS One 2014;9:e105983. https://doi.org/10.1371/journal.pone.0105983
  14. Huang M, Ong BH, Hoo AE, et al. Prognostic factors for survival after extracorporeal membrane oxygenation for cardiogenic shock. ASAIO J 2020;66:141-5. https://doi.org/10.1097/MAT.0000000000000984
  15. Delaney AP, Dan A, McCaffrey J, Finfer S. The role of albumin as a resuscitation fluid for patients with sepsis: a systematic review and meta-analysis. Crit Care Med 2011;39:386-91. https://doi.org/10.1097/CCM.0b013e3181ffe217
  16. Bro-Jeppesen J, Kjaergaard J, Wanscher M, et al. Systemic inflammatory response and potential prognostic implications after out-of-hospital cardiac arrest: a substudy of the target temperature management trial. Crit Care Med 2015;43:1223-32. https://doi.org/10.1097/CCM.0000000000000937
  17. Caironi P, Tognoni G, Masson S, et al. Albumin replacement in patients with severe sepsis or septic shock. N Engl J Med 2014;370: 1412-21. https://doi.org/10.1056/NEJMoa1305727
  18. Guthrie RD Jr, Hines C Jr. Use of intravenous albumin in the critically ill patient. Am J Gastroenterol 1991;86:255-63. https://pubmed.ncbi.nlm.nih.gov/1998305/