| Title: |
Prognostic impact of extubation in patients receiving veno-arterial extracorporeal life support: a propensity-score-matched study ; Impact pronostique de l’extubation des patients sous ECMO veino-artérielle : une étude après appariement par score de propension |
| Authors: |
Béhouche, Alexandre |
| Contributors: |
Université Grenoble Alpes - UFR Médecine (UGA UFRM); Université Grenoble Alpes (UGA); Lucie Gaide-Chevronnay |
| Source: |
https://dumas.ccsd.cnrs.fr/dumas-04144736 ; Médecine humaine et pathologie. 2021. |
| Publisher Information: |
CCSD |
| Publication Year: |
2021 |
| Collection: |
Université Grenoble Alpes: HAL |
| Subject Terms: |
ECMO (médecine) -- Pronostic (médecine); Réanimation -- Pronostic (médecine); Extubation endotrachéale; Suivi de cohortes de malades; ECMO veino-artérielle; [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology |
| Description: |
Purpose: The optimal extubation strategy for ECLS patients remains unclear, and the only studies on this topic in the literature have significant biases. We aimed to explore the prognostic impact of an early ventilator-weaning strategy in ECLS patients after controlling for confounding factors. Methods: A 10-year retrospective study included 241 patients who received extracorporeal life support for at least 48 hours, corresponding to a total of 977 days spent on life support. The a priori probability of extubation for each day of life support was calculated according to daily biological examinations, drug doses, clinical observations and admission data to pair each day containing an extubation event with one on which the patient was not extubated. The primary outcome was survival at day 28. The secondary outcomes were survival at day 7, respiratory infections and safety criteria. Results: Two cohorts of 61 patients with similar observed variables were generated. Survival at day 28 was better in patients extubated under assistance in univariate (p-value = 0.003) and multivariate (HR = 0.37 [0.2 – 0.68], p-value = 0.002) analyses. Patients who underwent failed early extubation did not have a different prognosis from those for whom early extubation was not attempted. Successful early extubation was associated with a better outcome than a failed attempt or no attempt at early extubation (p-values = 0.006 and < 0.001, respectively). Survival at day 7 and the rate of respiratory infections were better in patients who were extubated early than in those who were not. Safety data did not differ between the two groups. Conclusion: Early extubation during life support was associated with a superior outcome in our propensity-matched cohort study. The safety data were reassuring. However, due to the lack of prospective randomized studies, the causality remains uncertain. ; Contexte : La stratégie d’extubation des patients assistés par ECMO veino-artérielle (ECMO-VA) reste mal définie. En effet, la plupart des études de la ... |
| Document Type: |
master thesis |
| Language: |
French |
| Relation: |
PPN: 257037454 |
| Availability: |
https://dumas.ccsd.cnrs.fr/dumas-04144736; https://dumas.ccsd.cnrs.fr/dumas-04144736v1/document; https://dumas.ccsd.cnrs.fr/dumas-04144736v1/file/2021GRAL5067_behouche_alexandre_dif.pdf |
| Rights: |
info:eu-repo/semantics/OpenAccess |
| Accession Number: |
edsbas.ECB0B4A0 |
| Database: |
BASE |