Acute mesenteric ischaemia in refractory shock on veno-arterial extracorporeal membrane oxygenation
Open accessAbstract
BACKGROUND: Acute mesenteric ischaemia is a severe complication in critically ill patients, but has never been evaluated in patients on veno-arterial extracorporeal membrane oxygenation (V-A ECMO). This study was designed to determine the prevalence of mesenteric ischaemia in patients supported by V-A ECMO and to evaluate its risk factors, as well as to appreciate therapeutic modalities and outcome. METHODS: In a retrospective single centre study (January 2013 to January 2017), all consecutive adult patients who underwent V-A ECMO were included, with exclusion of those dying in the first 24 hours. Diagnosis of mesenteric ischaemia was performed using digestive endoscopy, computed tomography scan or first-line laparotomy. RESULTS: One hundred and fifty V-A ECMOs were implanted (65 for post-cardiotomy shock, 85 for acute cardiogenic shock, including 39 patients after refractory cardiac arrest). Overall, median age was 58 (48-69) years and mortality 56%. Acute mesenteric ischaemia was suspected in 38 patients, with a delay of four (2-7) days after ECMO implantation, and confirmed in 14 patients, that is, a prevalence of 9%. Exploratory laparotomy was performed in six out of 14 patients, the others being too unstable to undergo surgery. All patients with mesenteric ischaemia died. Independent risk factors for developing mesenteric ischaemia were renal replacement therapy (odds ratio (OR) 4.5, 95% confidence interval (CI) 1.3-15.7, p=0.02) and onset of a second shock within the first five days (OR 7.8, 95% CI 1.5-41.3, p=0.02). Conversely, early initiation of enteral nutrition was negatively associated with mesenteric ischaemia (OR 0.15, 95% CI 0.03-0.69, p=0.02). CONCLUSIONS: Acute mesenteric ischaemia is a relatively frequent but dramatic complication among patients on V-A ECMO.
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Risk factors for mesenteric ischemia in venoarterial extracorporeal membrane oxygenation have included renal replacement therapy and higher vasopressor dosing but not timing or route of nutritional support.
“Risk factors for mesenteric ischemia in venoarterial extracorporeal membrane oxygenation have included renal replacement therapy and higher vasopressor dosing but not timing or route of nutritional support.162”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [162]
The ‘Variables associated with acute mesenteric ischaemia’ section supports the RRT association and reports higher norepinephrine doses in affected patients. But it directly contradicts the claim about nutritional support: initiation of enteral nutrition in the first five days was negatively associated with ischaemia onset. The paper does not establish that vasopressor dose was an independent risk factor. (LLM, conf=0.88)
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- Authors
- Renaudier, M., de Roux, Q., Bougouin, W., Boccara, J., Dubost, B., Attias, A., Fiore, A., de’Angelis, N., Folliguet, T., Mulé, S., Amiot, A., Langeron, O., & Mongardon, N.
- Affiliations
- Assistance Publique – Hôpitaux de Paris (FR)
- Service d’anesthésie-réanimation chirurgicale, réanimation chirurgicale polyvalente, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, France
- Paris Cardiovascular Research Center (FR)
- Université Paris-Est Créteil (FR)
- Univ Paris Est Creteil, Faculté de Santé, France
- Institut Pasteur (FR)
- Inserm (FR)
- Corresponding author
- Mongardon, Nicolas
- ORCID
- Venue
- European Heart Journal. Acute Cardiovascular Care
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-05-27
- Volume
- 10
- Issue
- 1
- Pages
- 62-70
- ISSN
- 2048-8726 (ISSN-L)
- 2048-8734
- OpenAlex
- W3032276957
- Cited by
- 34
- References
- 11
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 7 · 2023: 3 · 2022: 6 · 2021: 6 · 2020: 3
- FWCI
- 4.12
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- European Heart Journal Acute Cardiovascular Care (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Physical Sciences › Engineering › Biomedical Engineering › Mechanical Circulatory Support Devices
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Keywords
- acute mesenteric ischemia, venoarterial extracorporeal membrane oxygenation, refractory shock, cardiogenic shock, postcardiotomy cardiogenic shock, renal replacement therapy, risk factors, early enteral nutrition, ECMO complications, mortality
- MeSH terms
- Adult, Heart Arrest, Humans, Middle Aged, Retrospective Studies, Shock, Cardiogenic, Extracorporeal Membrane Oxygenation, Mesenteric Ischemia
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