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Extubation Criteria for Patients With Total Artificial Heart (TAH) FREE TO VIEW

Jillian Maloney*, MD; Bhavesh Patel, MD; Linda Staley, NP; Amelia Lowell, RRT; Dawn Jaroszewski, MD; Francisco Arabia, MD
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Mayo Clinic, Phoenix, AZ

Chest. 2012;142(4_MeetingAbstracts):405A. doi:10.1378/chest.1386035
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SESSION TYPE: Post operative ICU issues Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Over 5.5 million people have heart failure in the United States and as many as 100,000 have advanced heart failure awaiting transplant. As cardiothoracic surgical techniques advance, the incidence of patients receiving total artificial hearts (TAH) as a bridge to transplant has increased with over 950 devices implanted worldwide. Substantial clinical evidence has validated predictors of successful extubation in cardiac surgery patients; however it is uncertain whether these apply to extubation of patients post-TAH implantation. We present pilot data on salient factors associated with successful extubation.

METHODS: A retrospective descriptive evaluation of patients >18 years old receiving a TAH between 2010 and 2011. Continuous measures were described using means, standard deviations, medians, and ranges. Categorical measures were described using counts and percentages. Modified Burns Wean Assessment Program (BWAP) score was compared between those with extubation failures <72 hours versus those without failures < 72 hours using a t-test.

RESULTS: Twelve patients received TAH with median age of 52.5 as a bridge to transplant. Patients with extubation failures <72 hours and those without extubation failure <72 hours were similar in age, BMI, gender, Intermacs profile, cardiopulmonary bypass time, and aorta cross clamp time. The modified BWAP was statistically significant (p<0.05) between patients that failed extubation within 72 hours and those without extubation failure in <72 hours. Univariate analysis suggests renal injury, gastrointestinal injury, multi-organ failure, sternal closure>72 hours, and cardiac edema/tamponade may be associated with extubation failure in this patient population. Increased ICU mortality and 30 day mortality also may be associated with extubation failure in TAH patients.

CONCLUSIONS: Within the limitations of a descriptive study with a small number of patients, a modified BWAP has the potential to predict extubation failure in patients with TAH which may be associated with increased morbidity and mortality. Further prospective evaluation of a modified BWAP score in this population is recommended.

CLINICAL IMPLICATIONS: A modified BWAP score may possibly predict extubation failure in patients with TAH which may accompany increased morbidity and mortality.

DISCLOSURE: Francisco Arabia: Consultant fee, speaker bureau, advisory committee, etc.: Part time consultant

The following authors have nothing to disclose: Jillian Maloney, Bhavesh Patel, Linda Staley, Amelia Lowell, Dawn Jaroszewski

No Product/Research Disclosure Information

Mayo Clinic, Phoenix, AZ




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