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Peripheral versus central extracorporeal membrane oxygenation for postcardiotomy shock: Multicenter registry, systematic review, and meta-analysis
G. Mariscalco, A. Salsano, A. Fiore, M. Dalén, VG. Ruggieri, D. Saeed, K. Jónsson, G. Gatti, S. Zipfel, AM. Dell'Aquila, A. Perrotti, A. Loforte, U. Livi, M. Pol, C. Spadaccio, M. Pettinari, S. Ragnarsson, K. Alkhamees, Z. El-Dean, K. Bounader,...
Language English Country United States
Document type Journal Article, Meta-Analysis, Systematic Review
- MeSH
- Adult MeSH
- Cardiac Surgical Procedures adverse effects MeSH
- Middle Aged MeSH
- Humans MeSH
- Extracorporeal Membrane Oxygenation * adverse effects methods mortality MeSH
- Postoperative Complications surgery MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Shock surgery MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
- Systematic Review MeSH
BACKGROUND: We hypothesized that cannulation strategy in venoarterial extracorporeal membrane oxygenation (VA-ECMO) could play a crucial role in the perioperative survival of patients affected by postcardiotomy shock. METHODS: Between January 2010 and March 2018, 781 adult patients receiving VA-ECMO for postcardiotomy shock at 19 cardiac surgical centers were retrieved from the Postcardiotomy Veno-arterial Extracorporeal Membrane Oxygenation study registry. A parallel systematic review and meta-analysis (PubMed/MEDLINE, Embase, and Cochrane Library) through December 2018 was also accomplished. RESULTS: Central and peripheral VA-ECMO cannulation were performed in 245 (31.4%) and 536 (68.6%) patients, respectively. Main indications for the institution VA-ECMO were failure to wean from cardiopulmonary bypass (38%) and heart failure following cardiopulmonary bypass weaning (48%). The doubly robust analysis after inverse probability treatment weighting by propensity score demonstrated that central VA-ECMO was associated with greater hospital mortality (odds ratio 1.54; 95% confidence interval, 1.09-2.18), reoperation for bleeding/tamponade (odds ratio, 1.96; 95% confidence interval, 1.37-2.81), and transfusion of more than 9 RBC units (odds ratio, 2.42; 95% confidence interval, 1.59-3.67). The systematic review provided a total of 2491 individuals with postcardiotomy shock treated with VA-ECMO. Pooled prevalence of in-hospital/30-day mortality in overall patient population was 66.6% (95% confidence interval, 64.7-68.4%), and pooled unadjusted risk ratio analysis confirmed that patients undergoing peripheral VA-ECMO had a lower in-hospital/30-day mortality than patients undergoing central cannulation (risk ratio, 0.92; 95% confidence interval, 0.87-0.98). Adjustments for important confounders did not alter our results. CONCLUSIONS: In patients with postcardiotomy shock treated with VA-ECMO, central cannulation was associated with greater in-hospital mortality than peripheral cannulation.
Cardiothoracic Department University Hospital of Udine Udine Italy
Cardiovascular Surgery University Hospital of Dusseldorf Dusseldorf Germany
Department of Cardiac Surgery Sahlgrenska University Hospital Gothenburg Sweden
Department of Cardiothoracic Surgery Golden Jubilee National Hospital Glasgow United Kingdom
Department of Cardiothoracic Surgery Münster University Hospital Münster Germany
Department of Cardiothoracic Surgery University of Lund Lund Sweden
Department of Cardiovascular Surgery Ziekenhuis Oost Limburgl Genk Belgium
Department of Surgery University of Oulu Oulu Finland
Department of Thoracic and Cardio Vascular Surgery University Hospital Jean Minjoz Besançon France
Division of Cardiac Surgery Ospedali Riuniti Trieste Italy
Division of Cardiothoracic and Vascular Surgery Pontchaillou University Hospital Rennes France
Division of Cardiothoracic and Vascular Surgery Robert Debré University Hospital Reims France
Hamburg University Heart Center Hamburg Germany
Heart Center Turku University Hospital and University of Turku Turku Finland
Institute of Clinical and Experimental Medicine Prague Czech Republic
References provided by Crossref.org
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- $a Mariscalco, Giovanni $u Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, United Kingdom. Electronic address: giovannimariscalco@yahoo.it.
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- $a BACKGROUND: We hypothesized that cannulation strategy in venoarterial extracorporeal membrane oxygenation (VA-ECMO) could play a crucial role in the perioperative survival of patients affected by postcardiotomy shock. METHODS: Between January 2010 and March 2018, 781 adult patients receiving VA-ECMO for postcardiotomy shock at 19 cardiac surgical centers were retrieved from the Postcardiotomy Veno-arterial Extracorporeal Membrane Oxygenation study registry. A parallel systematic review and meta-analysis (PubMed/MEDLINE, Embase, and Cochrane Library) through December 2018 was also accomplished. RESULTS: Central and peripheral VA-ECMO cannulation were performed in 245 (31.4%) and 536 (68.6%) patients, respectively. Main indications for the institution VA-ECMO were failure to wean from cardiopulmonary bypass (38%) and heart failure following cardiopulmonary bypass weaning (48%). The doubly robust analysis after inverse probability treatment weighting by propensity score demonstrated that central VA-ECMO was associated with greater hospital mortality (odds ratio 1.54; 95% confidence interval, 1.09-2.18), reoperation for bleeding/tamponade (odds ratio, 1.96; 95% confidence interval, 1.37-2.81), and transfusion of more than 9 RBC units (odds ratio, 2.42; 95% confidence interval, 1.59-3.67). The systematic review provided a total of 2491 individuals with postcardiotomy shock treated with VA-ECMO. Pooled prevalence of in-hospital/30-day mortality in overall patient population was 66.6% (95% confidence interval, 64.7-68.4%), and pooled unadjusted risk ratio analysis confirmed that patients undergoing peripheral VA-ECMO had a lower in-hospital/30-day mortality than patients undergoing central cannulation (risk ratio, 0.92; 95% confidence interval, 0.87-0.98). Adjustments for important confounders did not alter our results. CONCLUSIONS: In patients with postcardiotomy shock treated with VA-ECMO, central cannulation was associated with greater in-hospital mortality than peripheral cannulation.
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