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Venoarterial Extracorporeal Membrane Oxygenation for Postcardiotomy Shock-Analysis of the Extracorporeal Life Support Organization Registry
M. Kowalewski, K. Zieliński, D. Brodie, G. MacLaren, G. Whitman, GM. Raffa, U. Boeken, K. Shekar, YS. Chen, C. Bermudez, D. D'Alessandro, X. Hou, J. Haft, J. Belohlavek, I. Dziembowska, P. Suwalski, P. Alexander, RP. Barbaro, M. Gaudino, M. Di...
Language English Country United States
Document type Journal Article, Research Support, Non-U.S. Gov't
Grant support
K12 HL138039
NHLBI NIH HHS - United States
- MeSH
- Heart Valve Prosthesis Implantation adverse effects mortality MeSH
- Adult MeSH
- Cardiac Surgical Procedures * adverse effects mortality MeSH
- Shock, Cardiogenic etiology therapy MeSH
- Catheterization, Central Venous adverse effects mortality MeSH
- Coronary Artery Bypass adverse effects mortality MeSH
- Middle Aged MeSH
- Humans MeSH
- Extracorporeal Membrane Oxygenation adverse effects mortality statistics & numerical data trends MeSH
- Survival Rate MeSH
- Adolescent MeSH
- Young Adult MeSH
- Hospital Mortality MeSH
- Catheterization, Peripheral adverse effects mortality MeSH
- Prognosis MeSH
- Registries MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Heart Transplantation adverse effects mortality MeSH
- Age Factors MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
OBJECTIVES: Refractory postcardiotomy cardiogenic shock complicating cardiac surgery yields nearly 100% mortality when untreated. Use of venoarterial extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock has increased worldwide recently. The aim of the current analysis was to outline the trends in use, changing patient profiles, and in-hospital outcomes including complications in patients undergoing venoarterial extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock. DESIGN: Analysis of extracorporeal life support organization registry from January 2010 to December 2018. SETTING: Multicenter worldwide registry. PATIENTS: Seven-thousand one-hundred eighty-five patients supported with venoarterial extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock. INTERVENTIONS: Venoarterial extracorporeal membrane oxygenation. MEASUREMENTS AND MAIN RESULTS: Hospital death, weaning from extracorporeal membrane oxygenation, hospital complications. Mortality predictors were assessed by multivariable logistic regression. Propensity score matching was performed for comparison of peripheral and central cannulation for extracorporeal membrane oxygenation. A significant trend toward more extracorporeal membrane oxygenation use in recent years (coefficient, 0.009; p < 0.001) was found. Mean age was 56.3 ± 14.9 years and significantly increased over time (coefficient, 0.513; p < 0.001). Most commonly, venoarterial extracorporeal membrane oxygenation was instituted after coronary artery bypass surgery (26.8%) and valvular surgery (25.6%), followed by heart transplantation (20.7%). Overall, successful extracorporeal membrane oxygenation weaning was possible in 4,520 cases (56.4%), and survival to hospital discharge was achieved in 41.7% of cases. In-hospital mortality rates remained constant over time (coefficient, -8.775; p = 0.682), whereas complication rates were significantly reduced (coefficient, -0.009; p = 0.003). Higher mortality was observed after coronary artery bypass surgery (65.4%), combined coronary artery bypass surgery with valve (68.4%), and aortic (69.6%) procedures than other indications. Lower mortality rates were observed in heart transplantation recipients (46.0%). Age (p < 0.001), central cannulation (p < 0.001), and occurrence of complications while on extracorporeal membrane oxygenation were independently associated with poorer prognosis. CONCLUSIONS: The analysis confirmed increased use of venoarterial extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock. Mortality rates remained relatively constant over time despite a decrease in complications, in the setting of supporting older patients.
Adult Intensive Care Services The Prince Charles Hospital Brisbane VIC Australia
Cardiac Surgery Unit ISMETT Palermo Italy
Cardiac Surgery Unit University Hospital University of Chieti Chieti Italy
Cardiothoracic Intensive Care Unit National University Hospital Singapore
Cardiovascular Research Institute Maastricht Maastricht The Netherlands
Cardiovascular Surgery Intensive Care Unit Johns Hopkins Hospital Baltimore MD
Department of Cardiac Surgery University of Dusseldorf Dusseldorf Germany
Department of Cardio Thoracic Surgery Massachusetts Medical Centre Boston MA
Department of Cardio Thoracic Surgery Well Cornell Medicine New York NY
Department of Cardiothoracic Surgery Jefferson University Philadelphia PA
Department of Pediatrics C S Mott Children's Hospital University of Michigan Ann Arbor MI
Section of Cardiac Surgery University of Michigan Ann Arbor MI
References provided by Crossref.org
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