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Patient and Management Variables Associated With Survival After Postcardiotomy Extracorporeal Membrane Oxygenation in Adults: The PELS-1 Multicenter Cohort Study
S. Mariani, S. Heuts, BCT. van Bussel, M. Di Mauro, D. Wiedemann, D. Saeed, M. Pozzi, A. Loforte, U. Boeken, R. Samalavicius, K. Bounader, X. Hou, JJH. Bunge, H. Buscher, L. Salazar, B. Meyns, D. Herr, MLS. Matteucci, S. Sponga, G. MacLaren, C....
Jazyk angličtina Země Anglie, Velká Británie
Typ dokumentu multicentrická studie, časopisecké články
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PubMed
37421269
DOI
10.1161/jaha.123.029609
Knihovny.cz E-zdroje
- MeSH
- dospělí MeSH
- kardiochirurgické výkony * škodlivé účinky MeSH
- kardiogenní šok etiologie terapie MeSH
- lidé MeSH
- mimotělní membránová oxygenace * škodlivé účinky MeSH
- mortalita v nemocnicích MeSH
- následná péče MeSH
- pooperační komplikace etiologie MeSH
- propuštění pacienta MeSH
- retrospektivní studie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
Background Extracorporeal membrane oxygenation (ECMO) has been increasingly used for postcardiotomy cardiogenic shock, but without a concomitant reduction in observed in-hospital mortality. Long-term outcomes are unknown. This study describes patients' characteristics, in-hospital outcome, and 10-year survival after postcardiotomy ECMO. Variables associated with in-hospital and postdischarge mortality are investigated and reported. Methods and Results The retrospective international multicenter observational PELS-1 (Postcardiotomy Extracorporeal Life Support) study includes data on adults requiring ECMO for postcardiotomy cardiogenic shock between 2000 and 2020 from 34 centers. Variables associated with mortality were estimated preoperatively, intraoperatively, during ECMO, and after the occurrence of any complications, and then analyzed at different time points during a patient's clinical course, through mixed Cox proportional hazards models containing fixed and random effects. Follow-up was established by institutional chart review or contacting patients. This analysis included 2058 patients (59% were men; median [interquartile range] age, 65.0 [55.0-72.0] years). In-hospital mortality was 60.5%. Independent variables associated with in-hospital mortality were age (hazard ratio [HR], 1.02 [95% CI, 1.01-1.02]) and preoperative cardiac arrest (HR, 1.41 [95% CI, 1.15-1.73]). In the subgroup of hospital survivors, the overall 1-, 2-, 5-, and 10-year survival rates were 89.5% (95% CI, 87.0%-92.0%), 85.4% (95% CI, 82.5%-88.3%), 76.4% (95% CI, 72.5%-80.5%), and 65.9% (95% CI, 60.3%-72.0%), respectively. Variables associated with postdischarge mortality included older age, atrial fibrillation, emergency surgery, type of surgery, postoperative acute kidney injury, and postoperative septic shock. Conclusions In adults, in-hospital mortality after postcardiotomy ECMO remains high; however, two-thirds of those who are discharged from hospital survive up to 10 years. Patient selection, intraoperative decisions, and ECMO management remain key variables associated with survival in this cohort. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03857217.
Adult Intensive Care Services The Prince Charles Hospital Brisbane Australia
Cardiac Intensive Care Unit Johns Hopkins Hospital Baltimore MD
Cardiac Surgery Unit Cardiac Thoracic and Vascular Department Niguarda Hospital Milan Italy
Department of Cardiac Surgery Leipzig Heart Center Leipzig Germany
Department of Cardiac Surgery Louis Pradel Cardiologic Hospital Lyon France
Department of Cardiac Surgery Medical Faculty Heinrich Heine University Duesseldorf Germany
Department of Cardiac Surgery Medical University of Vienna Vienna Austria
Department of Cardio Thoracic Surgery University Hospital Henri Mondor Créteil Paris France
Department of Cardiology Fundación Cardiovascular de Colombia Bucaramanga Colombia
Department of Cardiothoracic Surgery University Medical Center Regensburg Regensburg Germany
Department of Cardiovascular Surgery Ziekenhuis Oost Limburg Genk Belgium
Department of Intensive Care Adults Erasmus Medical Center Rotterdam the Netherlands
Department of Surgical Sciences University of Turin Turin Italy
Department of Thoracic and Cardiovascular Surgery Korea University Anam Hospital Seoul South Korea
Departments of Medicine and Surgery University of Maryland Baltimore MD
Division of Cardiac Surgery Cardiothoracic Department University Hospital of Udine Udine Italy
Division of Cardiac Surgery Memorial Healthcare System Hollywood FL
Division of Cardiothoracic and Vascular Surgery Pontchaillou University Hospital Rennes France
Intensive Care Unit The Alfred Hospital Melbourne Victoria Australia
Ospedale del Cuore Fondazione Toscana G Monasterio Massa Italy
Citace poskytuje Crossref.org
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