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.

2nd Department of Medicine Department of Cardiovascular Medicine 1st Faculty of Medicine Charles University Prague and General University Hospital Prague Czech Republic

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 and Pediatric Cardiovascular Surgery National Taiwan University Hospital Taipei Taiwan

Cardiovascular Surgery Intensive Care Unit Johns Hopkins Hospital Baltimore MD

Center for Acute Respiratory Failure and Department of Medicine Columbia University College of Physicians and Surgeons New York Presbyterian Hospital New York NY

Center for Cardiac Intensive Care Beijing Anzhen Hospital Capital Medical University Beijing People's Republic of China

Clinical Department of Cardiac Surgery Central Clinical Hospital of the Ministry of Interior and Administration Centre of Postgraduate Medical Education Warsaw Poland

Department of Cardiac Surgery University of Dusseldorf Dusseldorf Germany

Department of Cardio Thoracic Surgery Heart and Vascular Centre Maastricht University Medical Centre Maastricht The Netherlands

Department of Cardio Thoracic Surgery Massachusetts Medical Centre Boston MA

Department of Cardio Thoracic Surgery Well Cornell Medicine New York NY

Department of Cardiology Boston Children's Hospital Department of Pediatrics Harvard Medical School Boston MA

Department of Cardiothoracic Surgery Jefferson University Philadelphia PA

Department of Pathophysiology Faculty of Pharmacy Collegium Medicum Nicolaus Copernicus University Toruń Poland

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

Thoracic Research Centre Collegium Medicum Nicolaus Copernicus University Innovative Medical Forum Bydgoszcz Poland

Warsaw Medical University Warsaw Poland

Crit Care Med. 2021 Jul 1;49(7):1202-1204. doi: 10.1097/CCM.0000000000004927. PubMed

Zobrazit více v PubMed

Abrams D, Combes A, Brodie D. Extracorporeal membrane oxygenation in cardiopulmonary disease in adults. J Am Coll Cardiol. 2014;63:2769–2778 PubMed

Lorusso R, Raffa GM, Alenizy K et al. Structured review of post-cardiotomy extracorporeal membrane oxygenation: Part 1-adult patients. J Heart Lung Transplant. 2019;38:1125–1143 PubMed PMC

Vallabhajosyula S, Arora S, Sakhuja A et al. Trends, predictors, and outcomes of temporary mechanical circulatory support for postcardiac surgery cardiogenic shock. Am J Cardiol. 2019;123:489–497 PubMed

Stretch R, Sauer CM, Yuh DD, et al. National trends in the utilization of short-term mechanical circulatory support: incidence, outcomes, and cost analysis. J Am Coll Cardiol. 2014;64:1407–15. PubMed

Ge M, Pan T, Wang JX, et al. Outcomes of early versus delayed initiation of extracorporeal life support in cardiac surgery. J Cardiothorac Surg. 2019;14:129. PubMed PMC

Whitman GJ. Extracorporeal membrane oxygenation for the treatment of postcardiotomy shock. J Thorac Cardiovasc Surg. 2017;153:95–101 PubMed

Thiagarajan RR, Barbaro RP, Rycus PT et al. Extracorporeal life support organization registry international report 2016. ASAIO J 2017;63:60–67 PubMed

Nasr VG, Raman L, Barbaro RP et al. Highlights from the extracorporeal life support organization registry: 2006–2017. ASAIO J 2019;65:537–544 PubMed

Lorusso R, Vizzardi E, Johnson DM et al. Cardiac surgery in adult patients with remitted or active malignancies: A review of preoperative screening, surgical management and short- and long-term postoperative results. Eur J Cardiothorac Surg. 2018;54:10–18 PubMed

Lorusso R, Gelsomino S, Parise O et al. Venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock in elderly patients: Trends in application and outcome from the extracorporeal life support organization (elso) registry. Ann Thorac Surg. 2017;104:62–69 PubMed

Kowalewski M, Raffa GM, Zielinski K et al. The impact of centre’s heart transplant status and volume on in-hospital outcomes following extracorporeal membrane oxygenation for refractory post-cardiotomy cardiogenic shock: A meta-analysis. BMC Cardiovasc Disord. 2020;20:10. PubMed PMC

Storey JD. A direct approach to false discovery rates. J R Stat Soc Ser B. 2002;64:479–498.

Nattino G, Pennell ML, Lemeshow S. Assessing the goodness of fit of logistic regression models in large samples: A modification of the hosmer-lemeshow test. Biometrics. 2020 PubMed

DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: A nonparametric approach. Biometrics. 1988;44:837–845 PubMed

McCarthy FH, McDermott KM, Kini V et al. Trends in u.S. Extracorporeal membrane oxygenation use and outcomes: 2002–2012. Semin Thorac Cardiovasc Surg. 2015;27:81–88 PubMed PMC

Ibanez B, James S, Agewall S et al. 2017 esc guidelines for the management of acute myocardial infarction in patients presenting with st-segment elevation: The task force for the management of acute myocardial infarction in patients presenting with st-segment elevation of the european society of cardiology (esc). Eur Heart J. 2018;39:119–177 PubMed

Hernandez AF, Grab JD, Gammie JS et al. A decade of short-term outcomes in post cardiac surgery ventricular assist device implantation: Data from the society of thoracic surgeons’ national cardiac database. Circulation. 2007;116:606–612 PubMed

Hayanga JWA, Aboagye J, Bush E et al. Contemporary Analysis of Charges and Mortality in the use of Extracorporeal Membrane Oxygenation: A Cautionary Tale. JTCVS Open [Internet]. 2020;Available from: 10.1016/j.xjon.2020.02.003 PubMed DOI PMC

Rastan AJ, Dege A, Mohr M et al. Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. J Thorac Cardiovasc Surg. 2010;139:302–311, 311 e301 PubMed

Ranney DN, Benrashid E, Meza JM et al. Central cannulation as a viable alternative to peripheral cannulation in extracorporeal membrane oxygenation. Semin Thorac Cardiovasc Surg. 2017;29:188–195 PubMed

Kowalewski M, Raffa G, Zielinski K et al. Baseline surgical status and short-term mortality after extracorporeal membrane oxygenation for post-cardiotomy shock: A meta-analysis. Perfusion. 2019:267659119865122 PubMed

Meani P, Matteucci M, Jiritano F et al. Long-term survival and major outcomes in post-cardiotomy extracorporeal membrane oxygenation for adult patients in cardiogenic shock. Ann Cardiothorac Surg. 2019;8:116–122 PubMed PMC

Lo Coco V, Lorusso R, Raffa GM et al. Clinical complications during veno-arterial extracorporeal membrane oxigenation in post-cardiotomy and non post-cardiotomy shock: Still the achille’s heel. J Thorac Dis. 2018;10:6993–7004 PubMed PMC

Raffa GM, Kowalewski M, Meani P et al. -hospital outcomes after emergency or prophylactic veno-arterial extracorporeal membrane oxygenation during transcatheter aortic valve implantation: A comprehensive review of the literature. Perfusion. 2019;34:354–363 PubMed

Raffa GM, Kowalewski M, Brodie D et al. Meta-analysis of peripheral or central extracorporeal membrane oxygenation in postcardiotomy and non-postcardiotomy shock. Ann Thorac Surg. 2019;107:311–321 PubMed

Raffa GM, Gelsomino S, Sluijpers N et al. In-hospital outcome of post-cardiotomy extracorporeal life support in adult patients: The 2007–2017 maastricht experience. Crit Care Resusc. 2017;19:53–61 PubMed

Lawler PR, Silver DA, Scirica BM et al. Extracorporeal membrane oxygenation in adults with cardiogenic shock. Circulation. 2015;131:676–680 PubMed

Wu MY, Lin PJ, Lee MY et al. Using extracorporeal life support to resuscitate adult postcardiotomy cardiogenic shock: Treatment strategies and predictors of short-term and midterm survival. Resuscitation. 2010;81:1111–1116 PubMed

Smith M, Vukomanovic A, Brodie D et al. Duration of veno-arterial extracorporeal life support (VA ECMO) and outcome: an analysis of the Extracorporeal Life Support Organization (ELSO) registry. Crit Care. 2017;21:45. PubMed PMC

Richardson AS, Schmidt M, Bailey M et al. Ecmo cardio-pulmonary resuscitation (ecpr), trends in survival from an international multicentre cohort study over 12-years. Resuscitation. 2017;112:34–40 PubMed

Mashiko Y, Abe T, Tokuda Y et al. Extracorporeal membrane oxygenation support for postcardiotomy cardiogenic shock in adult patients: Predictors of in-hospital mortality and failure to be weaned from extracorporeal membrane oxygenation. J Artif Organs. 2020 PubMed

Khorsandi M, Dougherty S, Bouamra O et al. Extra-corporeal membrane oxygenation for refractory cardiogenic shock after adult cardiac surgery: A systematic review and meta-analysis. J Cardiothorac Surg. 2017;12:55. PubMed PMC

Flecher E, Anselmi A, Corbineau H et al. Current aspects of extracorporeal membrane oxygenation in a tertiary referral centre: Determinants of survival at follow-up. Eur J Cardiothorac Surg. 2014;46:665–671; discussion 671 PubMed

Smith C, Bellomo R, Raman JS et al. An extracorporeal membrane oxygenation-based approach to cardiogenic shock in an older population. Ann Thorac Surg. 2001;71:1421–1427 PubMed

Fiser SM, Tribble CG, Kaza AK et al. When to discontinue extracorporeal membrane oxygenation for postcardiotomy support. Ann Thorac Surg. 2001;71:210–4. PubMed

Barbaro RP, Odetola FO, Kidwell KM et al. Association of hospital-level volume of extracorporeal membrane oxygenation cases and mortality. Analysis of the extracorporeal life support organization registry. Am J Respir Crit Care Med. 2015;191:894–901 PubMed PMC

Kowalewski M, Malvindi PG, Zielinski K et al. Left ventricle unloading with veno-arterial extracorporeal membrane oxygenation for cardiogenic shock. Systematic review and meta-analysis. J Clin Med. 2020;9 PubMed PMC

Al-Fares AA, Randhawa VK, Englesakis M et al. Optimal strategy and timing of left ventricular venting during veno-arterial extracorporeal life support for adults in cardiogenic shock: A systematic review and meta-analysis. Circ Heart Fail. 2019;12:e006486. PubMed

Mariscalco G, Salsano A, Fiore A et al. Peripheral versus central extracorporeal membrane oxygenation for postcardiotomy shock: Multicenter registry, systematic review, and meta-analysis. J Thorac Cardiovasc Surg. 2019 PubMed

Lo Coco V, Swol J, De Piero ME et al. Dynamic Extracorporeal Life Support: A Novel Management Modality in Temporary Cardio-Circulatory Assistance. Artif Organs. 2020. November 15. Epub ahead of print. PubMed

Fina D, Matteucci M, Jiritano F et al. Extracorporeal membrane oxygenation without therapeutic anticoagulation in adults: A systematic review of the current literature. Int J Artif Organs. 2020:391398820904372 PubMed

Piacente C, Martucci G, Miceli V et al. A narrative review of antithrombin use during veno-venous extracorporeal membrane oxygenation in adults: Rationale, current use, effects on anticoagulation, and outcomes. Perfusion. 2020:267659120913803 PubMed

Pontailler M, Demondion P, Lebreton G et al. Experience with Extracorporeal Life Support for Cardiogenic Shock in the Older Population more than 70 Years of Age. ASAIO J 2017;63:279–284. PubMed

Sertic F, Diagne D, Rame E et al. Short-term outcomes and predictors of in-hospital mortality with the use of veno-arterial extracorporeal membrane oxygenation in elderly patients with refractory cardiogenic shock. J Cardiovasc Surg (Torino). 2019;60:636–638 PubMed

Mendiratta P, Tang X, Collins RT 2nd et al. membrane oxygenation for respiratory failure in the elderly: a review of the Extracorporeal Life Support Organization registry. ASAIO J. 2014;60:385–90. PubMed

Biancari F, Saeed D, Fiore A et al. Postcardiotomy venoarterial extracorporeal membrane oxygenation in patients aged 70 years or older. Ann Thorac Surg. 2019;108:1257–1264 PubMed

Saxena P, Neal J, Joyce LD et al. Extracorporeal membrane oxygenation support in postcardiotomy elderly patients: The mayo clinic experience. Ann Thorac Surg. 2015;99:2053–2060 PubMed

Lee SN, Jo MS, Yoo KD. Impact of age on extracorporeal membrane oxygenation survival of patients with cardiac failure. Clin Interv Aging. 2017;12:1347–1353. PubMed PMC

Kowalewski M, Zieliński K, Maria Raffa G et al. Mortality Predictors in Elderly Patients With Cardiogenic Shock on Venoarterial Extracorporeal Life Support. Analysis From the Extracorporeal Life Support Organization Registry. Crit Care Med. 2020. October 14 (ahead of print) PubMed

Kowalewski M, Zieliński K, Gozdek M et al. Cardiogenic shock and veno‐arterial extracorporeal life support in heart transplantation/ventricle assist device centres vs. non‐transplant/ventricle assist device units: meta‐analysis. ESC Heart Failure (ahead of print) doi: 10.1002/ehf2.13080 PubMed DOI PMC

Meani P, Matteucci M, Jiritano F et al. Long-term survival and major outcomes in post-cardiotomy extracorporeal membrane oxygenation for adult patients in cardiogenic shock. Ann Cardiothorac Surg. 2019. January;8(1):116–122 PubMed PMC

Characteristics and Outcomes of Prolonged Venoarterial Extracorporeal Membrane Oxygenation After Cardiac Surgery: The Post-Cardiotomy Extracorporeal Life Support (PELS-1) Cohort Study

Neurologic complications in patients receiving aortic versus subclavian versus femoral arterial cannulation for post-cardiotomy extracorporeal life support: results of the PELS observational multicenter study

Patient and Management Variables Associated With Survival After Postcardiotomy Extracorporeal Membrane Oxygenation in Adults: The PELS-1 Multicenter Cohort Study