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.

2 Department of Anesthesiology Centre of Anesthesia Intensive Care and Pain Management Vilnius University Hospital Santariskiu Klinikos Vilnius Lithuania

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

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

Cardiac Surgery Unit Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Research Hospital Rozzano Milan Italy

Cardio Thoracic Surgery Department and Cardiovascular Research Institute Maastricht Maastricht the Netherlands

Cardiothoracic Intensive Care Unit National University Heart Centre National University Hospital Singapore Singapore

Center for Cardiac Intensive Care Beijing Institute of Heart Lung and Blood Vessels Diseases Beijing Anzhen Hospital Capital Medical University Beijing China

Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation Istituti di Ricovero e Cura a Carattere Scientifico Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione) Palermo 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 Cardiac Surgery University Hospitals Leuven and Department of Cardiovascular Sciences University of Leuven Leuven Belgium

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 Intensive Care Medicine and Cardiovascular Research Institute Maastricht Maastricht the Netherlands

Department of Intensive Care Medicine Center of Applied Medical Research St Vincent's Hospital Darlinghurs New South Wales Australia

Department of Medicine and Surgery Cardiac Surgery Clinic San Gerardo Hospital University of Milano Bicocca Monza Italy

Department of Medicine and Surgery University of Parma Cardiac Surgery Unit University Hospital of Parma Parma Italy

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 Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliero Universitaria di Bologna Bologna Italy

Division of Cardiac Surgery Memorial Healthcare System Hollywood FL

Division of Cardiothoracic and Vascular Surgery Pontchaillou University Hospital Rennes France

Division of Cardiovascular and Thoracic Surgery Department of Surgery Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand

Extracorporeal Membrane Oxygenation Unit Departamento de Anestesia Clínica Las Condes Las Condes Santiago Chile

Indiana University Health Advanced Heart and Lung Care Indiana University Methodist Hospital Indianapolis IN

Intensive Care Unit The Alfred Hospital Melbourne Victoria Australia

Ospedale del Cuore Fondazione Toscana G Monasterio Massa Italy

Struttura Organizzativa Dipartimentale di Cardiochirurgia Ospedali Riuniti 'Umberto 1 Lancisi Salesi' Università Politecnica delle Marche Ancona Italy

University of New South Wales Sydney Australia

Zobrazit více v PubMed

Lorusso R, Shekar K, MacLaren G, Schmidt M, Pellegrino V, Meyns B, Haft J, Vercaemst L, Pappalardo F, Bermudez C, et al. ELSO interim guidelines for venoarterial extracorporeal membrane oxygenation in adult cardiac patients. ASAIO J. 2021;67:827–844. doi: 10.1097/MAT.0000000000001510 PubMed DOI

Lorusso R, Whitman G, Milojevic M, Raffa G, McMullan DM, Boeken U, Haft J, Bermudez C, Shah A, D'Alessandro DA. 2020 EACTS/ELSO/STS/AATS expert consensus on post‐cardiotomy extracorporeal life support in adult patients. J Thorac Cardiovasc Surg. 2021;161:1287–1331. doi: 10.1016/j.jtcvs.2020.09.045 PubMed DOI

Lorusso R, Raffa GM, Alenizy K, Sluijpers N, Makhoul M, Brodie D, McMullan M, Wang IW, Meani P, MacLaren G, et al. Structured review of post‐cardiotomy extracorporeal membrane oxygenation: part 1‐adult patients. J Heart Lung Transplant. 2019;38:1125–1143. doi: 10.1016/j.healun.2019.08.014 PubMed DOI PMC

Meani P, Matteucci M, Jiritano F, Fina D, Panzeri F, Raffa GM, Kowalewski M, Morici N, Viola G, Sacco A, 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. doi: 10.21037/acs.2018.12.04 PubMed DOI PMC

Vallabhajosyula S, Arora S, Sakhuja A, Lahewala S, Kumar V, Shantha GPS, Egbe AC, Stulak JM, Gersh BJ, Gulati R, et al. Trends, predictors, and outcomes of temporary mechanical circulatory support for postcardiac surgery cardiogenic shock. Am J Cardiol. 2019;123:489–497. doi: 10.1016/j.amjcard.2018.10.029 PubMed DOI

McCarthy FH, McDermott KM, Kini V, Gutsche JT, Wald JW, Xie D, Szeto WY, Bermudez CA, Atluri P, Acker MA, et al. Trends in U.S. extracorporeal membrane oxygenation use and outcomes: 2002‐2012. Semin Thorac Cardiovasc Surg. 2015;27:81–88. doi: 10.1053/j.semtcvs.2015.07.005 PubMed DOI PMC

Kowalewski M, Zielinski K, Brodie D, MacLaren G, Whitman G, Raffa GM, Boeken U, Shekar K, Chen YS, Bermudez C, et al. Venoarterial extracorporeal membrane oxygenation for postcardiotomy shock‐analysis of the extracorporeal life support organization registry. Crit Care Med. 2021;49:1107–1117. doi: 10.1097/CCM.0000000000004922 PubMed DOI PMC

Biancari F, Dalen M, Fiore A, Ruggieri VG, Saeed D, Jonsson K, Gatti G, Zipfel S, Perrotti A, Bounader K, et al. Multicenter study on postcardiotomy venoarterial extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg. 2020;159:1844–1854.e6. doi: 10.1016/j.jtcvs.2019.06.039 PubMed DOI

Kowalewski M, Raffa G, Zielinski K, Meani P, Alanazi M, Gilbers M, Heuts S, Natour E, Bidar E, Schreurs R, et al. Baseline surgical status and short‐term mortality after extracorporeal membrane oxygenation for post‐cardiotomy shock: a meta‐analysis. Perfusion. 2020;35:246–254. doi: 10.1177/0267659119865122 PubMed DOI

Biancari F, Perrotti A, Ruggieri VG, Mariscalco G, Dalen M, Dell'Aquila AM, Jonsson K, Ragnarsson S, Di Perna D, Bounader K, et al. Five‐year survival after post‐cardiotomy veno‐arterial extracorporeal membrane oxygenation. Eur Heart J Acute Cardiovasc Care. 2021;10:595–601. doi: 10.1093/ehjacc/zuaa039 PubMed DOI

Schaefer AK, Riebandt J, Bernardi MH, Distelmaier K, Goliasch G, Zimpfer D, Laufer G, Wiedemann D. Fate of patients weaned from post‐cardiotomy extracorporeal life support. Eur J Cardiothorac Surg. 2022;61:1178–1185. doi: 10.1093/ejcts/ezac035 PubMed DOI

Balan TA, Putter H. A tutorial on frailty models. Stat Methods Med Res. 2020;29:3424–3454. doi: 10.1177/0962280220921889 PubMed DOI PMC

Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, Gonzalez‐Juanatey JR, Harjola VP, Jankowska EA, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37:2129–2200. doi: 10.1093/eurheartj/ehw128 PubMed DOI

Unosawa S, Sezai A, Hata M, Nakata K, Yoshitake I, Wakui S, Kimura H, Takahashi K, Hata H, Shiono M. Long‐term outcomes of patients undergoing extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. Surg Today. 2013;43:264–270. doi: 10.1007/s00595-012-0322-6 PubMed DOI

van Buuren S, Groothuis‐Oudshoorn K. Mice: multivariate imputation by chained equations in R. J Stat Softw. 2011;45:1–67. doi: 10.18637/jss.v045.i03 DOI

Raffa GM, Kowalewski M, Brodie D, Ogino M, Whitman G, Meani P, Pilato M, Arcadipane A, Delnoij T, Natour E, et al. Meta‐analysis of peripheral or central extracorporeal membrane oxygenation in postcardiotomy and non‐postcardiotomy shock. Ann Thorac Surg. 2019;107:311–321. doi: 10.1016/j.athoracsur.2018.05.063 PubMed DOI

Charlesworth M, Garcia M, Head L, Barker JM, Ashworth AD, Barnard JB, Feddy L, Venkateswaran RV. Venoarterial extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock‐a six‐year service evaluation. Artif Organs. 2020;44:709–716. doi: 10.1111/aor.13647 PubMed DOI

Brewer JM, Tran A, Yu J, Ali MI, Poulos CM, Gates J, Gluck J, Underhill D. ECMO after cardiac surgery: a single center study on survival and optimizing outcomes. J Cardiothorac Surg. 2021;16:264. doi: 10.1186/s13019-021-01638-0 PubMed DOI PMC

Chen F, Wang L, Shao J, Wang H, Hou X, Jia M. Survival following venoarterial extracorporeal membrane oxygenation in postcardiotomy cardiogenic shock adults. Perfusion. 2020;35:747–755. doi: 10.1177/0267659120931306 PubMed DOI PMC

Hu RTC, Broad JD, Osawa EA, Ancona P, Iguchi Y, Miles LF, Bellomo R. 30‐day outcomes post veno‐arterial extra corporeal membrane oxygenation (VA‐ECMO) after cardiac surgery and predictors of survival. Heart Lung Circ. 2020;29:1217–1225. doi: 10.1016/j.hlc.2020.01.009 PubMed DOI

Biancari F, Perrotti A, Dalen M, Guerrieri M, Fiore A, Reichart D, Dell'Aquila AM, Gatti G, Ala‐Kokko T, Kinnunen EM, et al. Meta‐analysis of the outcome after postcardiotomy venoarterial extracorporeal membrane oxygenation in adult patients. J Cardiothorac Vasc Anesth. 2018;32:1175–1182. doi: 10.1053/j.jvca.2017.08.048 PubMed DOI

Levy D, Laghlam D, Estagnasie P, Brusset A, Squara P, Nguyen LS. Post‐operative right ventricular failure after cardiac surgery: a cohort study. Front Cardiovasc Med. 2021;8:667328. doi: 10.3389/fcvm.2021.667328 PubMed DOI PMC

Mariscalco G, Salsano A, Fiore A, Dalen M, Ruggieri VG, Saeed D, Jonsson K, Gatti G, Zipfel S, Dell'Aquila AM, et al. Peripheral versus central extracorporeal membrane oxygenation for postcardiotomy shock: multicenter registry, systematic review, and meta‐analysis. J Thorac Cardiovasc Surg. 2020;160:1207–1216. doi: 10.1016/j.jtcvs.2019.10.078 PubMed DOI

Mariscalco G, El‐Dean Z, Yusuff H, Fux T, Dell'Aquila AM, Jonsson K, Ragnarsson S, Fiore A, Dalen M, di Perna D, et al. Duration of venoarterial extracorporeal membrane oxygenation and mortality in postcardiotomy cardiogenic shock. J Cardiothorac Vasc Anesth. 2020;35:2662–2668. doi: 10.1053/j.jvca.2020.11.003 PubMed DOI

Fux T, Holm M, Corbascio M, Lund LH, van der Linden J. Venoarterial extracorporeal membrane oxygenation for postcardiotomy shock: risk factors for mortality. J Thorac Cardiovasc Surg. 2018;156:1894–1902. doi: 10.1016/j.jtcvs.2018.05.061 PubMed DOI

Biancari F, Fiore A, Jonsson K, Gatti G, Zipfel S, Ruggieri VG, Perrotti A, Bounader K, Loforte A, Lechiancole A, et al. Prognostic significance of arterial lactate levels at weaning from postcardiotomy venoarterial extracorporeal membrane oxygenation. J Clin Med. 2019;8:2218. doi: 10.3390/jcm8122218 PubMed DOI PMC

Kumar TK, Zurakowski D, Dalton H, Talwar S, Allard‐Picou A, Duebener LF, Sinha P, Moulick A. Extracorporeal membrane oxygenation in postcardiotomy patients: factors influencing outcome. J Thorac Cardiovasc Surg. 2010;140:330–336. doi: 10.1016/j.jtcvs.2010.02.034 PubMed DOI

Li CL, Wang H, Jia M, Ma N, Meng X, Hou XT. The early dynamic behavior of lactate is linked to mortality in postcardiotomy patients with extracorporeal membrane oxygenation support: a retrospective observational study. J Thorac Cardiovasc Surg. 2015;149:1445–1450. doi: 10.1016/j.jtcvs.2014.11.052 PubMed DOI

Mashiko Y, Abe T, Tokuda Y, Oshima H, Usui A. 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;23:225–232. doi: 10.1007/s10047-020-01160-5 PubMed DOI

Wang L, Yang F, Wang X, Xie H, Fan E, Ogino M, Brodie D, Wang H, Hou X. Predicting mortality in patients undergoing VA‐ECMO after coronary artery bypass grafting: the REMEMBER score. Crit Care. 2019;23:11. doi: 10.1186/s13054-019-2307-y PubMed DOI PMC

Fux T, Holm M, van der Linden J. Arterial lactate before initiation of venoarterial extracorporeal membrane oxygenation for postcardiotomy shock improves postimplant outcome prediction. J Thorac Cardiovasc Surg. 2019;157:e266–e267. doi: 10.1016/j.jtcvs.2018.12.046 PubMed DOI

Biancari F, Dell'Aquila AM, Mariscalco G. Predicting mortality after postcardiotomy venoarterial extracorporeal membrane oxygenation. Ann Transl Med. 2019;7:S100. doi: 10.21037/atm.2019.04.74 PubMed DOI PMC

Biancari F, Dalén M, Fiore A, Dell'Aquila AM, Jónsson K, Ragnarsson S, Gatti G, Gabrielli M, Zipfel S, Ruggieri VG, et al. Gender and the outcome of postcardiotomy veno‐arterial extracorporeal membrane oxygenation. J Cardiothorac Vasc Anesth. 2021;36:1678–1685. doi: 10.1053/j.jvca.2021.05.015 PubMed DOI

Mesotten D, Meijs DAM, van Bussel BCT, Stessel B, Mehagnoul‐Schipper J, Hana A, Scheeren CIE, Strauch U, van de Poll MCG, Ghossein‐Doha C, et al. Differences and similarities among COVID‐19 patients treated in seven ICUs in three countries within one region: an observational cohort study. Crit Care Med. 2022;50:595–606. doi: 10.1097/CCM.0000000000005314 PubMed DOI PMC

Chen SW, Tsai FC, Lin YS, Chang CH, Chen DY, Chou AH, Chen TH. Long‐term outcomes of extracorporeal membrane oxygenation support for postcardiotomy shock. J Thorac Cardiovasc Surg. 2017;154:469–477. doi: 10.1016/j.jtcvs.2017.02.055 PubMed DOI

Singer M, Deutschman CS, Seymour CW, Shankar‐Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, et al. The third international consensus definitions for sepsis and septic shock (Sepsis‐3). JAMA. 2016;315:801–810. doi: 10.1001/jama.2016.0287 PubMed DOI PMC

Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–3104. doi: 10.1093/eurheartj/ehy339 PubMed DOI

Adult tobacco use information . Centers for Disease Control and Prevention. Accessed May 23, 2023. https://www.cdc.gov/nchs/nhis/tobacco/tobacco_glossary.htm

Global Initiative for Chronic Obstructive Lung Disease . 2023. Accessed May 23, 2023. https://goldcopd.org/

Nashef SA, Roques F, Sharples LD, Nilsson J, Smith C, Goldstone AR, Lockowandt U. EuroSCORE II. Eur J Cardiothorac Surg. 2012;41:734–745. doi: 10.1093/ejcts/ezs043 PubMed DOI

Bousquet J, Mantzouranis E, Cruz AA, Ait‐Khaled N, Baena‐Cagnani CE, Bleecker ER, Brightling CE, Burney P, Bush A, Busse WW, et al. Uniform definition of asthma severity, control, and exacerbations: document presented for the World Health Organization Consultation on Severe Asthma. J Allergy Clin Immunol. 2010;126:926–938. doi: 10.1016/j.jaci.2010.07.019 PubMed DOI

McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Bohm M, Burri H, Butler J, Celutkiene J, Chioncel O, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42:3599–3726. doi: 10.1093/eurheartj/ehab368 PubMed DOI

Gorter TM, van Veldhuisen DJ, Bauersachs J, Borlaug BA, Celutkiene J, Coats AJS, Crespo‐Leiro MG, Guazzi M, Harjola VP, Heymans S, et al. Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2018;20:16–37. doi: 10.1002/ejhf.1029 PubMed DOI

Bozkurt B, Coats AJS, Tsutsui H, Abdelhamid CM, Adamopoulos S, Albert N, Anker SD, Atherton J, Bohm M, Butler J, et al. Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure: endorsed by the Canadian Heart Failure Society, Heart Failure Association of India, Cardiac Society of Australia and New Zealand, and Chinese Heart Failure Association. Eur J Heart Fail. 2021;23:352–380. doi: 10.1002/ejhf.2115 PubMed DOI

Singh SSA, Dalzell JR, Berry C, Al‐Attar N. Primary graft dysfunction after heart transplantation: a thorn amongst the roses. Heart Fail Rev. 2019;24:805–820. doi: 10.1007/s10741-019-09794-1 PubMed DOI PMC

Easton JD, Saver JL, Albers GW, Alberts MJ, Chaturvedi S, Feldmann E, Hatsukami TS, Higashida RT, Johnston SC, Kidwell CS, et al. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke. 2009;40:2276–2293. PubMed

Shanmugam G. Vasoplegic syndrome–the role of methylene blue. Eur J Cardiothorac Surg. 2005;28:705–710. doi: 10.1016/j.ejcts.2005.07.011 PubMed DOI

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

Zobrazit více v PubMed

ClinicalTrials.gov
NCT03857217