Venoarterial Extracorporeal Membrane Oxygenation for Postcardiotomy Shock-Analysis of the Extracorporeal Life Support Organization Registry.
Venoarterial Extracorporeal Membrane Oxygenation for Postcardiotomy Shock-Analysis of the Extracorporeal Life Support Organization Registry.
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DOI：
10.1097/ccm.0000000000004922
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发表时间：
2021-07-01
影响因子：
8.8
通讯作者：
Lorusso R
中科院分区：
文献类型：
--
作者：
Kowalewski M;Zieliński K;Brodie D;MacLaren G;Whitman G;Raffa GM;Boeken U;Shekar K;Chen YS;Bermudez C;D'Alessandro D;Hou X;Haft J;Belohlavek J;Dziembowska I;Suwalski P;Alexander P;Barbaro RP;Gaudino M;Di Mauro M;Maessen J;Lorusso R
Refractory post-cardiotomy cardiogenic shock (PCS) complicating cardiac surgery yields nearly 100% mortality when untreated. Use of veno-arterial (V-A) extracorporeal membrane oxygenation (ECMO) for PCS 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 V-A ECMO for PCS. Analysis of Extracorporeal Life Support Organization (ELSO) registry from January 2010 through December 2018. multicenter worldwide registry. 7,185 patients supported with V-A ECMO for PCS. V-A ECMO. Hospital death, weaning from ECMO, hospital complications. Mortality predictors were assessed by multivariable logistic regression. Propensity score matching was performed for comparison of peripheral and central cannulation for ECMO. A significant trend toward more ECMO use in recent years (coef.:0.009; p<0.001) was found. Mean age was 56.3±14.9 years and significantly increased over time (coef.:0.513; p<0.001). Most commonly, V-A ECMO was instituted after coronary artery bypass surgery (CABG) (26.8%) and valvular surgery (25.6%), followed by heart transplantation (20.7%). Overall, successful ECMO 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 (coef.:−8.775;p=0.682) while complication rates were significantly reduced (coef.:−0.009;p=0.003). Higher mortality was observed after CABG (65.4%), combined CABG 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 ECMO were independently associated with poorer prognosis. The analysis confirmed increased use of V-A ECMO for PCS. Mortality rates remained relatively constant over time despite a decrease in complications, in the setting of supporting older patients.
