Peripheral versus central extracorporeal membrane oxygenation for postcardiotomy shock : Multicenter registry, systematic review, and meta-analysis
(2020) In Journal of Thoracic and Cardiovascular Surgery 160(5). p.44-1216- Abstract
Background: We hypothesized that cannulation strategy in venoarterial extracorporeal membrane oxygenation (VA-ECMO) could play a crucial role in the perioperative survival of patients affected by postcardiotomy shock. Methods: Between January 2010 and March 2018, 781 adult patients receiving VA-ECMO for postcardiotomy shock at 19 cardiac surgical centers were retrieved from the Postcardiotomy Veno-arterial Extracorporeal Membrane Oxygenation study registry. A parallel systematic review and meta-analysis (PubMed/MEDLINE, Embase, and Cochrane Library) through December 2018 was also accomplished. Results: Central and peripheral VA-ECMO cannulation were performed in 245 (31.4%) and 536 (68.6%) patients, respectively. Main indications for... (More)
Background: We hypothesized that cannulation strategy in venoarterial extracorporeal membrane oxygenation (VA-ECMO) could play a crucial role in the perioperative survival of patients affected by postcardiotomy shock. Methods: Between January 2010 and March 2018, 781 adult patients receiving VA-ECMO for postcardiotomy shock at 19 cardiac surgical centers were retrieved from the Postcardiotomy Veno-arterial Extracorporeal Membrane Oxygenation study registry. A parallel systematic review and meta-analysis (PubMed/MEDLINE, Embase, and Cochrane Library) through December 2018 was also accomplished. Results: Central and peripheral VA-ECMO cannulation were performed in 245 (31.4%) and 536 (68.6%) patients, respectively. Main indications for the institution VA-ECMO were failure to wean from cardiopulmonary bypass (38%) and heart failure following cardiopulmonary bypass weaning (48%). The doubly robust analysis after inverse probability treatment weighting by propensity score demonstrated that central VA-ECMO was associated with greater hospital mortality (odds ratio 1.54; 95% confidence interval, 1.09-2.18), reoperation for bleeding/tamponade (odds ratio, 1.96; 95% confidence interval, 1.37-2.81), and transfusion of more than 9 RBC units (odds ratio, 2.42; 95% confidence interval, 1.59-3.67). The systematic review provided a total of 2491 individuals with postcardiotomy shock treated with VA-ECMO. Pooled prevalence of in-hospital/30-day mortality in overall patient population was 66.6% (95% confidence interval, 64.7-68.4%), and pooled unadjusted risk ratio analysis confirmed that patients undergoing peripheral VA-ECMO had a lower in-hospital/30-day mortality than patients undergoing central cannulation (risk ratio, 0.92; 95% confidence interval, 0.87-0.98). Adjustments for important confounders did not alter our results. Conclusions: In patients with postcardiotomy shock treated with VA-ECMO, central cannulation was associated with greater in-hospital mortality than peripheral cannulation.
(Less)
- author
- author collaboration
- organization
- publishing date
- 2020
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- cardiac surgery, ECMO, extracorporeal membrane oxygenation, postcardiotomy
- in
- Journal of Thoracic and Cardiovascular Surgery
- volume
- 160
- issue
- 5
- pages
- 44 - 1216
- publisher
- Mosby-Elsevier
- external identifiers
-
- pmid:31864699
- scopus:85092577129
- ISSN
- 0022-5223
- DOI
- 10.1016/j.jtcvs.2019.10.078
- language
- English
- LU publication?
- yes
- id
- 4ebbacaa-6e71-4a06-88bc-5e7362f92f02
- date added to LUP
- 2020-11-06 07:16:29
- date last changed
- 2024-04-17 18:02:38
@article{4ebbacaa-6e71-4a06-88bc-5e7362f92f02,
abstract = {{<p>Background: We hypothesized that cannulation strategy in venoarterial extracorporeal membrane oxygenation (VA-ECMO) could play a crucial role in the perioperative survival of patients affected by postcardiotomy shock. Methods: Between January 2010 and March 2018, 781 adult patients receiving VA-ECMO for postcardiotomy shock at 19 cardiac surgical centers were retrieved from the Postcardiotomy Veno-arterial Extracorporeal Membrane Oxygenation study registry. A parallel systematic review and meta-analysis (PubMed/MEDLINE, Embase, and Cochrane Library) through December 2018 was also accomplished. Results: Central and peripheral VA-ECMO cannulation were performed in 245 (31.4%) and 536 (68.6%) patients, respectively. Main indications for the institution VA-ECMO were failure to wean from cardiopulmonary bypass (38%) and heart failure following cardiopulmonary bypass weaning (48%). The doubly robust analysis after inverse probability treatment weighting by propensity score demonstrated that central VA-ECMO was associated with greater hospital mortality (odds ratio 1.54; 95% confidence interval, 1.09-2.18), reoperation for bleeding/tamponade (odds ratio, 1.96; 95% confidence interval, 1.37-2.81), and transfusion of more than 9 RBC units (odds ratio, 2.42; 95% confidence interval, 1.59-3.67). The systematic review provided a total of 2491 individuals with postcardiotomy shock treated with VA-ECMO. Pooled prevalence of in-hospital/30-day mortality in overall patient population was 66.6% (95% confidence interval, 64.7-68.4%), and pooled unadjusted risk ratio analysis confirmed that patients undergoing peripheral VA-ECMO had a lower in-hospital/30-day mortality than patients undergoing central cannulation (risk ratio, 0.92; 95% confidence interval, 0.87-0.98). Adjustments for important confounders did not alter our results. Conclusions: In patients with postcardiotomy shock treated with VA-ECMO, central cannulation was associated with greater in-hospital mortality than peripheral cannulation.</p>}},
author = {{Mariscalco, Giovanni and Salsano, Antonio and Fiore, Antonio and Dalén, Magnus and Ruggieri, Vito G. and Saeed, Diyar and Jónsson, Kristján and Gatti, Giuseppe and Zipfel, Svante and Dell'Aquila, Angelo M. and Perrotti, Andrea and Loforte, Antonio and Livi, Ugolino and Pol, Marek and Spadaccio, Cristiano and Pettinari, Matteo and Ragnarsson, Sigurdur and Alkhamees, Khalid and El-Dean, Zein and Bounader, Karl and Biancari, Fausto}},
issn = {{0022-5223}},
keywords = {{cardiac surgery; ECMO; extracorporeal membrane oxygenation; postcardiotomy}},
language = {{eng}},
number = {{5}},
pages = {{44--1216}},
publisher = {{Mosby-Elsevier}},
series = {{Journal of Thoracic and Cardiovascular Surgery}},
title = {{Peripheral versus central extracorporeal membrane oxygenation for postcardiotomy shock : Multicenter registry, systematic review, and meta-analysis}},
url = {{http://dx.doi.org/10.1016/j.jtcvs.2019.10.078}},
doi = {{10.1016/j.jtcvs.2019.10.078}},
volume = {{160}},
year = {{2020}},
}