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Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation in Patients Aged 70 Years or Older

Biancari, Fausto ; Saeed, Diyar ; Fiore, Antonio ; Dalén, Magnus ; Ruggieri, Vito G. ; Jónsson, Kristján ; Gatti, Giuseppe ; Zipfel, Svante ; Dell'Aquila, Angelo M. and Chocron, Sidney , et al. (2019) In Annals of Thoracic Surgery 108(4). p.1257-1264
Abstract

Background: There is uncertainty whether venoarterial extracorporeal membrane oxygenation (VA-ECMO) should be used in older patients with cardiopulmonary failure after cardiac surgery. Methods: This was a retrospective multicenter study of 781 patients who required postcardiotomy VA-ECMO for cardiopulmonary failure after adult cardiac surgery from 2010 to 2018 at 19 cardiac surgery centers. A parallel systematic review with meta-analysis of the literature was performed. Results: The hospital mortality in the overall Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation (PC-ECMO) series was 64.4%. A total of 255 patients were 70 years old or older (32.7%), and their hospital mortality was significantly higher than in younger... (More)

Background: There is uncertainty whether venoarterial extracorporeal membrane oxygenation (VA-ECMO) should be used in older patients with cardiopulmonary failure after cardiac surgery. Methods: This was a retrospective multicenter study of 781 patients who required postcardiotomy VA-ECMO for cardiopulmonary failure after adult cardiac surgery from 2010 to 2018 at 19 cardiac surgery centers. A parallel systematic review with meta-analysis of the literature was performed. Results: The hospital mortality in the overall Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation (PC-ECMO) series was 64.4%. A total of 255 patients were 70 years old or older (32.7%), and their hospital mortality was significantly higher than in younger patients (76.1% vs 58.7%; adjusted odds ratio, 2.199; 95% confidence interval [CI], 1.536 to 3.149). Arterial lactate level greater than 6 mmol/L before starting VA-ECMO was the only predictor of hospital mortality among patients 70 years old or older in univariate analysis (82.6% vs 70.4%; P =.029). Meta-analysis of current and previous studies showed that early mortality after postcardiotomy VA-ECMO was significantly higher in patients aged 70 years or older compared with younger patients (odds ratio, 2.09; 95% CI, 1.59 to 2.75; 5 studies including 1547 patients; I2, 5.9%). The pooled early mortality rate among patients aged 70 years or older was 78.8% (95% CI, 74.1 to 83.5; 6 studies including 617 patients; I2, 41.8%). Two studies reported 1-year mortality (including hospital mortality) of 79.9% and 75.6%, respectively, in patients 70 years old or older. Conclusions: Advanced age should not be considered a contraindication for postcardiotomy VA-ECMO. However, in view of the high risk of early mortality, meaningful scrutiny is needed before using VA-ECMO after cardiac surgery in older patients.

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Annals of Thoracic Surgery
volume
108
issue
4
pages
8 pages
publisher
Elsevier
external identifiers
  • scopus:85071612281
  • pmid:31185202
ISSN
0003-4975
DOI
10.1016/j.athoracsur.2019.04.063
language
English
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yes
id
7280d541-154a-4a77-8e19-b631a6e7e851
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2019-09-30 11:50:46
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2020-05-24 06:26:22
@article{7280d541-154a-4a77-8e19-b631a6e7e851,
  abstract     = {<p>Background: There is uncertainty whether venoarterial extracorporeal membrane oxygenation (VA-ECMO) should be used in older patients with cardiopulmonary failure after cardiac surgery. Methods: This was a retrospective multicenter study of 781 patients who required postcardiotomy VA-ECMO for cardiopulmonary failure after adult cardiac surgery from 2010 to 2018 at 19 cardiac surgery centers. A parallel systematic review with meta-analysis of the literature was performed. Results: The hospital mortality in the overall Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation (PC-ECMO) series was 64.4%. A total of 255 patients were 70 years old or older (32.7%), and their hospital mortality was significantly higher than in younger patients (76.1% vs 58.7%; adjusted odds ratio, 2.199; 95% confidence interval [CI], 1.536 to 3.149). Arterial lactate level greater than 6 mmol/L before starting VA-ECMO was the only predictor of hospital mortality among patients 70 years old or older in univariate analysis (82.6% vs 70.4%; P =.029). Meta-analysis of current and previous studies showed that early mortality after postcardiotomy VA-ECMO was significantly higher in patients aged 70 years or older compared with younger patients (odds ratio, 2.09; 95% CI, 1.59 to 2.75; 5 studies including 1547 patients; I<sup>2</sup>, 5.9%). The pooled early mortality rate among patients aged 70 years or older was 78.8% (95% CI, 74.1 to 83.5; 6 studies including 617 patients; I<sup>2</sup>, 41.8%). Two studies reported 1-year mortality (including hospital mortality) of 79.9% and 75.6%, respectively, in patients 70 years old or older. Conclusions: Advanced age should not be considered a contraindication for postcardiotomy VA-ECMO. However, in view of the high risk of early mortality, meaningful scrutiny is needed before using VA-ECMO after cardiac surgery in older patients.</p>},
  author       = {Biancari, Fausto and Saeed, Diyar and Fiore, Antonio and Dalén, Magnus and Ruggieri, Vito G. and Jónsson, Kristján and Gatti, Giuseppe and Zipfel, Svante and Dell'Aquila, Angelo M. and Chocron, Sidney and Bounader, Karl and Amr, Gilles and Settembre, Nicla and Pälve, Kristiina and Loforte, Antonio and Gabrielli, Marco and Livi, Ugolino and Lechiancole, Andrea and Pol, Marek and Netuka, Ivan and Spadaccio, Cristiano and Pettinari, Matteo and De Keyzer, Dieter and Reichart, Daniel and Ragnarsson, Sigurdur and Alkhamees, Khalid and Lichtenberg, Artur and Fux, Thomas and El Dean, Zein and Fiorentino, Mariafrancesca and Mariscalco, Giovanni and Jeppsson, Anders and Welp, Henryk and Perrotti, Andrea},
  issn         = {0003-4975},
  language     = {eng},
  number       = {4},
  pages        = {1257--1264},
  publisher    = {Elsevier},
  series       = {Annals of Thoracic Surgery},
  title        = {Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation in Patients Aged 70 Years or Older},
  url          = {http://dx.doi.org/10.1016/j.athoracsur.2019.04.063},
  doi          = {10.1016/j.athoracsur.2019.04.063},
  volume       = {108},
  year         = {2019},
}