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Duration of Venoarterial Extracorporeal Membrane Oxygenation and Mortality in Postcardiotomy Cardiogenic Shock

Mariscalco, Giovanni ; El-Dean, Zein ; Yusuff, Hakeem ; Fux, Thomas ; Dell'Aquila, Angelo M. ; Jónsson, Kristján ; Ragnarsson, Sigurdur LU ; Fiore, Antonio ; Dalén, Magnus and di Perna, Dario , et al. (2021) In Journal of Cardiothoracic and Vascular Anesthesia 35(9). p.2662-2668
Abstract

Objective: The optimal duration of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in patients affected by postcardiotomy cardiogenic shock (PCS) remains controversial. The present study was conducted to investigate the effect of VA-ECMO duration on hospital outcomes. Design: Retrospective analysis of an international registry. Setting: Multicenter study including 19 tertiary university hospitals. Participants: Between January 2010 and March 2018, data on PCS patients receiving VA-ECMO were retrieved from the multicenter PC-ECMO registry. Interventions: Patients were stratified according to the following different durations of VA-ECMO therapy: ≤three days, four-to-seven days, eight-to-ten days, and >ten days. Measurements... (More)

Objective: The optimal duration of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in patients affected by postcardiotomy cardiogenic shock (PCS) remains controversial. The present study was conducted to investigate the effect of VA-ECMO duration on hospital outcomes. Design: Retrospective analysis of an international registry. Setting: Multicenter study including 19 tertiary university hospitals. Participants: Between January 2010 and March 2018, data on PCS patients receiving VA-ECMO were retrieved from the multicenter PC-ECMO registry. Interventions: Patients were stratified according to the following different durations of VA-ECMO therapy: ≤three days, four-to-seven days, eight-to-ten days, and >ten days. Measurements and Main Results: A total of 725 patients, with a mean age of 62.9 ± 12.9 years, were included. The mean duration of VA-ECMO was 7.1 ± 6.3 days (range 0-39 d), and 39.4% of patients were supported for ≤three days, 29.1% for four-seven days, 15.3% for eight-ten days, and finally 20.7% for >ten days. A total of 391 (53.9%) patients were weaned from VA-ECMO successfully; however, 134 (34.3%) of those patients died before discharge. Multivariate logistic regression showed that prolonged duration of VA-ECMO therapy (four-seven days: adjusted rate 53.6%, odds ratio [OR] 0.28, 95% confidence interval [CI] 0.18-0.44; eight-ten days: adjusted rate 61.3%, OR 0.51, 95% CI 0.29-0.87; and >ten days: adjusted rate 59.3%, OR 0.49, 95% CI 0.31-0.81) was associated with lower risk of mortality compared with VA-ECMO lasting ≤three days (adjusted rate 78.3%). Patients requiring VA-ECMO therapy for eight-ten days (OR 1.96, 95% CI 1.15-3.33) and >10 days (OR 1.85, 95% CI 1.14-3.02) had significantly greater mortality compared with those on VA-ECMO for 4 to 7 days. Conclusions: PCS patients weaned from VA-ECMO after four-seven days of support had significantly less mortality compared with those with shorter or longer mechanical support.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
cardiac surgery, duration, ECMO, extracorporeal membrane oxygenation, survival
in
Journal of Cardiothoracic and Vascular Anesthesia
volume
35
issue
9
pages
7 pages
publisher
Elsevier
external identifiers
  • scopus:85097112241
  • pmid:33250434
ISSN
1053-0770
DOI
10.1053/j.jvca.2020.11.003
language
English
LU publication?
yes
id
7fb83f2a-c730-4766-a10e-52e7162457b0
date added to LUP
2021-01-11 17:04:29
date last changed
2024-06-27 05:47:14
@article{7fb83f2a-c730-4766-a10e-52e7162457b0,
  abstract     = {{<p>Objective: The optimal duration of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in patients affected by postcardiotomy cardiogenic shock (PCS) remains controversial. The present study was conducted to investigate the effect of VA-ECMO duration on hospital outcomes. Design: Retrospective analysis of an international registry. Setting: Multicenter study including 19 tertiary university hospitals. Participants: Between January 2010 and March 2018, data on PCS patients receiving VA-ECMO were retrieved from the multicenter PC-ECMO registry. Interventions: Patients were stratified according to the following different durations of VA-ECMO therapy: ≤three days, four-to-seven days, eight-to-ten days, and &gt;ten days. Measurements and Main Results: A total of 725 patients, with a mean age of 62.9 ± 12.9 years, were included. The mean duration of VA-ECMO was 7.1 ± 6.3 days (range 0-39 d), and 39.4% of patients were supported for ≤three days, 29.1% for four-seven days, 15.3% for eight-ten days, and finally 20.7% for &gt;ten days. A total of 391 (53.9%) patients were weaned from VA-ECMO successfully; however, 134 (34.3%) of those patients died before discharge. Multivariate logistic regression showed that prolonged duration of VA-ECMO therapy (four-seven days: adjusted rate 53.6%, odds ratio [OR] 0.28, 95% confidence interval [CI] 0.18-0.44; eight-ten days: adjusted rate 61.3%, OR 0.51, 95% CI 0.29-0.87; and &gt;ten days: adjusted rate 59.3%, OR 0.49, 95% CI 0.31-0.81) was associated with lower risk of mortality compared with VA-ECMO lasting ≤three days (adjusted rate 78.3%). Patients requiring VA-ECMO therapy for eight-ten days (OR 1.96, 95% CI 1.15-3.33) and &gt;10 days (OR 1.85, 95% CI 1.14-3.02) had significantly greater mortality compared with those on VA-ECMO for 4 to 7 days. Conclusions: PCS patients weaned from VA-ECMO after four-seven days of support had significantly less mortality compared with those with shorter or longer mechanical support.</p>}},
  author       = {{Mariscalco, Giovanni and El-Dean, Zein and Yusuff, Hakeem and Fux, Thomas and Dell'Aquila, Angelo M. and Jónsson, Kristján and Ragnarsson, Sigurdur and Fiore, Antonio and Dalén, Magnus and di Perna, Dario and Gatti, Giuseppe and Juvonen, Tatu and Zipfel, Svante and Perrotti, Andrea and Bounader, Karl and Alkhamees, Khalid and Loforte, Antonio and Lechiancole, Andrea and Pol, Marek and Spadaccio, Cristiano and Pettinari, Matteo and De Keyzer, Dieter and Welp, Henryk and Maselli, Daniele and Lichtenberg, Artur and Ruggieri, Vito G. and Biancari, Fausto}},
  issn         = {{1053-0770}},
  keywords     = {{cardiac surgery; duration; ECMO; extracorporeal membrane oxygenation; survival}},
  language     = {{eng}},
  month        = {{09}},
  number       = {{9}},
  pages        = {{2662--2668}},
  publisher    = {{Elsevier}},
  series       = {{Journal of Cardiothoracic and Vascular Anesthesia}},
  title        = {{Duration of Venoarterial Extracorporeal Membrane Oxygenation and Mortality in Postcardiotomy Cardiogenic Shock}},
  url          = {{http://dx.doi.org/10.1053/j.jvca.2020.11.003}},
  doi          = {{10.1053/j.jvca.2020.11.003}},
  volume       = {{35}},
  year         = {{2021}},
}