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Multicenter study on postcardiotomy venoarterial extracorporeal membrane oxygenation

Biancari, Fausto ; Dalén, Magnus ; Fiore, Antonio ; Ruggieri, Vito G. ; Saeed, Diyar ; Jónsson, Kristján ; Gatti, Giuseppe ; Zipfel, Svante ; Perrotti, Andrea and Bounader, Karl , et al. (2019) In Journal of Thoracic and Cardiovascular Surgery
Abstract

Objectives: The aim of this study was to identify the risk factors associated with early mortality after postcardiotomy venoarterial extracorporeal membrane oxygenation. Methods: This is an analysis of the postcardiotomy extracorporeal membrane oxygenation registry, a retrospective multicenter cohort study including 781 patients aged more than 18 years who required venoarterial extracorporeal membrane oxygenation for cardiopulmonary failure after cardiac surgery from 2010 to 2018 at 19 cardiac surgery centers. Results: After a mean venoarterial extracorporeal membrane oxygenation therapy of 6.9 ± 6.2 days, hospital and 1-year mortality were 64.4% and 67.2%, respectively. Hospital mortality after venoarterial extracorporeal membrane... (More)

Objectives: The aim of this study was to identify the risk factors associated with early mortality after postcardiotomy venoarterial extracorporeal membrane oxygenation. Methods: This is an analysis of the postcardiotomy extracorporeal membrane oxygenation registry, a retrospective multicenter cohort study including 781 patients aged more than 18 years who required venoarterial extracorporeal membrane oxygenation for cardiopulmonary failure after cardiac surgery from 2010 to 2018 at 19 cardiac surgery centers. Results: After a mean venoarterial extracorporeal membrane oxygenation therapy of 6.9 ± 6.2 days, hospital and 1-year mortality were 64.4% and 67.2%, respectively. Hospital mortality after venoarterial extracorporeal membrane oxygenation therapy for more than 7 days was 60.5% (P = .105). Centers that had treated more than 50 patients with postcardiotomy venoarterial extracorporeal membrane oxygenation had a significantly lower hospital mortality than lower-volume centers (60.7% vs 70.7%, adjusted odds ratio, 0.58; 95% confidence interval, 0.41-0.82). The postcardiotomy extracorporeal membrane oxygenation score was derived by assigning a weighted integer to each independent pre–venoarterial extracorporeal membrane oxygenation predictors of hospital mortality as follows: female gender (1 point), advanced age (60-69 years, 2 points; ≥70 years, 4 points), prior cardiac surgery (1 point), arterial lactate 6.0 mmol/L or greater before venoarterial extracorporeal membrane oxygenation (2 points), aortic arch surgery (4 points), and preoperative stroke/unconsciousness (5 points). The hospital mortality rates according to the postcardiotomy extracorporeal membrane oxygenation score was 0 point, 45.6%; 1 point, 40.5%; 2 points, 51.1%; 3 points, 57.8%; 4 points, 70.7%; 5 points, 68.3%; 6 points, 77.5%; and 7 points or more, 89.7% (P < .0001). Conclusions: Age, female gender, prior cardiac surgery, preoperative acute neurologic events, aortic arch surgery, and increased arterial lactate were associated with increased risk of early mortality after postcardiotomy venoarterial extracorporeal membrane oxygenation. Center experience with postcardiotomy venoarterial extracorporeal membrane oxygenation may contribute to improved results.

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keywords
cardiac surgery, extracorporeal membrane oxygenation, postcardiotomy, venoarterial
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Journal of Thoracic and Cardiovascular Surgery
publisher
Mosby
external identifiers
  • scopus:85069671537
  • pmid:31358340
ISSN
0022-5223
DOI
10.1016/j.jtcvs.2019.06.039
language
English
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yes
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dbc2e59a-c237-4376-b250-c8609181b7a5
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2019-08-28 14:17:06
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2020-07-12 06:01:14
@article{dbc2e59a-c237-4376-b250-c8609181b7a5,
  abstract     = {<p>Objectives: The aim of this study was to identify the risk factors associated with early mortality after postcardiotomy venoarterial extracorporeal membrane oxygenation. Methods: This is an analysis of the postcardiotomy extracorporeal membrane oxygenation registry, a retrospective multicenter cohort study including 781 patients aged more than 18 years who required venoarterial extracorporeal membrane oxygenation for cardiopulmonary failure after cardiac surgery from 2010 to 2018 at 19 cardiac surgery centers. Results: After a mean venoarterial extracorporeal membrane oxygenation therapy of 6.9 ± 6.2 days, hospital and 1-year mortality were 64.4% and 67.2%, respectively. Hospital mortality after venoarterial extracorporeal membrane oxygenation therapy for more than 7 days was 60.5% (P = .105). Centers that had treated more than 50 patients with postcardiotomy venoarterial extracorporeal membrane oxygenation had a significantly lower hospital mortality than lower-volume centers (60.7% vs 70.7%, adjusted odds ratio, 0.58; 95% confidence interval, 0.41-0.82). The postcardiotomy extracorporeal membrane oxygenation score was derived by assigning a weighted integer to each independent pre–venoarterial extracorporeal membrane oxygenation predictors of hospital mortality as follows: female gender (1 point), advanced age (60-69 years, 2 points; ≥70 years, 4 points), prior cardiac surgery (1 point), arterial lactate 6.0 mmol/L or greater before venoarterial extracorporeal membrane oxygenation (2 points), aortic arch surgery (4 points), and preoperative stroke/unconsciousness (5 points). The hospital mortality rates according to the postcardiotomy extracorporeal membrane oxygenation score was 0 point, 45.6%; 1 point, 40.5%; 2 points, 51.1%; 3 points, 57.8%; 4 points, 70.7%; 5 points, 68.3%; 6 points, 77.5%; and 7 points or more, 89.7% (P &lt; .0001). Conclusions: Age, female gender, prior cardiac surgery, preoperative acute neurologic events, aortic arch surgery, and increased arterial lactate were associated with increased risk of early mortality after postcardiotomy venoarterial extracorporeal membrane oxygenation. Center experience with postcardiotomy venoarterial extracorporeal membrane oxygenation may contribute to improved results.</p>},
  author       = {Biancari, Fausto and Dalén, Magnus and Fiore, Antonio and Ruggieri, Vito G. and Saeed, Diyar and Jónsson, Kristján and Gatti, Giuseppe and Zipfel, Svante and Perrotti, Andrea and Bounader, Karl and Loforte, Antonio and Lechiancole, Andrea and Pol, Marek and Spadaccio, Cristiano and Pettinari, Matteo and Ragnarsson, Sigurdur and Alkhamees, Khalid and Mariscalco, Giovanni and Welp, Henryk and Pälve, Kristiina and Anttila, Vesa and Fux, Thomas and Amr, Gilles and Kalampokas, Nikolaos and Lichtenberg, Artur and Jeppsson, Anders and Gabrielli, Marco and Reichart, Daniel and Chocron, Sidney and Fiorentino, Mariafrancesca and Livi, Ugolino and Netuka, Ivan and De Keyzer, Dieter and Mogianos, Krister and El Dean, Zein and Dell'Aquila, Angelo M. and Settembre, Nicla and Rosato, Stefano},
  issn         = {0022-5223},
  language     = {eng},
  publisher    = {Mosby},
  series       = {Journal of Thoracic and Cardiovascular Surgery},
  title        = {Multicenter study on postcardiotomy venoarterial extracorporeal membrane oxygenation},
  url          = {http://dx.doi.org/10.1016/j.jtcvs.2019.06.039},
  doi          = {10.1016/j.jtcvs.2019.06.039},
  year         = {2019},
}