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Inter-institutional analysis of the outcome after postcardiotomy veno-arterial extracorporeal membrane oxygenation

Biancari, Fausto ; Mäkikallio, Timo ; Loforte, Antonio ; Kaserer, Alexander ; Ruggieri, Vito G. ; Cho, Sung Min ; Kang, Jin Kook ; Dalén, Magnus ; Welp, Henryk and Jónsson, Kristján , et al. (2023) In International Journal of Artificial Organs
Abstract

Introduction: Patients requiring postcardiotomy veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) have a high risk of early mortality. In this analysis, we evaluated whether any interinstitutional difference exists in the results of postcardiotomy V-A-ECMO. Methods: Studies on postcardiotomy V-A-ECMO were identified through a systematic review for individual patient data (IPD) meta-analysis. Analysis of interinstitutional results was performed using direct standardization, estimation of observed/expected in-hospital mortality ratio and propensity score matching. Results: Systematic review of the literature yielded 31 studies. Data from 10 studies on 1269 patients treated at 25 hospitals were available for the present... (More)

Introduction: Patients requiring postcardiotomy veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) have a high risk of early mortality. In this analysis, we evaluated whether any interinstitutional difference exists in the results of postcardiotomy V-A-ECMO. Methods: Studies on postcardiotomy V-A-ECMO were identified through a systematic review for individual patient data (IPD) meta-analysis. Analysis of interinstitutional results was performed using direct standardization, estimation of observed/expected in-hospital mortality ratio and propensity score matching. Results: Systematic review of the literature yielded 31 studies. Data from 10 studies on 1269 patients treated at 25 hospitals were available for the present analysis. In-hospital mortality was 66.7%. The relative risk of in-hospital mortality was significantly higher in six hospitals. Observed versus expected in-hospital mortality ratio showed that four hospitals were outliers with significantly increased mortality rates, and one hospital had significantly lower in-hospital mortality rate. Participating hospitals were classified as underperforming and overperforming hospitals if their observed/expected in-hospital mortality was higher or lower than 1.0, respectively. Among 395 propensity score matched pairs, the overperforming hospitals had significantly lower in-hospital mortality (60.3% vs 71.4%, p = 0.001) than underperforming hospitals. Low annual volume of postcardiotomy V-A-ECMO tended to be predictive of poor outcome only when adjusted for patients’ risk profile. Conclusions: In-hospital mortality after postcardiotomy V-A-ECMO differed significantly between participating hospitals. These findings suggest that in many centers there is room for improvement of the results of postcardiotomy V-A-ECMO.

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organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
ECMO, Extracorporeal membrane oxygenation, postcardiotomy, volume
in
International Journal of Artificial Organs
publisher
Wichtig Editore - Milano (Italy)
external identifiers
  • pmid:38053227
  • scopus:85178963400
ISSN
0391-3988
DOI
10.1177/03913988231214934
language
English
LU publication?
yes
id
e0c37499-a938-4e56-81a1-805eb8271797
date added to LUP
2024-01-11 11:07:35
date last changed
2024-04-12 03:59:54
@article{e0c37499-a938-4e56-81a1-805eb8271797,
  abstract     = {{<p>Introduction: Patients requiring postcardiotomy veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) have a high risk of early mortality. In this analysis, we evaluated whether any interinstitutional difference exists in the results of postcardiotomy V-A-ECMO. Methods: Studies on postcardiotomy V-A-ECMO were identified through a systematic review for individual patient data (IPD) meta-analysis. Analysis of interinstitutional results was performed using direct standardization, estimation of observed/expected in-hospital mortality ratio and propensity score matching. Results: Systematic review of the literature yielded 31 studies. Data from 10 studies on 1269 patients treated at 25 hospitals were available for the present analysis. In-hospital mortality was 66.7%. The relative risk of in-hospital mortality was significantly higher in six hospitals. Observed versus expected in-hospital mortality ratio showed that four hospitals were outliers with significantly increased mortality rates, and one hospital had significantly lower in-hospital mortality rate. Participating hospitals were classified as underperforming and overperforming hospitals if their observed/expected in-hospital mortality was higher or lower than 1.0, respectively. Among 395 propensity score matched pairs, the overperforming hospitals had significantly lower in-hospital mortality (60.3% vs 71.4%, p = 0.001) than underperforming hospitals. Low annual volume of postcardiotomy V-A-ECMO tended to be predictive of poor outcome only when adjusted for patients’ risk profile. Conclusions: In-hospital mortality after postcardiotomy V-A-ECMO differed significantly between participating hospitals. These findings suggest that in many centers there is room for improvement of the results of postcardiotomy V-A-ECMO.</p>}},
  author       = {{Biancari, Fausto and Mäkikallio, Timo and Loforte, Antonio and Kaserer, Alexander and Ruggieri, Vito G. and Cho, Sung Min and Kang, Jin Kook and Dalén, Magnus and Welp, Henryk and Jónsson, Kristján and Ragnarsson, Sigurdur and Hernández Pérez, Francisco J. and Gatti, Giuseppe and Alkhamees, Khalid and Fiore, Antonio and Lechiancole, Andrea and Rosato, Stefano and Spadaccio, Cristiano and Pettinari, Matteo and Perrotti, Andrea and Sahli, Sebastian D. and L’Acqua, Camilla and Arafat, Amr A. and Albabtain, Monirah A. and AlBarak, Mohammed M. and Laimoud, Mohamed and Djordjevic, Ilija and Krasivskyi, Ihor and Samalavicius, Robertas and Jankuviene, Agne and Alonso-Fernandez-Gatta, Marta and Wilhelm, Markus J. and Juvonen, Tatu and Mariscalco, Giovanni}},
  issn         = {{0391-3988}},
  keywords     = {{ECMO; Extracorporeal membrane oxygenation; postcardiotomy; volume}},
  language     = {{eng}},
  publisher    = {{Wichtig Editore - Milano (Italy)}},
  series       = {{International Journal of Artificial Organs}},
  title        = {{Inter-institutional analysis of the outcome after postcardiotomy veno-arterial extracorporeal membrane oxygenation}},
  url          = {{http://dx.doi.org/10.1177/03913988231214934}},
  doi          = {{10.1177/03913988231214934}},
  year         = {{2023}},
}