Fausto Biancari, Andrea Perrotti, Magnus Dalén, Mariapia Guerrieri, Antonio Fiore, Daniel Reichart, Angelo M. Dell’Aquila, Giuseppe Gatti, Tero Ala-Kokko, Eeva-Maija Kinnunen, Tuomas Tauriainen, Sidney Chocron, Juhani K.E. Airaksinen, Vito G. Ruggieri, Debora Brascia, Meta-Analysis of the Outcome After Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation in Adult Patients, Journal of Cardiothoracic and Vascular Anesthesia, Volume 32, Issue 3, 2018, Pages 1175-1182, ISSN 1053-0770, https://doi.org/10.1053/j.jvca.2017.08.048
Meta-analysis of the outcome after postcardiotomy venoarterial extracorporeal membrane oxygenation in adult patients
|Author:||Biancari, Fausto1,2; Perrotti, Andrea3; Dalén, Magnus4;|
1Heart Center, Turku University Hospital and Department of Surgery, University of Turku, Turku, Finland
2Department of Surgery, University of Oulu, Oulu, Finland
3Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
4Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
5Department of Cardiothoracic Surgery, Henri Mondor University Hospital, AP-HP, Paris-Est University, Créteil, France
6Hamburg University Heart Center, Hamburg, Germany
7Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
8Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
9Department of Anesthesiology, Division of Intensive Care Medicine, Oulu University Hospital, Medical Research Center Oulu, Oulu University, Oulu, Finland
10Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
|Online Access:||PDF Full Text (PDF, 1.3 MB)|
|Persistent link:|| http://urn.fi/urn:nbn:fi-fe2019102134095
|Publish Date:|| 2019-10-21
Objective: This study was planned to pool existing data on outcome and to evaluate the efficacy of postcardiotomy venoarterial extracorporeal membrane oxygenation (VA-ECMO) in adult patients.
Design: Systematic review of the literature and meta-analysis.
Setting: Multi-institutional study.
Participants: Adult patients with acute heart failure immediately after cardiac surgery.
Interventions: VA-ECMO after cardiac surgery. Studies evaluating only heart transplant patients were excluded from this analysis.
Measurements and Main Results: A literature search was performed to identify studies published since 2000. Thirty-one studies reported on 2,986 patients (mean age, 58.1 years) who required postcardiotomy VA-ECMO. The weaning rate from VA-ECMO was 59.5% and hospital survival was 36.1% (95% CI 31.5–40.8). The pooled rate of reoperation for bleeding was 42.9%, major neurological event 11.3%, lower limb ischemia 10.8%, deep sternal wound infection/mediastinitis 14.7%, and renal replacement therapy 47.1%. The pooled mean number of transfused red blood cell units was 17.7 (95% CI 13.3–22.1). The mean stay in the intensive care unit was 13.3 days (95% CI 10.2–16.4). Survivors were significantly younger (mean, 55.7 v 63.6 years, p = 0.015) and their blood lactate level before starting VA-ECMO was lower (mean, 7.7 v 10.7 mmol/L, p = 0.028) than patients who died. One-year survival rate was 30.9% (95% CI 24.3–37.5).
Conclusions: Pooled data showed that VA-ECMO may salvage one-third of patients unresponsive to any other resuscitative treatment after adult cardiac surgery.
Journal of cardiothoracic and vascular anesthesia
|Pages:||1175 - 1182|
|Type of Publication:||
A1 Journal article – refereed
|Field of Science:||
3126 Surgery, anesthesiology, intensive care, radiology
© 2017 Elsevier Inc. All rights reserved. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/.