Meta-analysis of the outcome after postcardiotomy venoarterial extracorporeal membrane oxygenation in adult patients
Biancari, Fausto; Perrotti, Andrea; Dalén, Magnus; Guerrieri, Mariapia; Fiore, Antonio; Reichart, Daniel; Dell’Aquila, Angelo M.; Gatti, Giuseppe; Ala-Kokko, Tero; Kinnunen, Eeva-Maija; Tauriainen, Tuomas; Chocron, Sidney; Airaksinen, Juhani K. E.; Ruggieri, Vito G.; Brascia, Debora (2017-09-01)
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
© 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/.
https://creativecommons.org/licenses/by-nc-nd/4.0/
https://urn.fi/URN:NBN:fi-fe2019102134095
Tiivistelmä
Abstract
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.
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