University of Oulu

Fausto Biancari, Diyar Saeed, Antonio Fiore, Magnus Dalén, Vito G. Ruggieri, Kristján Jónsson, Giuseppe Gatti, Svante Zipfel, Angelo M. Dell’Aquila, Sidney Chocron, Karl Bounader, Gilles Amr, Nicla Settembre, Kristiina Pälve, Antonio Loforte, Marco Gabrielli, Ugolino Livi, Andrea Lechiancole, Marek Pol, Ivan Netuka, Cristiano Spadaccio, Matteo Pettinari, Dieter De Keyzer, Daniel Reichart, Sigurdur Ragnarsson, Khalid Alkhamees, Artur Lichtenberg, Thomas Fux, Zein El Dean, Mariafrancesca Fiorentino, Giovanni Mariscalco, Anders Jeppsson, Henryk Welp, Andrea Perrotti, Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation in Patients Aged 70 Years or Older, The Annals of Thoracic Surgery, Volume 108, Issue 4, 2019, Pages 1257-1264, ISSN 0003-4975, https://doi.org/10.1016/j.athoracsur.2019.04.063

Postcardiotomy venoarterial extracorporeal membrane oxygenation in patients aged 70 years or older

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Author: Biancari, Fausto1,2; Saeed, Diyar3; Fiore, Antonio4;
Organizations: 1Heart Center, Turku University Hospital and Department of Surgery, University of Turku, Turku, Finland
2Department of Surgery, University of Oulu, Oulu, Finland
3Department of Cardiovascular Surgery, University Hospital of Dusseldorf, Dusseldorf, Germany
4Department of Cardiothoracic Surgery, Henri Mondor University Hospital, AP-HP, Paris-Est University, Créteil, France
5Department of Molecular Medicine and Surgery, and Department of Cardiac Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
6Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, France
7Department of Cardiac Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
8Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
9Hamburg University Heart Center, Hamburg, Germany
10Department of Cardiothoracic Surgery, Münster University Hospital, Münster, Germany
11Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
12Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
13Department of Vascular Surgery, Nancy University Hospital, University of Lorraine, Nancy, France
14Department of Cardiothoracic, Transplantation, and Vascular Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy
15Cardiothoracic Department, University Hospital of Udine, Udine, Italy
16Institute of Clinical and Experimental Medicine, Prague, Czech Republic
17Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom
18Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
19Department of Cardiothoracic Surgery, University of Lund, Lund, Sweden
20Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia
21Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, United Kingdom
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 1.2 MB)
Persistent link: http://urn.fi/urn:nbn:fi-fe2019111838466
Language: English
Published: Elsevier, 2019
Publish Date: 2020-06-08
Description:

Abstract

Background: There is uncertainty whether venoarterial extracorporeal membrane oxygenation (VA-ECMO) should be used in older patients with cardiopulmonary failure after cardiac surgery.

Methods: This was a retrospective multicenter study of 781 patients who required postcardiotomy VA-ECMO for cardiopulmonary failure after adult cardiac surgery from 2010 to 2018 at 19 cardiac surgery centers. A parallel systematic review with meta-analysis of the literature was performed.

Results: The hospital mortality in the overall Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation (PC-ECMO) series was 64.4%. A total of 255 patients were 70 years old or older (32.7%), and their hospital mortality was significantly higher than in younger patients (76.1% vs 58.7%; adjusted odds ratio, 2.199; 95% confidence interval [CI], 1.536 to 3.149). Arterial lactate level greater than 6 mmol/L before starting VA-ECMO was the only predictor of hospital mortality among patients 70 years old or older in univariate analysis (82.6% vs 70.4%; P = 0.029). Meta-analysis of current and previous studies showed that early mortality after postcardiotomy VA-ECMO was significantly higher in patients aged 70 years or older compared with younger patients (odds ratio, 2.09; 95% CI, 1.59 to 2.75; 5 studies including 1547 patients; I², 5.9%). The pooled early mortality rate among patients aged 70 years or older was 78.8% (95% CI, 74.1 to 83.5; 6 studies including 617 patients; I², 41.8%). Two studies reported 1-year mortality (including hospital mortality) of 79.9% and 75.6%, respectively, in patients 70 years old or older.

Conclusions: Advanced age should not be considered a contraindication for postcardiotomy VA-ECMO. However, in view of the high risk of early mortality, meaningful scrutiny is needed before using VA-ECMO after cardiac surgery in older patients.

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Series: The annals of thoracic surgery
ISSN: 0003-4975
ISSN-E: 1552-6259
ISSN-L: 0003-4975
Volume: 108
Issue: 4
Pages: 1257 - 1264
DOI: 10.1016/j.athoracsur.2019.04.063
OADOI: https://oadoi.org/10.1016/j.athoracsur.2019.04.063
Type of Publication: A2 Review article in a scientific journal
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Subjects:
Copyright information: © 2019 by The Society of Thoracic Surgeons Published by Elsevier. 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/