University of Oulu

Fausto Biancari, Magnus Dalén, Antonio Fiore, Vito G. Ruggieri, Diyar Saeed, Kristján Jónsson, Giuseppe Gatti, Svante Zipfel, Andrea Perrotti, Karl Bounader, Antonio Loforte, Andrea Lechiancole, Marek Pol, Cristiano Spadaccio, Matteo Pettinari, Sigurdur Ragnarsson, Khalid Alkhamees, Giovanni Mariscalco, Henryk Welp, Kristiina Pälve, Vesa Anttila, Thomas Fux, Gilles Amr, Nikolaos Kalampokas, Artur Lichtenberg, Anders Jeppsson, Marco Gabrielli, Daniel Reichart, Sidney Chocron, Mariafrancesca Fiorentino, Ugolino Livi, Ivan Netuka, Dieter De Keyzer, Krister Mogianos, Zein El Dean, Angelo M. Dell’Aquila, Nicla Settembre, Stefano Rosato, Multicenter study on postcardiotomy venoarterial extracorporeal membrane oxygenation, The Journal of Thoracic and Cardiovascular Surgery, Volume 159, Issue 5, 2020, Pages 1844-1854.e6, ISSN 0022-5223, https://doi.org/10.1016/j.jtcvs.2019.06.039

Multicenter study on postcardiotomy venoarterial extracorporeal membrane oxygenation

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Author: Biancari, Fausto1,2; Dalén, Magnus3; 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 Molecular Medicine and Surgery, Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
4Department of Cardiothoracic Surgery, Henri Mondor University Hospital, AP-HP, Paris-Est University, Créteil, France
5Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, France
6Cardiovascular Surgery, University Hospital of Duesseldorf, Dusseldorf, Germany
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 Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
11Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
12Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy
13Cardiothoracic Department, University Hospital of Udine, Udine, Italy
14Institute of Clinical and Experimental Medicine, Prague, Czech Republic
15Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom
16Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
17Department of Cardiothoracic Surgery, University of Lund, Lund, Sweden
18Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia
19Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, United Kingdom
20Department of Cardiothoracic Surgery, Münster University Hospital, Münster, Germany
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 3.3 MB)
Persistent link: http://urn.fi/urn:nbn:fi-fe2020060540801
Language: English
Published: Elsevier, 2020
Publish Date: 2020-07-02
Description:

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 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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Collaborators of the PC-ECMO Study Group: Kristiina Pälve, MD, PhD, Vesa Anttila, MD, PhD, MD, Thomas Fux, MD, PhD, Gilles Amr, MD, Nikolaos Kalampokas, MD, Artur Lichtenberg, MD, Anders Jeppsson, MD, PhD, Marco Gabrielli, MD, Daniel Reichart, MD, Sidney Chocron, MD, PhD, Mariafrancesca Fiorentino, MD, Ugolino Livi, MD, Ivan Netuka, MD, Dieter De Keyzer, MD, Krister Mogianos, MD, Zein El Dean, MRCS, LLM, Angelo M. Dell’Aquila, MD, Nicla Settembre, MD, PhD, and Stefano Rosato, MSc.

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Series: Journal of thoracic and cardiovascular surgery
ISSN: 0022-5223
ISSN-E: 1097-685X
ISSN-L: 0022-5223
Volume: 159
Pages: 1844 - 1854.e6
DOI: 10.1016/j.jtcvs.2019.06.039
OADOI: https://oadoi.org/10.1016/j.jtcvs.2019.06.039
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
3126 Surgery, anesthesiology, intensive care, radiology
Subjects:
Copyright information: © 2019 by The American Association for Thoracic Surgery. 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/