Roberto Lorusso1, Sandro Gelsomino2, Orlando Parise2, Priya Mendiratta3, Parthak Prodhan4, Peter Rycus5, Graeme MacLaren6, Thomas V Brogan7, Yih-Sharng Chen8, Jos Maessen2, Xiaotong Hou9, Ravi R Thiagarajan10. 1. Cardio-Thoracic Surgery Unit, Maastricht University Medical Centre, Maastricht, The Netherlands. Electronic address: roberto.lorussobs@gmail.com. 2. Cardio-Thoracic Surgery Unit, Maastricht University Medical Centre, Maastricht, The Netherlands. 3. Division of Geriatrics, University of Arkansas, Little Rock, Arkansas. 4. Division of Cardiology, University of Arkansas, Little Rock, Arkansas. 5. Extracorporeal Life Support Organization (ELSO), Ann Arbor, Michigan. 6. Cardiothoracic Intensive Care Unit, National University, Singapore. 7. Department of Pediatrics, Division of Critical Care, Seattle Children's Hospital, Seattle, Washington. 8. Cardiovascular Surgery & Ped Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan. 9. Centre for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. 10. Cardiac Intensive Care Unit, Boston Children's Hospital, Boston, Massachusetts.
Abstract
BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock (RCS) is increasingly used in adult patients, but age represents a controversial factor in this setting. METHODS: Data from the Extracorporeal Life Support Organization registry was analyzed to assess in-hospital survival of elderly patients (≥70 years of age) undergoing VA-ECMO for RCS from 1992 to 2015. In-hospital survival and complications for elderly patients were compared with data in younger adults (≥18 to <70 years of age) supported with VA-ECMO during the same time period for similar indications. RESULTS: The mean age of the patient cohort (n = 5,408) was 53.0 ± 15.7 years (range, 18 to 91 years). The elderly group included 735 patients (13.6%), with a mean age of 75.2 ± 4.4 years. In the elderly group, pre-ECMO cardiac procedures were performed in 134 cases (18.9%), and 2.2% received VA-ECMO for postcardiotomy support compared with 0.7% in the younger cohort. The mean duration of VA-ECMO in the elderly group was 101 ± 91 h compared with 138 ± 146 h in the younger group (p < 0.001). Overall, survival to hospital discharge for the entire adult cohort was 41.4% (2,240 of 5,408), with 30.5% (224 of 735) in the elderly patient group and 43.1% (2,016 of 4,673) in the younger patient group (p < 0.001). Elderly patients had a higher rate of multiorgan failure. At multivariable analysis age represented an independent negative predictor of in-hospital survival. CONCLUSIONS: Based on the acceptable survival to hospital discharge in our study, older age alone should not represent an absolute contraindication when considering VA-ECMO support for RCS.
BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock (RCS) is increasingly used in adult patients, but age represents a controversial factor in this setting. METHODS: Data from the Extracorporeal Life Support Organization registry was analyzed to assess in-hospital survival of elderly patients (≥70 years of age) undergoing VA-ECMO for RCS from 1992 to 2015. In-hospital survival and complications for elderly patients were compared with data in younger adults (≥18 to <70 years of age) supported with VA-ECMO during the same time period for similar indications. RESULTS: The mean age of the patient cohort (n = 5,408) was 53.0 ± 15.7 years (range, 18 to 91 years). The elderly group included 735 patients (13.6%), with a mean age of 75.2 ± 4.4 years. In the elderly group, pre-ECMO cardiac procedures were performed in 134 cases (18.9%), and 2.2% received VA-ECMO for postcardiotomy support compared with 0.7% in the younger cohort. The mean duration of VA-ECMO in the elderly group was 101 ± 91 h compared with 138 ± 146 h in the younger group (p < 0.001). Overall, survival to hospital discharge for the entire adult cohort was 41.4% (2,240 of 5,408), with 30.5% (224 of 735) in the elderly patient group and 43.1% (2,016 of 4,673) in the younger patient group (p < 0.001). Elderly patients had a higher rate of multiorgan failure. At multivariable analysis age represented an independent negative predictor of in-hospital survival. CONCLUSIONS: Based on the acceptable survival to hospital discharge in our study, older age alone should not represent an absolute contraindication when considering VA-ECMO support for RCS.
Authors: Guido Michels; Tobias Wengenmayer; Christian Hagl; Christian Dohmen; Bernd W Böttiger; Johann Bauersachs; Andreas Markewitz; Adrian Bauer; Jan-Thorsten Gräsner; Roman Pfister; Alexander Ghanem; Hans-Jörg Busch; Uwe Kreimeier; Andreas Beckmann; Matthias Fischer; Clemens Kill; Uwe Janssens; Stefan Kluge; Frank Born; Hans Martin Hoffmeister; Michael Preusch; Udo Boeken; Reimer Riessen; Holger Thiele Journal: Clin Res Cardiol Date: 2018-09-04 Impact factor: 5.460
Authors: G Michels; T Wengenmayer; C Hagl; C Dohmen; B W Böttiger; J Bauersachs; A Markewitz; A Bauer; J-T Gräsner; R Pfister; A Ghanem; H-J Busch; U Kreimeier; A Beckmann; M Fischer; C Kill; U Janssens; S Kluge; F Born; H M Hoffmeister; M Preusch; U Boeken; R Riessen; H Thiele Journal: Med Klin Intensivmed Notfmed Date: 2018-09 Impact factor: 0.840
Authors: G Michels; T Wengenmayer; C Hagl; C Dohmen; B W Böttiger; J Bauersachs; A Markewitz; A Bauer; J-T Gräsner; R Pfister; A Ghanem; H-J Busch; U Kreimeier; A Beckmann; M Fischer; C Kill; U Janssens; S Kluge; F Born; H M Hoffmeister; M Preusch; U Boeken; R Riessen; H Thiele Journal: Anaesthesist Date: 2018-08 Impact factor: 1.041
Authors: Adeel Abbasi; Cynthia Devers; Christopher S Muratore; Colin Harrington; Corey E Ventetuolo Journal: J Crit Care Date: 2017-10-18 Impact factor: 3.425
Authors: Rahul S Loungani; Marat Fudim; Dave Ranney; Ajar Kochar; Marc D Samsky; Desiree Bonadonna; Akinobu Itoh; Hiroo Takayama; Koji Takeda; Daniel Wojdyla; Adam D DeVore; Mani Daneshmand Journal: J Card Fail Date: 2021-01-13 Impact factor: 5.712
Authors: Faeq Husain-Syed; Zaccaria Ricci; Daniel Brodie; Jean-Louis Vincent; V Marco Ranieri; Arthur S Slutsky; Fabio Silvio Taccone; Luciano Gattinoni; Claudio Ronco Journal: Intensive Care Med Date: 2018-07-24 Impact factor: 17.440
Authors: Roberto Lorusso; Giuseppe Maria Raffa; Khalid Alenizy; Niels Sluijpers; Maged Makhoul; Daniel Brodie; Mike McMullan; I-Wen Wang; Paolo Meani; Graeme MacLaren; Mariusz Kowalewski; Heidi Dalton; Ryan Barbaro; Xiaotong Hou; Nicholas Cavarocchi; Yih-Sharng Chen; Ravi Thiagarajan; Peta Alexander; Bahaaldin Alsoufi; Christian A Bermudez; Ashish S Shah; Jonathan Haft; David A D'Alessandro; Udo Boeken; Glenn J R Whitman Journal: J Heart Lung Transplant Date: 2019-08-10 Impact factor: 10.247
Authors: Ali İhsan Hasde; Mehmet Cahit Sarıcaoğlu; Nur Dikmen Yaman; Çağdaş Baran; Evren Özçınar; Mehmet Çakıcı; Mustafa Bahadır İnan; Ahmet Ruchan Akar Journal: Interact Cardiovasc Thorac Surg Date: 2021-04-08