Fausto Biancari1, Andrea Perrotti2, Magnus Dalén3, Mariapia Guerrieri4, Antonio Fiore5, Daniel Reichart6, Angelo M Dell'Aquila7, Giuseppe Gatti8, Tero Ala-Kokko9, Eeva-Maija Kinnunen10, Tuomas Tauriainen10, Sidney Chocron2, Juhani K E Airaksinen10, Vito G Ruggieri11, Debora Brascia10. 1. Heart Center, Turku University Hospital and Department of Surgery, University of Turku, Turku, Finland; Department of Surgery, University of Oulu, Oulu, Finland. Electronic address: faustobiancari@yahoo.it. 2. Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France. 3. Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 4. Department of Surgery, University of Oulu, Oulu, Finland. 5. Department of Cardiothoracic Surgery, Henri Mondor University Hospital, AP-HP, Paris-Est University, Créteil, France. 6. Hamburg University Heart Center, Hamburg, Germany. 7. Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany. 8. Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy. 9. Department of Anesthesiology, Division of Intensive Care Medicine, Oulu University Hospital, Medical Research Center Oulu, Oulu University, Oulu, Finland. 10. Heart Center, Turku University Hospital and Department of Surgery, University of Turku, Turku, Finland. 11. Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France.
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.
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.
Authors: Anne Willers; Justyna Swol; Hergen Buscher; Zoe McQuilten; Sander M J van Kuijk; Hugo Ten Cate; Peter T Rycus; Stephen McKellar; Roberto Lorusso; Joseph E Tonna Journal: Crit Care Med Date: 2022-02-03 Impact factor: 9.296
Authors: Priya R Menon; Anna Flo Forner; Mateo Marin-Cuartas; Sven Lehmann; Diyar Saeed; André Ginther; Michael A Borger; Jörg Ender Journal: Interact Cardiovasc Thorac Surg Date: 2021-05-10
Authors: Fausto Biancari; Antonio Fiore; Kristján Jónsson; Giuseppe Gatti; Svante Zipfel; Vito G Ruggieri; Andrea Perrotti; Karl Bounader; Antonio Loforte; Andrea Lechiancole; Diyar Saeed; Artur Lichtenberg; Marek Pol; Cristiano Spadaccio; Matteo Pettinari; Krister Mogianos; Khalid Alkhamees; Giovanni Mariscalco; Zein El Dean; Nicla Settembre; Henryk Welp; Angelo M Dell'Aquila; Thomas Fux; Tatu Juvonen; Magnus Dalén Journal: J Clin Med Date: 2019-12-15 Impact factor: 4.241