Fausto Biancari1, Diyar Saeed2, Antonio Fiore3, Magnus Dalén4, Vito G Ruggieri5, Kristján Jónsson6, Giuseppe Gatti7, Svante Zipfel8, Angelo M Dell'Aquila9, Sidney Chocron10, Karl Bounader11, Gilles Amr5, Nicla Settembre12, Kristiina Pälve13, Antonio Loforte14, Marco Gabrielli7, Ugolino Livi15, Andrea Lechiancole15, Marek Pol16, Ivan Netuka16, Cristiano Spadaccio17, Matteo Pettinari18, Dieter De Keyzer18, Daniel Reichart8, Sigurdur Ragnarsson19, Khalid Alkhamees20, Artur Lichtenberg2, Thomas Fux4, Zein El Dean21, Mariafrancesca Fiorentino14, Giovanni Mariscalco21, Anders Jeppsson6, Henryk Welp9, Andrea Perrotti10. 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 Cardiovascular Surgery, University Hospital of Dusseldorf, Dusseldorf, Germany. 3. Department of Cardiothoracic Surgery, Henri Mondor University Hospital, AP-HP, Paris-Est University, Créteil, France. 4. Department of Molecular Medicine and Surgery, and Department of Cardiac Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden. 5. Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, France. 6. Department of Cardiac Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden. 7. Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy. 8. Hamburg University Heart Center, Hamburg, Germany. 9. Department of Cardiothoracic Surgery, Münster University Hospital, Münster, Germany. 10. Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France. 11. Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France. 12. Department of Vascular Surgery, Nancy University Hospital, University of Lorraine, Nancy, France. 13. Heart Center, Turku University Hospital and Department of Surgery, University of Turku, Turku, Finland. 14. Department of Cardiothoracic, Transplantation, and Vascular Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy. 15. Cardiothoracic Department, University Hospital of Udine, Udine, Italy. 16. Institute of Clinical and Experimental Medicine, Prague, Czech Republic. 17. Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom. 18. Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium. 19. Department of Cardiothoracic Surgery, University of Lund, Lund, Sweden. 20. Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia. 21. Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, United Kingdom.
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 = .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.
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 = .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.
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: Mariusz Kowalewski; Kamil Zieliński; Daniel Brodie; Graeme MacLaren; Glenn Whitman; Giuseppe M Raffa; Udo Boeken; Kiran Shekar; Yih-Sharng Chen; Christian Bermudez; David D'Alessandro; Xiaotong Hou; Jonathan Haft; Jan Belohlavek; Inga Dziembowska; Piotr Suwalski; Peta Alexander; Ryan P Barbaro; Mario Gaudino; Michele Di Mauro; Jos Maessen; Roberto Lorusso Journal: Crit Care Med Date: 2021-07-01 Impact factor: 9.296