Fausto Biancari1, Magnus Dalén2, Antonio Fiore3, Vito G Ruggieri4, Diyar Saeed5, Kristján Jónsson6, Giuseppe Gatti7, Svante Zipfel8, Andrea Perrotti9, Karl Bounader10, Antonio Loforte11, Andrea Lechiancole12, Marek Pol13, Cristiano Spadaccio14, Matteo Pettinari15, Sigurdur Ragnarsson16, Khalid Alkhamees17, Giovanni Mariscalco18, Henryk Welp19. 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 Molecular Medicine and Surgery, Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 3. Department of Cardiothoracic Surgery, Henri Mondor University Hospital, AP-HP, Paris-Est University, Créteil, France. 4. Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, France. 5. Cardiovascular Surgery, University Hospital of Duesseldorf, Dusseldorf, Germany. 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 Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France. 10. Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France. 11. Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy. 12. Cardiothoracic Department, University Hospital of Udine, Udine, Italy. 13. Institute of Clinical and Experimental Medicine, Prague, Czech Republic. 14. Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom. 15. Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium. 16. Department of Cardiothoracic Surgery, University of Lund, Lund, Sweden. 17. Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia. 18. Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, United Kingdom. 19. Department of Cardiothoracic Surgery, Münster University Hospital, Münster, Germany.
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.
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.
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