Giovanni Mariscalco1, Antonio Salsano2, Antonio Fiore3, Magnus Dalén4, Vito G Ruggieri5, Diyar Saeed6, Kristján Jónsson7, Giuseppe Gatti8, Svante Zipfel9, Angelo M Dell'Aquila10, Andrea Perrotti11, Antonio Loforte12, Ugolino Livi13, Marek Pol14, Cristiano Spadaccio15, Matteo Pettinari16, Sigurdur Ragnarsson17, Khalid Alkhamees18, Zein El-Dean19, Karl Bounader20, Fausto Biancari21. 1. Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, United Kingdom. Electronic address: giovannimariscalco@yahoo.it. 2. Division of Cardiac Surgery, Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy. 3. Department of Cardiothoracic Surgery, Henri Mondor University Hospital, AP-HP, Paris-Est University, Créteil, France. 4. Department of Molecular Medicine and Surgery, Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 5. Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, France. 6. Cardiovascular Surgery, University Hospital of Dusseldorf, Dusseldorf, Germany. 7. Department of Cardiac Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden. 8. Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy. 9. Hamburg University Heart Center, Hamburg, Germany. 10. Department of Cardiothoracic Surgery, Münster University Hospital, Münster, Germany. 11. Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France. 12. Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy. 13. Cardiothoracic Department, University Hospital of Udine, Udine, Italy. 14. Institute of Clinical and Experimental Medicine, Prague, Czech Republic. 15. Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom. 16. Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburgl, Genk, Belgium. 17. Department of Cardiothoracic Surgery, University of Lund, Lund, Sweden. 18. Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia. 19. Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, United Kingdom. 20. Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France. 21. Heart Center, Turku University Hospital and University of Turku, Turku, Finland; Department of Surgery, University of Oulu, Oulu, Finland.
Abstract
BACKGROUND: We hypothesized that cannulation strategy in venoarterial extracorporeal membrane oxygenation (VA-ECMO) could play a crucial role in the perioperative survival of patients affected by postcardiotomy shock. METHODS: Between January 2010 and March 2018, 781 adult patients receiving VA-ECMO for postcardiotomy shock at 19 cardiac surgical centers were retrieved from the Postcardiotomy Veno-arterial Extracorporeal Membrane Oxygenation study registry. A parallel systematic review and meta-analysis (PubMed/MEDLINE, Embase, and Cochrane Library) through December 2018 was also accomplished. RESULTS: Central and peripheral VA-ECMO cannulation were performed in 245 (31.4%) and 536 (68.6%) patients, respectively. Main indications for the institution VA-ECMO were failure to wean from cardiopulmonary bypass (38%) and heart failure following cardiopulmonary bypass weaning (48%). The doubly robust analysis after inverse probability treatment weighting by propensity score demonstrated that central VA-ECMO was associated with greater hospital mortality (odds ratio 1.54; 95% confidence interval, 1.09-2.18), reoperation for bleeding/tamponade (odds ratio, 1.96; 95% confidence interval, 1.37-2.81), and transfusion of more than 9 RBC units (odds ratio, 2.42; 95% confidence interval, 1.59-3.67). The systematic review provided a total of 2491 individuals with postcardiotomy shock treated with VA-ECMO. Pooled prevalence of in-hospital/30-day mortality in overall patient population was 66.6% (95% confidence interval, 64.7-68.4%), and pooled unadjusted risk ratio analysis confirmed that patients undergoing peripheral VA-ECMO had a lower in-hospital/30-day mortality than patients undergoing central cannulation (risk ratio, 0.92; 95% confidence interval, 0.87-0.98). Adjustments for important confounders did not alter our results. CONCLUSIONS: In patients with postcardiotomy shock treated with VA-ECMO, central cannulation was associated with greater in-hospital mortality than peripheral cannulation.
BACKGROUND: We hypothesized that cannulation strategy in venoarterial extracorporeal membrane oxygenation (VA-ECMO) could play a crucial role in the perioperative survival of patients affected by postcardiotomy shock. METHODS: Between January 2010 and March 2018, 781 adult patients receiving VA-ECMO for postcardiotomy shock at 19 cardiac surgical centers were retrieved from the Postcardiotomy Veno-arterial Extracorporeal Membrane Oxygenation study registry. A parallel systematic review and meta-analysis (PubMed/MEDLINE, Embase, and Cochrane Library) through December 2018 was also accomplished. RESULTS: Central and peripheral VA-ECMO cannulation were performed in 245 (31.4%) and 536 (68.6%) patients, respectively. Main indications for the institution VA-ECMO were failure to wean from cardiopulmonary bypass (38%) and heart failure following cardiopulmonary bypass weaning (48%). The doubly robust analysis after inverse probability treatment weighting by propensity score demonstrated that central VA-ECMO was associated with greater hospital mortality (odds ratio 1.54; 95% confidence interval, 1.09-2.18), reoperation for bleeding/tamponade (odds ratio, 1.96; 95% confidence interval, 1.37-2.81), and transfusion of more than 9 RBC units (odds ratio, 2.42; 95% confidence interval, 1.59-3.67). The systematic review provided a total of 2491 individuals with postcardiotomy shock treated with VA-ECMO. Pooled prevalence of in-hospital/30-day mortality in overall patient population was 66.6% (95% confidence interval, 64.7-68.4%), and pooled unadjusted risk ratio analysis confirmed that patients undergoing peripheral VA-ECMO had a lower in-hospital/30-day mortality than patients undergoing central cannulation (risk ratio, 0.92; 95% confidence interval, 0.87-0.98). Adjustments for important confounders did not alter our results. CONCLUSIONS: In patients with postcardiotomy shock treated with VA-ECMO, central cannulation was associated with greater in-hospital mortality than peripheral cannulation.
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