Björk Björnsdóttir1, Fausto Biancari2, Magnus Dalén3, Angelo M Dell'Aquila4, Kristján Jónsson5, Antonio Fiore6, Giovanni Mariscalco7, Zein El-Dean7, Giuseppe Gatti8, Svante Zipfel9, Andrea Perrotti10, Karl Bounader11, Khalid Alkhamees12, Antonio Loforte13, Andrea Lechiancole14, Marek Pol15, Cristiano Spadaccio16, Matteo Pettinari17, Dieter De Keyzer17, Henryk Welp4, Giuseppe Speziale18, Artur Lichtenberg19, Vito G Ruggieri20, Hakeem Yusuf21, Sigurdur Ragnarsson22. 1. Department of Cardiothoracic Surgery, Skane University Hospital and Lund University, Lund, Sweden. 2. Clinica Montevergine, GVM Care & Research, Mercogliano, Italy; Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland. 3. Department of Molecular Medicine and Surgery, Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 4. Department of Cardiothoracic Surgery, Münster University Hospital, Münster, Germany. 5. Department of Cardiac Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden. 6. Department of Cardiothoracic Surgery, Henri Mondor University Hospital, AP-HP, Paris-Est University, Créteil, France. 7. Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom. 8. Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy. 9. Hamburg University Heart Center, Hamburg, 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. Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia. 13. Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy. 14. Cardiothoracic Department, University Hospital of Udine, Udine, Italy. 15. Institute of Clinical and Experimental Medicine, Prague, Czech Republic. 16. Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom; Department of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA. 17. Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium. 18. Division of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy. 19. Department of Cardiovascular Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany. 20. Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, France. 21. Department of Cardiac Anesthesia and Intensive Care, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom. 22. Department of Cardiothoracic Surgery, Skane University Hospital and Lund University, Lund, Sweden. Electronic address: sigurdur.ragnarsson@med.lu.se.
Abstract
OBJECTIVES: To compare the outcomes of patients with postcardiotomy shock treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) only compared with VA-ECMO and intra-aortic balloon pump (IABP). DESIGN: A retrospective multicenter registry study. SETTING: At 19 cardiac surgery units. PARTICIPANTS: A total of 615 adult patients who required VA-ECMO from 2010 to 2018. The patients were divided into 2 groups depending on whether they received VA-ECMO only (ECMO only group) or VA-ECMO plus IABP (ECMO-IABP group). MEASUREMENTS AND MAIN RESULTS: The overall series mean age was 63 ± 13 years, and 33% were female. The ECMO-only group included 499 patients, and 116 patients were in the ECMO-IABP group. Urgent and/or emergent procedures were more common in the ECMO-only group. Central cannulation was performed in 47% (n = 54) in the ECMO-IABP group compared to 27% (n = 132) in the ECMO-only group. In the ECMO-IABP group, 58% (n = 67) were successfully weaned from ECMO, compared to 46% (n = 231) in the ECMO-only group (p = 0.026). However, in-hospital mortality was 63% in the ECMO-IABP group compared to 65% in the ECMO-only group (p = 0.66). Among 114 propensity score-matched pairs, ECMO-IABP group had comparable weaning rates (57% v 53%, p = 0.51) and in-hospital mortality (64% v 58%, p = 0.78). CONCLUSIONS: This multicenter study showed that adjunctive IABP did not translate into better outcomes in patients treated with VA-ECMO for postcardiotomy shock.
OBJECTIVES: To compare the outcomes of patients with postcardiotomy shock treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) only compared with VA-ECMO and intra-aortic balloon pump (IABP). DESIGN: A retrospective multicenter registry study. SETTING: At 19 cardiac surgery units. PARTICIPANTS: A total of 615 adult patients who required VA-ECMO from 2010 to 2018. The patients were divided into 2 groups depending on whether they received VA-ECMO only (ECMO only group) or VA-ECMO plus IABP (ECMO-IABP group). MEASUREMENTS AND MAIN RESULTS: The overall series mean age was 63 ± 13 years, and 33% were female. The ECMO-only group included 499 patients, and 116 patients were in the ECMO-IABP group. Urgent and/or emergent procedures were more common in the ECMO-only group. Central cannulation was performed in 47% (n = 54) in the ECMO-IABP group compared to 27% (n = 132) in the ECMO-only group. In the ECMO-IABP group, 58% (n = 67) were successfully weaned from ECMO, compared to 46% (n = 231) in the ECMO-only group (p = 0.026). However, in-hospital mortality was 63% in the ECMO-IABP group compared to 65% in the ECMO-only group (p = 0.66). Among 114 propensity score-matched pairs, ECMO-IABP group had comparable weaning rates (57% v 53%, p = 0.51) and in-hospital mortality (64% v 58%, p = 0.78). CONCLUSIONS: This multicenter study showed that adjunctive IABP did not translate into better outcomes in patients treated with VA-ECMO for postcardiotomy shock.