Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation in Patients Aged 70 Years or Older

Forskningsoutput: TidskriftsbidragÖversiktsartikel

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.

Detaljer

Författare
  • Fausto Biancari
  • Diyar Saeed
  • Antonio Fiore
  • Magnus Dalén
  • Vito G. Ruggieri
  • Kristján Jónsson
  • Giuseppe Gatti
  • Svante Zipfel
  • Angelo M. Dell'Aquila
  • Sidney Chocron
  • Karl Bounader
  • Gilles Amr
  • Nicla Settembre
  • Kristiina Pälve
  • Antonio Loforte
  • Marco Gabrielli
  • Ugolino Livi
  • Andrea Lechiancole
  • Marek Pol
  • Ivan Netuka
  • Cristiano Spadaccio
  • Matteo Pettinari
  • Dieter De Keyzer
  • Daniel Reichart
  • Khalid Alkhamees
  • Artur Lichtenberg
  • Thomas Fux
  • Zein El Dean
  • Mariafrancesca Fiorentino
  • Giovanni Mariscalco
  • Anders Jeppsson
  • Henryk Welp
  • Andrea Perrotti
Enheter & grupper
Externa organisationer
  • Turku University Hospital
  • University of Oulu
  • Universitätsklinikum Düsseldorf
  • Henri Mondor Hospital
  • Karolinska University Hospital
  • Hopital Robert Debre CHU de Reims
  • Sahlgrenska University Hospital
  • Ospedali riuniti di Trieste
  • University Medical Center Hamburg-Eppendorf
  • Universitätsklinikum Münster
  • University Hospital Jean Minjoz
  • Pontchaillou University Hospital
  • University Hospital of Nancy
  • St. Orsola-Malpighi University Hospital
  • University Hospital of Udine
  • Institute for Clinical and Experimental Medicine
  • Ziekenhuis Oost-Limburg
  • Glenfield Hospital
Forskningsområden

Ämnesklassifikation (UKÄ) – OBLIGATORISK

  • Kardiologi
Originalspråkengelska
Sidor (från-till)1257-1264
Antal sidor8
TidskriftAnnals of Thoracic Surgery
Volym108
Utgåva nummer4
StatusPublished - 2019
PublikationskategoriForskning
Peer review utfördJa