Extracorporeal Membrane Oxygenation Support in Postcardiotomy Elderly Patients: The Mayo Clinic Experience

Saxena, Pankaj; Neal, James R.; Joyce, Lyle D.; Greason, Kevin L.; Schaff, Hartzell V.; Guru, Pramod; Shi, William Y.; Burkhart, Harold M.; Li, Zhuo; Oliver, William C.; Pike, Roxann B.; Haile, Dawit T.; Schears, Gregory J.

doi:10.1016/j.athoracsur.2014.11.075

Cited by 71 publications

(70 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although there was not a significant survival advantage, this approach is supported by previous experiences showing that delayed ECLS implantation in PCS patients is associated with poor survival 14,15. In our experience, only one patient was operated on for an acute type A aortic dissection and he eventually survived to hospital discharge.…”

supporting

confidence: 68%

“…24,25 In the present analysis, half of the study population showed signs of satisfactory myocardial recovery allowing for ECLS weaning but only 39% survived to hospital discharge. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] In addition, a recent metaanalysis found that the pooled hospital survival after postcardiotomy ECLS was 36% (95% CI 31.5-40.8). [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] In addition, a recent metaanalysis found that the pooled hospital survival after postcardiotomy ECLS was 36% (95% CI 31.5-40.8).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Outcomes after extracorporeal life support for postcardiotomy cardiogenic shock

et al. 2019

View full text Add to dashboard Cite

Background and Aim of the Study Extracorporeal life support (ECLS) may be necessary in refractory postcardiotomy cardiogenic shock (PCS) unresponsive to optimal medical treatment. We sought to analyze the results and temporal outcomes of ECLS for PCS. Methods We performed an observational analysis of our prospective database. In order to analyze the temporal trends of ECLS for PCS, patients were divided into two groups according to the period of ECLS implantation: Group I from January 2007‐June 2012, Group II from July 2012‐December 2017. The primary endpoint was survival to hospital discharge. Results During the study period, 90 patients required ECLS for PCS (Group I n = 29, 32%; Group II n = 61, 68%). Mean age was 57.5 ± 15.0 years with 62% of males. Preoperative characteristics were comparable over the two periods. A high proportion of patients were in NYHA class III/IV (61%) or cardiogenic shock (22%). Group II showed a significantly higher proportion of miscellaneous cardiac surgery operations (23 vs 3%, P = 0.031). Crossclamp and cardiopulmonary bypass times were significantly shorter in Group II (85.4 vs 114.2 min, P = 0.023 and 135.2 vs 184.2 min, P = 0.022, respectively). The complication rate during ECLS support was comparable between both groups. Successful weaning from ECLS could be accomplished in 45 (50%) patients (Group I = 52% vs Group II = 49%, P = 0.822) after a mean support of 6.4 days. Thirty‐five (39%) patients survived to hospital discharge (Group I = 41% vs Group II = 38%, P = 0.738). Conclusions Outcomes following ECLS remained stable over an 11‐year period. ECLS may be limited in patients with severe preoperative cardiac dysfunction. Our data suggest that these patients may be better served with less invasive, percutaneous procedures.

show abstract

supporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Outcomes after extracorporeal life support for postcardiotomy cardiogenic shock

et al. 2019

View full text Add to dashboard Cite

show abstract

“…The Mayo Clinic group of Saxena and colleagues [3] reported a weaning rate (53.3%) and in-hospital mortality rate (75.6%) in patients 70 years or older. They detailed the intraoperative complications resulting in the need for ECMO.…”

Section: Invited Commentarymentioning

confidence: 98%

“…(3) The ECMO support has a limited time frame, but it is not clear how long ECMO should be continued after cardiac surgery. Although lactate monitory holds promise to predict successful weaning [3,4] and continuous hemodynamic transesophageal echocardiography appears valuable [5], more information is necessary. (4) Elderly ECMO patients are difficult to wean, requiring timely and definitive decisions regarding permanent assist devices or end-of-life care.…”

Section: Invited Commentarymentioning

confidence: 99%

Invited Commentary

Bando

2015

The Annals of Thoracic Surgery

View full text Add to dashboard Cite

“…The survival during this interval compared well with the previous results and Extracorporeal Life Support Organization (ELSO) reports. 4,5 The percentage of complications and the number of patients requiring CPR were less in the survivors' group, indicating that early referral and prevention of ECMO complications are equally important. These two elements could be the key to our success in the management of these patients.…”

mentioning

confidence: 93%