Long-term outcomes of patients undergoing extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock

Unosawa, Satoshi; Sezai, Akira; Hata, Mitsumasa; Nakata, Kohei; Yoshitake, Isamu; Wakui, Shinji; Kimura, Haruka; Takahashi, Kana; Hata, Hiroyuki; Shiono, Motomi

doi:10.1007/s00595-012-0322-6

Cited by 57 publications

(47 citation statements)

References 17 publications

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“…authors concluded that ECLS implantation in acute aortic dissection is associated with extremely high mortality irrespective of when the intervention is performed. The mean duration of temporary mechanical support in our series was quite longer than that reported in previous studies [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Our analysis did not find a survival advantage in the most recent cohort.…”

contrasting

confidence: 64%

“…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%

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Outcomes after extracorporeal life support for postcardiotomy cardiogenic shock

et al. 2019

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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.

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contrasting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Outcomes after extracorporeal life support for postcardiotomy cardiogenic shock

et al. 2019

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“…The VA ECMO line tubing can be tunneled through the skin to allow chest closure. This maybe significant in that “incomplete sternal closure” has been reported as an independent predictor of mortality, as identified in a study by Unosawa et al [27]. However, line change over to other sites, with axillary arterial, femoral arterial and femoral venous cannulation sites have previously been reported [5, 13].…”

Section: Discussionmentioning

confidence: 94%

“…One study [5] advocated use of sodium bicarbonate infusion at an early stage to reduce metabolic acidosis and the organ damage that might ensue. Diabetes mellitus [5, 23], obesity [5, 23], gastrointestinal complications whilst on ECMO, high EuroSCORE (>20) and protracted ECMO support (>48 h) were also amongst the commonly reported APIs [17, 21, 26, 27]. It must however be acknowledged that prolonged ECMO support might reflect the complexity of the original operation and the patient’s poor clinical.…”

Section: Resultsmentioning

confidence: 99%

Extra-corporeal membrane oxygenation for refractory cardiogenic shock after adult cardiac surgery: a systematic review and meta-analysis

Khorsandi

Dougherty

Bouamra

et al. 2017

J Cardiothorac Surg

163

120

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BackgroundPostcardiotomy cardiogenic shock (PCCS) refractory to inotropic support and intra-aortic balloon pump (IABP) occurs rarely but is almost universally fatal without mechanical circulatory support. In this systematic review and meta-analysis we looked at the evidence behind the use of veno-arterial extra-corporeal membrane oxygenation (VA ECMO) in refractory PCCS from a patient survival rate and determinants of outcome viewpoint.MethodsA systematic review was performed in January 2017 using PubMed (with no defined time period) using the keywords “postcardiotomy”, “cardiogenic shock”, “extracorporeal membrane oxygenation” and “cardiac surgery”. We excluded papers pertaining to ECMO following paediatric cardiac surgery, medical causes of cardiogenic shock, as well as case reports, review articles, expert opinions, and letters to the editor. Once the studies were collated, a meta-analysis was performed on the proportion of survivors in those papers that met the inclusion criteria. Meta-regression was performed for the most commonly reported adverse prognostic indicators (API).ResultsWe identified 24 studies and a cumulative pool of 1926 patients from 1992 to 2016. We tabulated the demographic data, including the strengths and weaknesses for each of the studies, outcomes of VA ECMO for refractory PCCS, complications, and APIs. All the studies were retrospective cohort studies. Meta-analysis of the moderately heterogeneous data (95% CI 0.29 to 0.34, p < 0.01, I 2 = 60%) revealed overall survival rate to hospital discharge of 30.8%. Some of the commonly reported APIs were advanced age (>70 years, 95% CI −0.057 to 0.001, P = 0.058), and long ECMO support (95% CI −0.068 to 0.166, P = 0.412). Postoperative renal failure, high EuroSCORE (>20%), diabetes mellitus, obesity, rising lactate whilst on ECMO, gastrointestinal complications had also been reported.ConclusionHaemodynamic support with VA ECMO provides a survival benefit with reasonable intermediate and long-term outcomes. Many studies had reported advanced age, renal failure and prolonged VA ECMO support as the most likely APIs for VA ECMO in PCCS. EuroSCORE can be utilized to anticipate the need for prophylactic perioperative VA ECMO in the high-risk category. APIs can be used to aid decision-making regarding both the institution and weaning of ECMO for refractory PCCS.

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“…(4-6) Initial successful applications of ECMO were almost exclusively among term neonates with pulmonary hypertension; however, ECMO has increasingly been used to support older children and adults with both cardiorespiratory failure and cardiac arrest. (6-8) Practice in the United Kingdom has focused on regional ECMO referral centers while development in the US has not been centralized. (7, 9)…”

Section: Introductionmentioning

confidence: 99%

Pediatric and Neonatal Extracorporeal Membrane Oxygenation

Freeman

Bennett

Casper

et al. 2014

Critical Care Medicine

155

104

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Objective Extracorporeal membrane oxygenation, an accepted rescue therapy for refractory cardiopulmonary failure, requires a complex multidisciplinary approach and advanced technology. Little is known about the relationship between a center’s case volume and patient mortality. The purpose of this study was to analyze the relationship between hospital extracorporeal membrane oxygenation annual volume and in-hospital mortality and assess if a minimum hospital volume could be recommended. Design Retrospective cohort study Setting A retrospective cohort admitted to children’s hospitals in the Pediatric Health Information System database from 2004-2011 supported with extracorporeal membrane oxygenation was identified. Indications were assigned based on patient age (neonatal vs. pediatric), diagnosis, and procedure codes. Average hospital annual volume was defined as 0-19, 20-49, or ≥50 cases per year. Maximum likelihood estimates were used to assess minimum annual case volume. Patients A total of 7322 pediatric patients aged 0-18 years of age were supported with extracorporeal membrane oxygenation and had an indication assigned. Interventions None Measurements and Main Results Average hospital extracorporeal membrane oxygenation volume ranged from 1-58 cases per year. Overall mortality was 43% but differed significantly by indication. After adjustment for case-mix, complexity of cardiac surgery, and year of treatment, patients treated at medium (OR 0.86, 95% CI 0.75-0.98) and high (OR 0.75, 95% CI 0.63-0.89) volume centers had significantly lower odds of death compared to those treated at low volume centers. The minimum annual case load most significantly associated with lower mortality was 22 (95% CI 22-28). Conclusion Pediatric centers with low extracorporeal membrane oxygenation average annual case volume had significantly higher mortality and a minimum volume of 22 cases per year was associated with improved mortality. We suggest this threshold be evaluated by additional study.

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Long-term outcomes of patients undergoing extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock

Abstract: Although postcardiotomy cardiogenic shock requiring ECMO support is associated with high morbidity and mortality, the long-term survival rate is acceptable.

Cited by 57 publications

References 17 publications

Outcomes after extracorporeal life support for postcardiotomy cardiogenic shock

Outcomes after extracorporeal life support for postcardiotomy cardiogenic shock

Extra-corporeal membrane oxygenation for refractory cardiogenic shock after adult cardiac surgery: a systematic review and meta-analysis

Pediatric and Neonatal Extracorporeal Membrane Oxygenation

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