On-Support and Postweaning Mortality in Postcardiotomy Extracorporeal Membrane Oxygenation
Issued Date
2023-01-01
Resource Type
ISSN
00034975
eISSN
15526259
Scopus ID
2-s2.0-85171754164
Pubmed ID
37414384
Journal Title
Annals of Thoracic Surgery
Rights Holder(s)
SCOPUS
Bibliographic Citation
Annals of Thoracic Surgery (2023)
Suggested Citation
Mariani S., Schaefer A.K., van Bussel B.C.T., Di Mauro M., Conci L., Szalkiewicz P., De Piero M.E., Heuts S., Ravaux J., van der Horst I.C.C., Saeed D., Pozzi M., Loforte A., Boeken U., Samalavicius R., Bounader K., Hou X., Bunge J.J.H., Buscher H., Salazar L., Meyns B., Herr D., Matteucci S., Sponga S., MacLaren G., Russo C., Formica F., Sakiyalak P., Fiore A., Camboni D., Raffa G.M., Diaz R., Wang I.w., Jung J.S., Belohlavek J., Pellegrino V., Bianchi G., Pettinari M., Barbone A., Garcia J.P., Whitman G., Shekar K., Wiedemann D., Lorusso R., Khalil J., Lehmann S., Obadia J.F., Kalampokas N., Flecher E., Dos Reis Miranda D., Sriranjan K., Mazzeffi M.A., Vedadi N., Di Eusanio M., Sorokin V., Ramanathan K., Costetti A., Schmid C., Castillo R., Mikulenka V., Solinas M. On-Support and Postweaning Mortality in Postcardiotomy Extracorporeal Membrane Oxygenation. Annals of Thoracic Surgery (2023). doi:10.1016/j.athoracsur.2023.05.045 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/90243
Title
On-Support and Postweaning Mortality in Postcardiotomy Extracorporeal Membrane Oxygenation
Author(s)
Mariani S.
Schaefer A.K.
van Bussel B.C.T.
Di Mauro M.
Conci L.
Szalkiewicz P.
De Piero M.E.
Heuts S.
Ravaux J.
van der Horst I.C.C.
Saeed D.
Pozzi M.
Loforte A.
Boeken U.
Samalavicius R.
Bounader K.
Hou X.
Bunge J.J.H.
Buscher H.
Salazar L.
Meyns B.
Herr D.
Matteucci S.
Sponga S.
MacLaren G.
Russo C.
Formica F.
Sakiyalak P.
Fiore A.
Camboni D.
Raffa G.M.
Diaz R.
Wang I.w.
Jung J.S.
Belohlavek J.
Pellegrino V.
Bianchi G.
Pettinari M.
Barbone A.
Garcia J.P.
Whitman G.
Shekar K.
Wiedemann D.
Lorusso R.
Khalil J.
Lehmann S.
Obadia J.F.
Kalampokas N.
Flecher E.
Dos Reis Miranda D.
Sriranjan K.
Mazzeffi M.A.
Vedadi N.
Di Eusanio M.
Sorokin V.
Ramanathan K.
Costetti A.
Schmid C.
Castillo R.
Mikulenka V.
Solinas M.
Schaefer A.K.
van Bussel B.C.T.
Di Mauro M.
Conci L.
Szalkiewicz P.
De Piero M.E.
Heuts S.
Ravaux J.
van der Horst I.C.C.
Saeed D.
Pozzi M.
Loforte A.
Boeken U.
Samalavicius R.
Bounader K.
Hou X.
Bunge J.J.H.
Buscher H.
Salazar L.
Meyns B.
Herr D.
Matteucci S.
Sponga S.
MacLaren G.
Russo C.
Formica F.
Sakiyalak P.
Fiore A.
Camboni D.
Raffa G.M.
Diaz R.
Wang I.w.
Jung J.S.
Belohlavek J.
Pellegrino V.
Bianchi G.
Pettinari M.
Barbone A.
Garcia J.P.
Whitman G.
Shekar K.
Wiedemann D.
Lorusso R.
Khalil J.
Lehmann S.
Obadia J.F.
Kalampokas N.
Flecher E.
Dos Reis Miranda D.
Sriranjan K.
Mazzeffi M.A.
Vedadi N.
Di Eusanio M.
Sorokin V.
Ramanathan K.
Costetti A.
Schmid C.
Castillo R.
Mikulenka V.
Solinas M.
Author's Affiliation
Siriraj Hospital
Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione
National University Health System
Heinrich-Heine-Universität Düsseldorf Medizinische Fakultät
Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona
Fundación Cardiovascular de Colombia
Beijing Anzhen Hospital, Capital Medical University
CARIM School for Cardiovascular Disease
Ziekenhuis Oost-Limburg
Vilniaus Universitetas
Erasmus MC
KU Leuven– University Hospital Leuven
Korea University College of Medicine
Hôpital Pontchaillou
St. Vincent's Hospital Sydney
Heinrich-Heine-Universität Düsseldorf
Humanitas Research Hospital
Indiana University-Purdue University Indianapolis
IRCCS Azienda Ospedaliero-Universitaria di Bologna
Hôpital Henri Mondor
Herzzentrum Leipzig
Klinikum der Universität Regensburg und Medizinische Fakultät
Clínica Las Condes
Charles University
Asst Grande Ospedale Metropolitano Niguarda
Policlinico Universitario, Udine
University of Maryland, Baltimore (UMB)
Azienda Ospedaliera San Gerardo Monza
Università degli Studi di Torino
Medizinische Universität Wien
The Alfred
Maastricht Universitair Medisch Centrum+
Azienda Ospedaliero-Universitaria di Parma
Memorial Healthcare System
The Prince Charles Hospital
The Johns Hopkins Hospital
Ospedale del Cuore Fondazione Toscana “G. Monasterio”
Louis Pradel Cardiologic Hospital
Ospedale del Cuore
Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione
National University Health System
Heinrich-Heine-Universität Düsseldorf Medizinische Fakultät
Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona
Fundación Cardiovascular de Colombia
Beijing Anzhen Hospital, Capital Medical University
CARIM School for Cardiovascular Disease
Ziekenhuis Oost-Limburg
Vilniaus Universitetas
Erasmus MC
KU Leuven– University Hospital Leuven
Korea University College of Medicine
Hôpital Pontchaillou
St. Vincent's Hospital Sydney
Heinrich-Heine-Universität Düsseldorf
Humanitas Research Hospital
Indiana University-Purdue University Indianapolis
IRCCS Azienda Ospedaliero-Universitaria di Bologna
Hôpital Henri Mondor
Herzzentrum Leipzig
Klinikum der Universität Regensburg und Medizinische Fakultät
Clínica Las Condes
Charles University
Asst Grande Ospedale Metropolitano Niguarda
Policlinico Universitario, Udine
University of Maryland, Baltimore (UMB)
Azienda Ospedaliera San Gerardo Monza
Università degli Studi di Torino
Medizinische Universität Wien
The Alfred
Maastricht Universitair Medisch Centrum+
Azienda Ospedaliero-Universitaria di Parma
Memorial Healthcare System
The Prince Charles Hospital
The Johns Hopkins Hospital
Ospedale del Cuore Fondazione Toscana “G. Monasterio”
Louis Pradel Cardiologic Hospital
Ospedale del Cuore
Other Contributor(s)
Abstract
Background: Postcardiotomy venoarterial extracorporeal membrane oxygenation (VA ECMO) is characterized by discrepancies between weaning and survival-to-discharge rates. This study analyzes the differences between postcardiotomy VA ECMO patients who survived, died on ECMO, or died after ECMO weaning. Causes of death and variables associated with mortality at different time points are investigated. Methods: The retrospective, multicenter, observational Postcardiotomy Extracorporeal Life Support Study (PELS) includes adults requiring postcardiotomy VA ECMO between 2000 and 2020. Variables associated with on-ECMO mortality and postweaning mortality were modeled using mixed Cox proportional hazards, including random effects for center and year. Results: In 2058 patients (men, 59%; median age, 65 years; interquartile range [IQR], 55-72 years), weaning rate was 62.7%, and survival to discharge was 39.6%. Patients who died (n = 1244) included 754 on-ECMO deaths (36.6%; median support time, 79 hours; IQR, 24-192 hours), and 476 postweaning deaths (23.1%; median support time, 146 hours; IQR, 96-235.5 hours). Multiorgan (n = 431 of 1158 [37.2%]) and persistent heart failure (n = 423 of 1158 [36.5%]) were the main causes of death, followed by bleeding (n = 56 of 754 [7.4%]) for on-ECMO mortality and sepsis (n = 61 of 401 [15.4%]) for postweaning mortality. On-ECMO death was associated with emergency surgery, preoperative cardiac arrest, cardiogenic shock, right ventricular failure, cardiopulmonary bypass time, and ECMO implantation timing. Diabetes, postoperative bleeding, cardiac arrest, bowel ischemia, acute kidney injury, and septic shock were associated with postweaning mortality. Conclusions: A discrepancy exists between weaning and discharge rate in postcardiotomy ECMO. Deaths occurred during ECMO support in 36.6% of patients, mostly associated with unstable preoperative hemodynamics. Another 23.1% of patients died after weaning in association with severe complications. This underscores the importance of postweaning care for postcardiotomy VA ECMO patients.