Patient and Management Variables Associated With Survival After Postcardiotomy Extracorporeal Membrane Oxygenation in Adults: The PELS-1 Multicenter Cohort Study
Issued Date
2023-07-18
Resource Type
eISSN
20479980
Scopus ID
2-s2.0-85165220059
Pubmed ID
37421269
Journal Title
Journal of the American Heart Association
Volume
12
Issue
14
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of the American Heart Association Vol.12 No.14 (2023)
Suggested Citation
Mariani S., Heuts S., Van Bussel B.C.T., Di Mauro M., Wiedemann D., 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., Sacha Matteucci M.L., 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., Shekar K., Whitman G.J.R., Lorusso R. Patient and Management Variables Associated With Survival After Postcardiotomy Extracorporeal Membrane Oxygenation in Adults: The PELS-1 Multicenter Cohort Study. Journal of the American Heart Association Vol.12 No.14 (2023). doi:10.1161/JAHA.123.029609 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/91477
Title
Patient and Management Variables Associated With Survival After Postcardiotomy Extracorporeal Membrane Oxygenation in Adults: The PELS-1 Multicenter Cohort Study
Author(s)
Mariani S.
Heuts S.
Van Bussel B.C.T.
Di Mauro M.
Wiedemann D.
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.
Sacha Matteucci M.L.
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.
Shekar K.
Whitman G.J.R.
Lorusso R.
Heuts S.
Van Bussel B.C.T.
Di Mauro M.
Wiedemann D.
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.
Sacha Matteucci M.L.
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.
Shekar K.
Whitman G.J.R.
Lorusso R.
Author's Affiliation
Korea University Anam Hospital
Siriraj Hospital
Departement Cardiovasculaire Wetenschappen
Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione
National University Health System
Heinrich-Heine-Universität Düsseldorf Medizinische Fakultät
Fundación Cardiovascular de Colombia
Beijing Anzhen Hospital, Capital Medical University
CARIM School for Cardiovascular Disease
Ziekenhuis Oost-Limburg
Vilniaus Universitetas
Erasmus MC
Università Politecnica delle Marche
UNSW Sydney
Hôpital Pontchaillou
St. Vincent's Hospital Sydney
Humanitas Research Hospital
IRCCS Azienda Ospedaliero-Universitaria di Bologna
Hôpital Henri Mondor
Herzzentrum Leipzig
Klinikum der Universität Regensburg und Medizinische Fakultät
Clínica Las Condes
Charles University
Indiana University Health
Asst Grande Ospedale Metropolitano Niguarda
Policlinico Universitario, Udine
University of Maryland, Baltimore (UMB)
Università degli Studi di Milano-Bicocca
Università degli Studi di Torino
Medizinische Universität Wien
The Alfred
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
Siriraj Hospital
Departement Cardiovasculaire Wetenschappen
Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione
National University Health System
Heinrich-Heine-Universität Düsseldorf Medizinische Fakultät
Fundación Cardiovascular de Colombia
Beijing Anzhen Hospital, Capital Medical University
CARIM School for Cardiovascular Disease
Ziekenhuis Oost-Limburg
Vilniaus Universitetas
Erasmus MC
Università Politecnica delle Marche
UNSW Sydney
Hôpital Pontchaillou
St. Vincent's Hospital Sydney
Humanitas Research Hospital
IRCCS Azienda Ospedaliero-Universitaria di Bologna
Hôpital Henri Mondor
Herzzentrum Leipzig
Klinikum der Universität Regensburg und Medizinische Fakultät
Clínica Las Condes
Charles University
Indiana University Health
Asst Grande Ospedale Metropolitano Niguarda
Policlinico Universitario, Udine
University of Maryland, Baltimore (UMB)
Università degli Studi di Milano-Bicocca
Università degli Studi di Torino
Medizinische Universität Wien
The Alfred
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
Other Contributor(s)
Abstract
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been increasingly used for postcardiotomy cardiogenic shock, but without a concomitant reduction in observed in-hospital mortality. Long-term outcomes are unknown. This study describes patients’ characteristics, in-hospital outcome, and 10-year survival after postcardiotomy ECMO. Variables associated with in-hospital and postdischarge mortality are investigated and reported. METHODS AND RESULTS: The retrospective international multicenter observational PELS-1 (Postcardiotomy Extracorporeal Life Support) study includes data on adults requiring ECMO for postcardiotomy cardiogenic shock between 2000 and 2020 from 34 centers. Variables associated with mortality were estimated preoperatively, intraoperatively, during ECMO, and after the occurrence of any complications, and then analyzed at different time points during a patient’s clinical course, through mixed Cox proportional hazards models containing fixed and random effects. Follow-up was established by institutional chart review or contacting patients. This analysis included 2058 patients (59% were men; median [interquartile range] age, 65.0 [55.0–72.0] years). In-hospital mortality was 60.5%. Independent variables associated with in-hospital mortality were age (hazard ratio [HR], 1.02 [95% CI, 1.01–1.02]) and preoperative cardiac arrest (HR, 1.41 [95% CI, 1.15–1.73]). In the subgroup of hospital survivors, the overall 1-, 2-, 5-, and 10-year survival rates were 89.5% (95% CI, 87.0%–92.0%), 85.4% (95% CI, 82.5%–88.3%), 76.4% (95% CI, 72.5%–80.5%), and 65.9% (95% CI, 60.3%–72.0%), respectively. Variables associated with postdischarge mortality included older age, atrial fibrillation, emergency surgery, type of surgery, postoperative acute kidney injury, and postoperative septic shock. CONCLUSIONS: In adults, in-hospital mortality after postcardiotomy ECMO remains high; however, two-thirds of those who are discharged from hospital survive up to 10 years. Patient selection, intraoperative decisions, and ECMO management remain key variables associated with survival in this cohort. REGISTRATION: URL: Https://www.clini caltr ials.gov; Unique identifier: NCT03857217.