The importance of timing in postcardiotomy venoarterial extracorporeal membrane oxygenation: A descriptive multicenter observational study

被引：13

作者：

Mariani, Silvia ^{[1
,2
]}

Wang, I-wen ^{[3
]}

van Bussel, Bas C. T. ^{[2
,4
]}

Heuts, Samuel ^{[1
,2
]}

Wiedemann, Dominik ^{[5
]}

Saeed, Diyar ^{[6
]}

van der Horst, Iwan C. C. ^{[2
,4
]}

Pozzi, Matteo ^{[7
]}

Loforte, Antonio ^{[8
]}

Boeken, Udo ^{[9
]}

Samalavicius, Robertas ^{[10
]}

Bounader, Karl ^{[11
]}

Hou, Xiaotong ^{[12
]}

Bunge, Jeroen J. H. ^{[13
]}

Buscher, Hergen ^{[14
]}

Salazar, Leonardo ^{[15
]}

Meyns, Bart ^{[16
,17
]}

Herr, Daniel ^{[18
,19
]}

Matteucci, Sacha ^{[20
]}

Sponga, Sandro ^{[21
]}

Ramanathan, Kollengode ^{[22
]}

Russo, Claudio ^{[23
]}

Formica, Francesco ^{[24
,25
]}

Sakiyalak, Pranya ^{[26
]}

Fiore, Antonio ^{[27
]}

Camboni, Daniele ^{[28
]}

Raffa, Giuseppe Maria ^{[29
]}

Diaz, Rodrigo ^{[30
]}

Jung, Jae-Seung ^{[31
]}

Belohlavek, Jan ^{[32
,33
]}

Pellegrino, Vin ^{[34
]}

Bianchi, Giacomo ^{[35
]}

Pettinari, Matteo ^{[36
]}

Barbone, Alessandro ^{[37
]}

Garcia, Jose P. ^{[38
]}

Shekar, Kiran ^{[39
]}

Whitman, Glenn ^{[40
]}

Lorusso, Roberto ^{[1
,2
]}

Ravaux, Justine ^{[41
,42
]}

Schaefer, Ann-Kristin ^{[5
]}

Conci, Luca ^{[5
]}

Szalkiewicz, Philipp ^{[5
]}

Khalil, Jawad ^{[6
]}

Lehmann, Sven ^{[6
]}

Obadia, Jean-Francois ^{[7
]}

Kalampokas, Nikolaos ^{[9
]}

Flecher, Erwan ^{[11
]}

Miranda, Dinis Dos Reis ^{[13
,43
]}

Sriranjan, Kogulan ^{[14
]}

Mazzeffi, Michael A. ^{[18
,19
]}

机构：

[1] Maastricht Univ Med Ctr, Cardiothorac Surg Dept, P Debyelaan 25, NL- 6202 AZ Maastricht, Netherlands

[2] Cardiovasc Res Inst Maastricht CARIM, Maastricht, Netherlands

[3] Mem Healthcare Syst, Div Cardiac Surg, Hollywood, FL USA

[4] Maastricht Univ Med Ctr, Dept Intens Care Med, Maastricht, Netherlands

[5] Med Univ Vienna, Dept Cardiac Surg, Vienna, Austria

[6] Leipzig Heart Ctr, Dept Cardiac Surg, Leipzig, Germany

[7] Louis Pradel Cardiol Hosp, Dept Cardiac Surg, Lyon, France

[8] IRCCS Azienda Osped Univ Bologna, Div Cardiac Surg, Bologna, Italy

[9] Heinrich Heine Univ, Fac Med, Dept Cardiac Surg, Dusseldorf, Germany

[10] Vilnius Univ Hosp, Santaros Klin, Ctr Anesthesia Intens Care & Pain Management, Dept Anesthesiol 2, Vilnius, Lithuania

[11] Pontchaillou Univ Hosp, Div Cardiothorac & Vasc Surg, Rennes, France

[12] Beijing Anzhen Hosp, Beijing Inst Heart Lung & Blood Vessel Dis, Ctr Cardiac Intens Care, Beijing, Peoples R China

[13] Erasmus MC, Dept Intens Care Adults, Rotterdam, Netherlands

[14] St Vincents Hosp, Dept Intens Care Med, Ctr Appl Med Res, Darlinghurst, NSW, Australia

[15] Fdn Cardiovasc Colombia, Dept Cardiol, Bucaramanga, Colombia

[16] Univ Leuven, Dept Cardiac Surg, Univ Hosp Leuven, Leuven, Belgium

[17] Univ Leuven, Dept Cardiovasc Sci, Leuven, Belgium

[18] Univ Maryland, Dept Med, Baltimore, MD 21201 USA

[19] Univ Maryland, Dept Surg, Baltimore, MD 21201 USA

[20] Univ Politecn Marche, SOD Cardiochirurg Osped Riuniti Umberto I Lancisi, Ancona, Italy

[21] Univ Hosp Udine, Cardiothorac Dept, Div Cardiac Surg, Udine, Italy

[22] Natl Univ Heart Ctr, Natl Univ Hosp, Cardiothorac Intens Care Unit, Singapore, Singapore

[23] Osped Niguarda Ca Granda, Cardiac Surg Unit, Cardiac Thorac & Vasc Dept, Milan, Italy

[24] Univ Milano Bicocca, San Gerardo Hosp, Dept Med & Surg, Cardiac Surg Clin, Monza, Italy

[25] Univ Parma, Univ Hosp Parma, Dept Med & Surg, Cardiac Surg Unit, Parma, Italy

[26] Mahidol Univ, Fac Med, Dept Surg, Div Cardiovasc Thorac Surg,Siriraj Hosp, Bangkok, Thailand

[27] Univ Hosp Henri Mondor, Dept Cardiothorac Surg, Paris, France

[28] Univ Med Ctr Regensburg, Dept Cardiothorac Surg, Regensburg, Germany

[29] Ist Mediterraneo Trapianti & Terapie Alta Special, Dept Treatment Study Cardiothorac Dis & Cardiotho, Palermo, Italy

[30] Clin Las Condes, ECMO Unit, Dept Anestesia, Santiago, Chile

[31] Korea Univ, Anam Hosp, Dept Thorac & Cardiovasc Surg, Seoul, South Korea

[32] Charles Univ Prague, Gen Teaching Hosp, Dept Internal Med Cardiovasc Med 2, Prague, Czech Republic

[33] Charles Univ Prague, Fac Med 1, Prague, Czech Republic

[34] Alfred Hosp, Intens Care Unit, Melbourne, Vic, Australia

[35] Osped Cuore, Fdn Toscana G Monasterio, Massa, Italy

[36] Ziekenhuis Oost Limburg, Dept Cardiovasc Surg, Genk, Belgium

[37] IRCCS, Humanitas Res Hosp, Cardiac Surg Unit, Rozzano, Italy

[38] Indiana Univ, Methodist Hosp, IU Hlth Adv Heart & Lung Care, Indianapolis, IN USA

[39] Prince Charles Hosp, Adult Intens Care Serv, Brisbane, Qld, Australia

[40] Johns Hopkins Univ Hosp, Cardiac Intens Care Unit, Baltimore, MD USA

[41] Cardiothorac Surg Dept, Maastricht, Netherlands

[42] Cardiovasc Res Inst Maastricht, Maastricht, Netherlands

[43] Erasmus MC, Dept Cardiol, Rotterdam, Netherlands

来源：

JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY | 2023年 / 166卷 / 06期

关键词：

mechanical circulatory support; extracorpo-real membrane oxygenation; extracorporeal life support; postcardiotomy cardiogenic shock; cardiac surgery; acute heart failure; EXPERT CONSENSUS; SUPPORT; OUTCOMES; SHOCK; ASSOCIATION; BIAS;

D O I：

10.1016/j.jtcvs.2023.04.042

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives: Postcardiotomy extracorporeal membrane oxygenation (ECMO) can be initiated intraoperatively or postoperatively based on indications, settings, patient profile, and conditions. The topic of implantation timing only recently gained attention from the clinical community. We compare patient characteristics as well as in-hospital and long-term survival between intraoperative and postoperative ECMO. Methods: The retrospective, multicenter, observational Postcardiotomy Extracorporeal Life Support (PELS-1) study includes adults who required ECMO due to post-cardiotomy shock between 2000 and 2020. We compared patients who received ECMO in the operating theater (intraoperative) with those in the intensive care unit (postoperative) on in-hospital and postdischarge outcomes. Results: We studied 2003 patients (women: 41.1%; median age: 65 years; interquartile range [IQR], 55.0-72.0). Intraoperative ECMO patients (n = 1287) compared with postoperative ECMO patients (n = 716) had worse preoperative risk profiles. Cardiogenic shock (45.3%), right ventricular failure (15.9%), and cardiac arrest (14.3%) were the main indications for postoperative ECMO initiation, with cannulation occurring after (median) 1 day (IQR, 1-3 days). Compared with intraoperative application, patients who received postoperative ECMO showed more complications, cardiac re-operations (intraoperative: 19.7%; postoperative: 24.8%, P = .011), percutaneous coronary interventions (intraoperative: 1.8%; postoperative: 3.6%, P = .026), and had greater in-hospital mortality (intraoperative: 57.5%; postoperative: 64.5%, P = .002). Among hospital survivors, ECMO duration was shorter after intraoperative ECMO (median, 104; IQR, 67.8-164.2 hours) compared with postoperative ECMO (median, 139.7; IQR, 95.8-192 hours, P < .001), whereas postdischarge long-term survival was similar between the 2 groups (P = .86). Conclusions: Intraoperative and postoperative ECMO implantations are associated with different patient characteristics and outcomes, with greater complications and in-hospital mortality after postoperative ECMO. Strategies to identify the optimal location and timing of postcardiotomy ECMO in relation to specific patient characteristics are warranted to optimize in-hospital outcomes.

引用

页数：46

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