Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation in Patients Aged 70 Years or Older
Nicla Settembre; Zein El Dean; Daniel Reichart; Angelo M.Dell’Aquila; Dieter De Keyzer; Cristiano Spadaccio; Sigurdur Ragnarsson; Diyar Saeed; Sidney Chocron; Ivan Netuka; Antonio Fiore; Ugolino Livi; Antonio Loforte; Marco Gabrielli; Andrea Perrotti; Magnus Dalén; Fausto Biancari; Kristiina Pälve; Gilles Amr; Thomas Fux; Giovanni Mariscalco; Anders Jeppsson; Henryk Welp; Khalid Alkhamees; Andrea Lechiancole; Giuseppe Gatti; Vito G.Ruggieri; Matteo Pettinari; Artur Lichtenberg; Mariafrancesca Fiorentino; Svante Zipfel; Marek Pol; Kristján Jónsson; Karl Bounader
Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation in Patients Aged 70 Years or Older
Nicla Settembre
Zein El Dean
Daniel Reichart
Angelo M.Dell’Aquila
Dieter De Keyzer
Cristiano Spadaccio
Sigurdur Ragnarsson
Diyar Saeed
Sidney Chocron
Ivan Netuka
Antonio Fiore
Ugolino Livi
Antonio Loforte
Marco Gabrielli
Andrea Perrotti
Magnus Dalén
Fausto Biancari
Kristiina Pälve
Gilles Amr
Thomas Fux
Giovanni Mariscalco
Anders Jeppsson
Henryk Welp
Khalid Alkhamees
Andrea Lechiancole
Giuseppe Gatti
Vito G.Ruggieri
Matteo Pettinari
Artur Lichtenberg
Mariafrancesca Fiorentino
Svante Zipfel
Marek Pol
Kristján Jónsson
Karl Bounader
ELSEVIER SCIENCE INC
Julkaisun pysyvä osoite on:
https://urn.fi/URN:NBN:fi-fe2021042822249
https://urn.fi/URN:NBN:fi-fe2021042822249
Tiivistelmä
Background. There is uncertainty whether venoarterial extracorporeal membrane oxygenation (VA-ECMO) should be used in older patients with cardiopulmonary failure after cardiac surgery.Methods. This was a retrospective multicenter study of 781 patients who required postcardiotomy VA-ECMO for cardiopulmonary failure after adult cardiac surgery from 2010 to 2018 at 19 cardiac surgery centers. A parallel systematic review with meta-analysis of the literature was performed.Results. The hospital mortality in the overall Post-cardiotomy Venoarterial Extracorporeal Membrane Oxygenation (PC-ECMO) series was 64.4%. A total of 255 patients were 70 years old or older (32.7%), and their hospital mortality was significantly higher than in younger patients (76.1% vs 58.7%; adjusted odds ratio, 2.199; 95% confidence interval [CI], 1.536 to 3.149). Arterial lactate level greater than 6 mmol/L before starting VA-ECMO was the only predictor of hospital mortality among patients 70 years old or older in univariate analysis (82.6% vs 70.4%; P = .029). Meta-analysis of current and previous studies showed that early mortality after postcardiotomy VA-ECMO was significantly higher in patients aged 70 years or older compared with younger patients (odds ratio, 2.09; 95% CI, 1.59 to 2.75; 5 studies including 1547 patients; I-2, 5.9%). The pooled early mortality rate among patients aged 70 years or older was 78.8% (95% CI, 74.1 to 83.5; 6 studies including 617 patients; I-2, 41.8%). Two studies reported 1-year mortality (including hospital mortality) of 79.9% and 75.6%, respectively, in patients 70 years old or older.Conclusions. Advanced age should not be considered a contraindication for postcardiotomy VA-ECMO. However, in view of the high risk of early mortality, meaningful scrutiny is needed before using VA-ECMO after cardiac surgery in older patients. (C) 2019 by The Society of Thoracic Surgeons
Kokoelmat
- Rinnakkaistallenteet [19207]