Meta-Analysis of the Outcome After Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation in Adult Patients
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Meta-Analysis of the Outcome After Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation in Adult Patients. / Biancari, Fausto; Perrotti, Andrea; Dalén, Magnus; Guerrieri, Mariapia; Fiore, Antonio; Reichart, Daniel; Dell'Aquila, Angelo M; Gatti, Giuseppe; Ala-Kokko, Tero; Kinnunen, Eeva-Maija; Tauriainen, Tuomas; Chocron, Sidney; Airaksinen, Juhani K E; Ruggieri, Vito G; Brascia, Debora.
in: J CARDIOTHOR VASC AN, Jahrgang 32, Nr. 3, 06.2018, S. 1175-1182.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Review › Forschung
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TY - JOUR
T1 - Meta-Analysis of the Outcome After Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation in Adult Patients
AU - Biancari, Fausto
AU - Perrotti, Andrea
AU - Dalén, Magnus
AU - Guerrieri, Mariapia
AU - Fiore, Antonio
AU - Reichart, Daniel
AU - Dell'Aquila, Angelo M
AU - Gatti, Giuseppe
AU - Ala-Kokko, Tero
AU - Kinnunen, Eeva-Maija
AU - Tauriainen, Tuomas
AU - Chocron, Sidney
AU - Airaksinen, Juhani K E
AU - Ruggieri, Vito G
AU - Brascia, Debora
N1 - Copyright © 2017 Elsevier Inc. All rights reserved.
PY - 2018/6
Y1 - 2018/6
N2 - OBJECTIVE: This study was planned to pool existing data on outcome and to evaluate the efficacy of postcardiotomy venoarterial extracorporeal membrane oxygenation (VA-ECMO) in adult patients.DESIGN: Systematic review of the literature and meta-analysis.SETTING: Multi-institutional study.PARTICIPANTS: Adult patients with acute heart failure immediately after cardiac surgery.INTERVENTIONS: VA-ECMO after cardiac surgery. Studies evaluating only heart transplant patients were excluded from this analysis.MEASUREMENTS AND MAIN RESULTS: A literature search was performed to identify studies published since 2000. Thirty-one studies reported on 2,986 patients (mean age, 58.1 years) who required postcardiotomy VA-ECMO. The weaning rate from VA-ECMO was 59.5% and hospital survival was 36.1% (95% CI 31.5-40.8). The pooled rate of reoperation for bleeding was 42.9%, major neurological event 11.3%, lower limb ischemia 10.8%, deep sternal wound infection/mediastinitis 14.7%, and renal replacement therapy 47.1%. The pooled mean number of transfused red blood cell units was 17.7 (95% CI 13.3-22.1). The mean stay in the intensive care unit was 13.3 days (95% CI 10.2-16.4). Survivors were significantly younger (mean, 55.7 v 63.6 years, p = 0.015) and their blood lactate level before starting VA-ECMO was lower (mean, 7.7 v 10.7 mmol/L, p = 0.028) than patients who died. One-year survival rate was 30.9% (95% CI 24.3-37.5).CONCLUSIONS: Pooled data showed that VA-ECMO may salvage one-third of patients unresponsive to any other resuscitative treatment after adult cardiac surgery.
AB - OBJECTIVE: This study was planned to pool existing data on outcome and to evaluate the efficacy of postcardiotomy venoarterial extracorporeal membrane oxygenation (VA-ECMO) in adult patients.DESIGN: Systematic review of the literature and meta-analysis.SETTING: Multi-institutional study.PARTICIPANTS: Adult patients with acute heart failure immediately after cardiac surgery.INTERVENTIONS: VA-ECMO after cardiac surgery. Studies evaluating only heart transplant patients were excluded from this analysis.MEASUREMENTS AND MAIN RESULTS: A literature search was performed to identify studies published since 2000. Thirty-one studies reported on 2,986 patients (mean age, 58.1 years) who required postcardiotomy VA-ECMO. The weaning rate from VA-ECMO was 59.5% and hospital survival was 36.1% (95% CI 31.5-40.8). The pooled rate of reoperation for bleeding was 42.9%, major neurological event 11.3%, lower limb ischemia 10.8%, deep sternal wound infection/mediastinitis 14.7%, and renal replacement therapy 47.1%. The pooled mean number of transfused red blood cell units was 17.7 (95% CI 13.3-22.1). The mean stay in the intensive care unit was 13.3 days (95% CI 10.2-16.4). Survivors were significantly younger (mean, 55.7 v 63.6 years, p = 0.015) and their blood lactate level before starting VA-ECMO was lower (mean, 7.7 v 10.7 mmol/L, p = 0.028) than patients who died. One-year survival rate was 30.9% (95% CI 24.3-37.5).CONCLUSIONS: Pooled data showed that VA-ECMO may salvage one-third of patients unresponsive to any other resuscitative treatment after adult cardiac surgery.
KW - Adult
KW - Cardiac Surgical Procedures/adverse effects
KW - Extracorporeal Membrane Oxygenation/mortality
KW - Heart Failure/etiology
KW - Humans
KW - Postoperative Complications/etiology
KW - Survival Rate/trends
KW - Treatment Outcome
U2 - 10.1053/j.jvca.2017.08.048
DO - 10.1053/j.jvca.2017.08.048
M3 - SCORING: Review article
C2 - 29158060
VL - 32
SP - 1175
EP - 1182
JO - J CARDIOTHOR VASC AN
JF - J CARDIOTHOR VASC AN
SN - 1053-0770
IS - 3
ER -
