Peripheral versus central extracorporeal membrane oxygenation for postcardiotomy shock: Multicenter registry, systematic review, and meta-analysis
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Peripheral versus central extracorporeal membrane oxygenation for postcardiotomy shock: Multicenter registry, systematic review, and meta-analysis. / Mariscalco, Giovanni; Salsano, Antonio; Fiore, Antonio; Dalén, Magnus; Ruggieri, Vito G; Saeed, Diyar; Jónsson, Kristján; Gatti, Giuseppe; Zipfel, Svante; Dell'Aquila, Angelo M; Perrotti, Andrea; Loforte, Antonio; Livi, Ugolino; Pol, Marek; Spadaccio, Cristiano; Pettinari, Matteo; Ragnarsson, Sigurdur; Alkhamees, Khalid; El-Dean, Zein; Bounader, Karl; Biancari, Fausto; PC-ECMO Study Group.
in: J THORAC CARDIOV SUR, Jahrgang 160, Nr. 5, 11.2020, S. 1207-1216.e44.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Peripheral versus central extracorporeal membrane oxygenation for postcardiotomy shock: Multicenter registry, systematic review, and meta-analysis
AU - Mariscalco, Giovanni
AU - Salsano, Antonio
AU - Fiore, Antonio
AU - Dalén, Magnus
AU - Ruggieri, Vito G
AU - Saeed, Diyar
AU - Jónsson, Kristján
AU - Gatti, Giuseppe
AU - Zipfel, Svante
AU - Dell'Aquila, Angelo M
AU - Perrotti, Andrea
AU - Loforte, Antonio
AU - Livi, Ugolino
AU - Pol, Marek
AU - Spadaccio, Cristiano
AU - Pettinari, Matteo
AU - Ragnarsson, Sigurdur
AU - Alkhamees, Khalid
AU - El-Dean, Zein
AU - Bounader, Karl
AU - Biancari, Fausto
AU - PC-ECMO Study Group
N1 - Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
PY - 2020/11
Y1 - 2020/11
N2 - BACKGROUND: We hypothesized that cannulation strategy in venoarterial extracorporeal membrane oxygenation (VA-ECMO) could play a crucial role in the perioperative survival of patients affected by postcardiotomy shock.METHODS: Between January 2010 and March 2018, 781 adult patients receiving VA-ECMO for postcardiotomy shock at 19 cardiac surgical centers were retrieved from the Postcardiotomy Veno-arterial Extracorporeal Membrane Oxygenation study registry. A parallel systematic review and meta-analysis (PubMed/MEDLINE, Embase, and Cochrane Library) through December 2018 was also accomplished.RESULTS: Central and peripheral VA-ECMO cannulation were performed in 245 (31.4%) and 536 (68.6%) patients, respectively. Main indications for the institution VA-ECMO were failure to wean from cardiopulmonary bypass (38%) and heart failure following cardiopulmonary bypass weaning (48%). The doubly robust analysis after inverse probability treatment weighting by propensity score demonstrated that central VA-ECMO was associated with greater hospital mortality (odds ratio 1.54; 95% confidence interval, 1.09-2.18), reoperation for bleeding/tamponade (odds ratio, 1.96; 95% confidence interval, 1.37-2.81), and transfusion of more than 9 RBC units (odds ratio, 2.42; 95% confidence interval, 1.59-3.67). The systematic review provided a total of 2491 individuals with postcardiotomy shock treated with VA-ECMO. Pooled prevalence of in-hospital/30-day mortality in overall patient population was 66.6% (95% confidence interval, 64.7-68.4%), and pooled unadjusted risk ratio analysis confirmed that patients undergoing peripheral VA-ECMO had a lower in-hospital/30-day mortality than patients undergoing central cannulation (risk ratio, 0.92; 95% confidence interval, 0.87-0.98). Adjustments for important confounders did not alter our results.CONCLUSIONS: In patients with postcardiotomy shock treated with VA-ECMO, central cannulation was associated with greater in-hospital mortality than peripheral cannulation.
AB - BACKGROUND: We hypothesized that cannulation strategy in venoarterial extracorporeal membrane oxygenation (VA-ECMO) could play a crucial role in the perioperative survival of patients affected by postcardiotomy shock.METHODS: Between January 2010 and March 2018, 781 adult patients receiving VA-ECMO for postcardiotomy shock at 19 cardiac surgical centers were retrieved from the Postcardiotomy Veno-arterial Extracorporeal Membrane Oxygenation study registry. A parallel systematic review and meta-analysis (PubMed/MEDLINE, Embase, and Cochrane Library) through December 2018 was also accomplished.RESULTS: Central and peripheral VA-ECMO cannulation were performed in 245 (31.4%) and 536 (68.6%) patients, respectively. Main indications for the institution VA-ECMO were failure to wean from cardiopulmonary bypass (38%) and heart failure following cardiopulmonary bypass weaning (48%). The doubly robust analysis after inverse probability treatment weighting by propensity score demonstrated that central VA-ECMO was associated with greater hospital mortality (odds ratio 1.54; 95% confidence interval, 1.09-2.18), reoperation for bleeding/tamponade (odds ratio, 1.96; 95% confidence interval, 1.37-2.81), and transfusion of more than 9 RBC units (odds ratio, 2.42; 95% confidence interval, 1.59-3.67). The systematic review provided a total of 2491 individuals with postcardiotomy shock treated with VA-ECMO. Pooled prevalence of in-hospital/30-day mortality in overall patient population was 66.6% (95% confidence interval, 64.7-68.4%), and pooled unadjusted risk ratio analysis confirmed that patients undergoing peripheral VA-ECMO had a lower in-hospital/30-day mortality than patients undergoing central cannulation (risk ratio, 0.92; 95% confidence interval, 0.87-0.98). Adjustments for important confounders did not alter our results.CONCLUSIONS: In patients with postcardiotomy shock treated with VA-ECMO, central cannulation was associated with greater in-hospital mortality than peripheral cannulation.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Cardiac Surgical Procedures/adverse effects
KW - Extracorporeal Membrane Oxygenation/adverse effects
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Postoperative Complications/surgery
KW - Shock/surgery
U2 - 10.1016/j.jtcvs.2019.10.078
DO - 10.1016/j.jtcvs.2019.10.078
M3 - SCORING: Journal article
C2 - 31864699
VL - 160
SP - 1207-1216.e44
JO - J THORAC CARDIOV SUR
JF - J THORAC CARDIOV SUR
SN - 0022-5223
IS - 5
ER -