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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, Vol. 160, No. 5, 11.2020, p. 1207-1216.e44.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Mariscalco, G, Salsano, A, Fiore, A, Dalén, M, Ruggieri, VG, Saeed, D, Jónsson, K, Gatti, G, Zipfel, S, Dell'Aquila, AM, Perrotti, A, Loforte, A, Livi, U, Pol, M, Spadaccio, C, Pettinari, M, Ragnarsson, S, Alkhamees, K, El-Dean, Z, Bounader, K, Biancari, F & PC-ECMO Study Group 2020, 'Peripheral versus central extracorporeal membrane oxygenation for postcardiotomy shock: Multicenter registry, systematic review, and meta-analysis', J THORAC CARDIOV SUR, vol. 160, no. 5, pp. 1207-1216.e44. https://doi.org/10.1016/j.jtcvs.2019.10.078

APA

Mariscalco, G., Salsano, A., Fiore, A., Dalén, M., Ruggieri, V. G., Saeed, D., Jónsson, K., Gatti, G., Zipfel, S., Dell'Aquila, A. M., Perrotti, A., Loforte, A., Livi, U., Pol, M., Spadaccio, C., Pettinari, M., Ragnarsson, S., Alkhamees, K., El-Dean, Z., ... PC-ECMO Study Group (2020). Peripheral versus central extracorporeal membrane oxygenation for postcardiotomy shock: Multicenter registry, systematic review, and meta-analysis. J THORAC CARDIOV SUR, 160(5), 1207-1216.e44. https://doi.org/10.1016/j.jtcvs.2019.10.078

Vancouver

Mariscalco G, Salsano A, Fiore A, Dalén M, Ruggieri VG, Saeed D et al. Peripheral versus central extracorporeal membrane oxygenation for postcardiotomy shock: Multicenter registry, systematic review, and meta-analysis. J THORAC CARDIOV SUR. 2020 Nov;160(5):1207-1216.e44. https://doi.org/10.1016/j.jtcvs.2019.10.078

Bibtex

@article{e9938f998ab74d5793acb6b2dddd3ef3,
title = "Peripheral versus central extracorporeal membrane oxygenation for postcardiotomy shock: Multicenter registry, systematic review, and meta-analysis",
abstract = "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.",
keywords = "Adult, Aged, Aged, 80 and over, Cardiac Surgical Procedures/adverse effects, Extracorporeal Membrane Oxygenation/adverse effects, Female, Humans, Male, Middle Aged, Postoperative Complications/surgery, Shock/surgery",
author = "Giovanni Mariscalco and Antonio Salsano and Antonio Fiore and Magnus Dal{\'e}n and Ruggieri, {Vito G} and Diyar Saeed and Kristj{\'a}n J{\'o}nsson and Giuseppe Gatti and Svante Zipfel and Dell'Aquila, {Angelo M} and Andrea Perrotti and Antonio Loforte and Ugolino Livi and Marek Pol and Cristiano Spadaccio and Matteo Pettinari and Sigurdur Ragnarsson and Khalid Alkhamees and Zein El-Dean and Karl Bounader and Fausto Biancari and {PC-ECMO Study Group}",
note = "Copyright {\textcopyright} 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.",
year = "2020",
month = nov,
doi = "10.1016/j.jtcvs.2019.10.078",
language = "English",
volume = "160",
pages = "1207--1216.e44",
journal = "J THORAC CARDIOV SUR",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "5",

}

RIS

TY - JOUR

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 -