A1 Vertaisarvioitu alkuperäisartikkeli tieteellisessä lehdessä

Peripheral versus central extracorporeal membrane oxygenation for postcardiotomy shock: Multicenter registry, systematic review, and meta-analysis




TekijätMariscalco 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; the PC-ECMO group

KustantajaElsevier

Julkaisuvuosi2020

JournalJournal of Thoracic and Cardiovascular Surgery

Tietokannassa oleva lehden nimiThe Journal of thoracic and cardiovascular surgery

Lehden akronyymiJ Thorac Cardiovasc Surg

Vuosikerta160

Numero5

Aloitussivu1207

Lopetussivu1216.e44

ISSN0022-5223

eISSN1097-685X

DOIhttps://doi.org/10.1016/j.jtcvs.2019.10.078

Rinnakkaistallenteen osoitehttps://research.utu.fi/converis/portal/detail/Publication/45523995


Tiivistelmä

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.


Ladattava julkaisu

This is an electronic reprint of the original article.
This reprint may differ from the original in pagination and typographic detail. Please cite the original version.





Last updated on 2024-26-11 at 20:43