A1 Refereed original research article in a scientific journal
Duration of Venoarterial Extracorporeal Membrane Oxygenation and Mortality in Postcardiotomy Cardiogenic Shock
Authors: Dalén M., di Perna D., Ragnarsson S., Fiore A., Zipfel S., Perrotti A., Gatti G., Juvonen T., Loforte A., Lechiancole A., Bounader K., Alkhamees K., Pettinari M., De Keyzer D., Pol M., Spadaccio C., Ruggieri V.G., Lichtenberg A., Maselli D., Welp H., Biancari Fausto, El-Dean Z., Mariscalco G., Fux T., Yusuff H., Jónsson K., Dell'Aquila A.M.
Publisher: W.B. Saunders
Publication year: 2021
Journal: Journal of Cardiothoracic and Vascular Anesthesia
Journal name in source: Journal of Cardiothoracic and Vascular Anesthesia
ISSN: 1053-0770
eISSN: 1532-8422
DOI: https://doi.org/10.1053/j.jvca.2020.11.003
Objective
The optimal duration of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in patients affected by postcardiotomy cardiogenic shock (PCS) remains controversial. The present study was conducted to investigate the effect of VA-ECMO duration on hospital outcomes.
Design
Retrospective analysis of an international registry.
Setting
Multicenter study including 19 tertiary university hospitals.
Participants
Between January 2010 and March 2018, data on PCS patients receiving VA-ECMO were retrieved from the multicenter PC-ECMO registry.
Interventions
Patients were stratified according to the following different durations of VA-ECMO therapy: ≤three days, four-to-seven days, eight-to-ten days, and >ten days.
Measurements and Main Results
A total of 725 patients, with a mean age of 62.9 ± 12.9 years, were included. The mean duration of VA-ECMO was 7.1 ± 6.3 days (range 0-39 d), and 39.4% of patients were supported for ≤three days, 29.1% for four-seven days, 15.3% for eight-ten days, and finally 20.7% for >ten days. A total of 391 (53.9%) patients were weaned from VA-ECMO successfully; however, 134 (34.3%) of those patients died before discharge. Multivariate logistic regression showed that prolonged duration of VA-ECMO therapy (four-seven days: adjusted rate 53.6%, odds ratio [OR] 0.28, 95% confidence interval [CI] 0.18-0.44; eight-ten days: adjusted rate 61.3%, OR 0.51, 95% CI 0.29-0.87; and >ten days: adjusted rate 59.3%, OR 0.49, 95% CI 0.31-0.81) was associated with lower risk of mortality compared with VA-ECMO lasting ≤three days (adjusted rate 78.3%). Patients requiring VA-ECMO therapy for eight-ten days (OR 1.96, 95% CI 1.15-3.33) and >10 days (OR 1.85, 95% CI 1.14-3.02) had significantly greater mortality compared with those on VA-ECMO for 4 to 7 days.
Conclusions
PCS patients weaned from VA-ECMO after four-seven days of support had significantly less mortality compared with those with shorter or longer mechanical support.
