A1 Refereed original research article in a scientific journal
Outcome of Repeat Venoarterial Extracorporeal Membrane Oxygenation in Postcardiotomy Cardiogenic Shock
Authors: Yusuff Hakeem, Biancari Fausto, Jónsson Kristján, Ragnarsson Sigurdur, Dalén Magnus, Fux Thomas, Dell'Aquila Angelo M., Fiore Antonio, Di Perna Dario, Gatti Giuseppe, Gabrielli Marco, Juvonen Tatu, Zipfel Svante, Bounader Karl, Perrotti Andrea, Loforte Antonio, Lechiancole Andrea, Pol Marek, Pettinari Matteo, De Keyzer Dieter, Welp Henryk, Maselli Daniele, Alkhamees Khalid, Ruggieri Vito G., Mariscalco Giovanni
Publisher: W B SAUNDERS CO-ELSEVIER INC
Publication year: 2021
Journal: Journal of Cardiothoracic and Vascular Anesthesia
Journal acronym: J CARDIOTHOR VASC AN
Volume: 35
Issue: 12
First page : 3620
Last page: 3625
Number of pages: 6
ISSN: 1053-0770
eISSN: 1532-8422
DOI: https://doi.org/10.1053/j.jvca.2021.03.001
Objective: Data on patients requiring a second run of venoarterial extracorporeal membrane oxygenation (VA-ECMO) support in patients affected by postcardiotomy cardiogenic shock (PCS) are very limited. The authors aimed to investigate the effect of a second run of VA-ECMO on PCS patient survival.
Design: Retrospective analysis of an international registry.Setting: Multicenter study, tertiary university hospitals.Participants: Data on adult PCS patients receiving a second run of VA-ECMO.
Measurements and Main Results: A total of 674 patients with a mean age of 62.9 +/- 12.7 years were analyzed, and 21 (3.1%) patients had a second run of VA-ECMO. None of them required more than two VA-ECMO runs. The median duration of VA-ECMO therapy was 135 hours (interquartile range [IQR] 61-226) in patients who did not require a VA-ECMO rerun. In the rerun VA-ECMO group the median overall duration of VA-ECMO therapy was 183 hours (IQR 107-344), and the median duration of the first run was 114 hours (IQR 66-169). Nine (42.9%) of the patients who required a second run of VA-ECMO died during VA-ECMO therapy, whereas five (23.8%) survived to hospital discharge. No differences between patients treated with single or second VA-ECMO runs were observed in terms of hospital mortality and late survival. In patients requiring a second VA-ECMO run, the actuarial survival estimates at three and 12 months after VA-ECMO weaning were 23.8% +/- 9.3% and 19.6% +/- 6.4%, respectively.
Conclusions: Repeat VA-ECMO therapy is a valid treatment strategy for PCS patients. Early and late survivals are similar between patients who have undergone a single or second run of VA-ECMO.
