Duration of Venoarterial Extracorporeal Membrane Oxygenation and Mortality in Postcardiotomy Cardiogenic Shock
| Autor: | Mariscalco, G, El-Dean, Z, Yusuff, H, Fux, T, Dell'Aquila, Am, Jónsson, K, Ragnarsson, S, Fiore, A, Dalén, M, di Perna, D, Gatti, G, Juvonen, T, Zipfel, S, Perrotti, A, Bounader, K, Alkhamees, K, Loforte, A, Lechiancole, A, Pol, M, Spadaccio, C, Pettinari, M, De Keyzer, D, Welp, H, Maselli, D, Lichtenberg, A, Ruggieri, Vg, Biancari, F, PC-ECMO, Group. |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Shock Cardiogenic 030204 cardiovascular system & hematology Logistic regression Lower risk survival Tertiary Care Centers 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology Extracorporeal membrane oxygenation Medicine Humans Hospital Mortality Aged Retrospective Studies business.industry Cardiogenic shock duration Shock Odds ratio extracorporeal membrane oxygenation Middle Aged University hospital medicine.disease Cardiogenic cardiac surgery ECMO Extracorporeal Membrane Oxygenation Confidence interval Cardiac surgery surgical procedures operative Anesthesiology and Pain Medicine Anesthesia Cardiology and Cardiovascular Medicine business |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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