Peripheral versus central extracorporeal membrane oxygenation for postcardiotomy shock: Multicenter registry, systematic review, and meta-analysis
| Autor: | Giovanni Mariscalco, Antonio Salsano, Antonio Fiore, Magnus Dalén, Vito G. Ruggieri, Diyar Saeed, Kristján Jónsson, Giuseppe Gatti, Svante Zipfel, Angelo M. Dell'Aquila, Andrea Perrotti, Antonio Loforte, Ugolino Livi, Marek Pol, Cristiano Spadaccio, Matteo Pettinari, Sigurdur Ragnarsson, Khalid Alkhamees, Zein El-Dean, Karl Bounader, Fausto Biancari, Susan Dashey, Hakeem Yusuff, Richard Porter, Caroline Sampson, Chris Harvey, Nicla Settembre, Thomas Fux, Gilles Amr, Artur Lichtenberg, Anders Jeppsson, Marco Gabrielli, Daniel Reichart, Henryk Welp, Sidney Chocron, Mariafrancesca Fiorentino, Andrea Lechiancole, Ivan Netuka, Dieter De Keyzer, Maarten Strauven, Kristiina Pälve |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male medicine.medical_specialty medicine.medical_treatment 030204 cardiovascular system & hematology law.invention 03 medical and health sciences 0302 clinical medicine Postoperative Complications law Interquartile range medicine Cardiopulmonary bypass Extracorporeal membrane oxygenation Humans Cardiac Surgical Procedures Aged Aged 80 and over business.industry postcardiotomy Shock Perioperative Odds ratio Middle Aged extracorporeal membrane oxygenation cardiac surgery ECMO Confidence interval Cardiac surgery surgical procedures operative 030228 respiratory system Relative risk Anesthesia Surgery Female Cardiology and Cardiovascular Medicine business |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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