Postcardiotomy venoarterial extracorporeal membrane oxygenation in patients aged 70 years or older
Biancari, Fausto; Saeed, Diyar; Fiore, Antonio; Dalén, Magnus; Ruggieri, Vito G.; Jónsson, Kristján; Gatti, Giuseppe; Zipfel, Svante; Dell’Aquila, Angelo M.; Chocron, Sidney; Bounader, Karl; Amr, Gilles; Settembre, Nicla; Pälve, Kristiina; Loforte, Antonio; Gabrielli, Marco; Livi, Ugolino; Lechiancole, Andrea; Pol, Marek; Netuka, Ivan; Spadaccio, Cristiano; Pettinari, Matteo; De Keyzer, Dieter; Reichart, Daniel; Ragnarsson, Sigurdur; Alkhamees, Khalid; Lichtenberg, Artur; Fux, Thomas; El Dean, Zein; Fiorentino, Mariafrancesca; Mariscalco, Giovanni; Jeppsson, Anders; Welp, Henryk; Perrotti, Andrea (2019-06-08)
Fausto Biancari, Diyar Saeed, Antonio Fiore, Magnus Dalén, Vito G. Ruggieri, Kristján Jónsson, Giuseppe Gatti, Svante Zipfel, Angelo M. Dell’Aquila, Sidney Chocron, Karl Bounader, Gilles Amr, Nicla Settembre, Kristiina Pälve, Antonio Loforte, Marco Gabrielli, Ugolino Livi, Andrea Lechiancole, Marek Pol, Ivan Netuka, Cristiano Spadaccio, Matteo Pettinari, Dieter De Keyzer, Daniel Reichart, Sigurdur Ragnarsson, Khalid Alkhamees, Artur Lichtenberg, Thomas Fux, Zein El Dean, Mariafrancesca Fiorentino, Giovanni Mariscalco, Anders Jeppsson, Henryk Welp, Andrea Perrotti, Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation in Patients Aged 70 Years or Older, The Annals of Thoracic Surgery, Volume 108, Issue 4, 2019, Pages 1257-1264, ISSN 0003-4975, https://doi.org/10.1016/j.athoracsur.2019.04.063
© 2019 by The Society of Thoracic Surgeons Published by Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/.
https://creativecommons.org/licenses/by-nc-nd/4.0/
https://urn.fi/URN:NBN:fi-fe2019111838466
Tiivistelmä
Abstract
Background: There is uncertainty whether venoarterial extracorporeal membrane oxygenation (VA-ECMO) should be used in older patients with cardiopulmonary failure after cardiac surgery.
Methods: This was a retrospective multicenter study of 781 patients who required postcardiotomy VA-ECMO for cardiopulmonary failure after adult cardiac surgery from 2010 to 2018 at 19 cardiac surgery centers. A parallel systematic review with meta-analysis of the literature was performed.
Results: The hospital mortality in the overall Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation (PC-ECMO) series was 64.4%. A total of 255 patients were 70 years old or older (32.7%), and their hospital mortality was significantly higher than in younger patients (76.1% vs 58.7%; adjusted odds ratio, 2.199; 95% confidence interval [CI], 1.536 to 3.149). Arterial lactate level greater than 6 mmol/L before starting VA-ECMO was the only predictor of hospital mortality among patients 70 years old or older in univariate analysis (82.6% vs 70.4%; P = 0.029). Meta-analysis of current and previous studies showed that early mortality after postcardiotomy VA-ECMO was significantly higher in patients aged 70 years or older compared with younger patients (odds ratio, 2.09; 95% CI, 1.59 to 2.75; 5 studies including 1547 patients; I², 5.9%). The pooled early mortality rate among patients aged 70 years or older was 78.8% (95% CI, 74.1 to 83.5; 6 studies including 617 patients; I², 41.8%). Two studies reported 1-year mortality (including hospital mortality) of 79.9% and 75.6%, respectively, in patients 70 years old or older.
Conclusions: Advanced age should not be considered a contraindication for postcardiotomy VA-ECMO. However, in view of the high risk of early mortality, meaningful scrutiny is needed before using VA-ECMO after cardiac surgery in older patients.
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