Venoarterial extracorporeal membrane oxygenation after coronary artery bypass grafting : results of a multicenter study
Biancari, Fausto; Dalén, Magnus; Perrotti, Andrea; Fiore, Antonio; Reichart, Daniel; Khodabandeh, Sorosh; Gulbins, Helmut; Zipfel, Svante; Al Shakaki, Mosab; Welp, Henryk; Vezzani, Antonella; Gherli, Tiziano; Lommi, Jaakko; Juvonen, Tatu; Svenarud, Peter; Chocron, Sidney; Verhoye, Jean Philippe; Bounader, Karl; Gatti, Giuseppe; Gabrielli, Marco; Saccocci, Matteo; Kinnunen, Eeva-Maija; Onorati, Francesco; Santarpino, Giuseppe; Alkhamees, Khalid; Ruggieri, Vito G.; Dell'Aquila, Angelo M. (2017-03-28)
Fausto Biancari, Magnus Dalén, Andrea Perrotti, Antonio Fiore, Daniel Reichart, Sorosh Khodabandeh, Helmut Gulbins, Svante Zipfel, Mosab Al Shakaki, Henryk Welp, Antonella Vezzani, Tiziano Gherli, Jaakko Lommi, Tatu Juvonen, Peter Svenarud, Sidney Chocron, Jean Philippe Verhoye, Karl Bounader, Giuseppe Gatti, Marco Gabrielli, Matteo Saccocci, Eeva-Maija Kinnunen, Francesco Onorati, Giuseppe Santarpino, Khalid Alkhamees, Vito G. Ruggieri, Angelo M. Dell’Aquila, Venoarterial extracorporeal membrane oxygenation after coronary artery bypass grafting: Results of a multicenter study, International Journal of Cardiology, Volume 241, 2017, Pages 109-114, ISSN 0167-5273, https://doi.org/10.1016/j.ijcard.2017.03.120
© 2017 Elsevier B.V. All rights reserved. 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-fe2019102134029
Tiivistelmä
Abstract
Background: The evidence of the benefits of using venoarterial extracorporeal membrane oxygenation (VA-ECMO) after coronary artery bypass grafting (CABG) is scarce.
Methods: We analyzed the outcomes of patients who received VA-ECMO therapy due to cardiac or respiratory failure after isolated CABG in 12 centers between 2005 and 2016. Patients treated preoperatively with ECMO were excluded from this study.
Results: VA-ECMO was employed in 148 patients after CABG for median of 5.0 days (mean, 6.4, SD 5.6 days). In-hospital mortality was 64.2%. Pooled in-hospital mortality was 65.9% without significant heterogeneity between the centers (I2 8.6%). The proportion of VA-ECMO in each center did not affect in-hospital mortality (p = 0.861). No patients underwent heart transplantation and six patients received a left ventricular assist device. Logistic regression showed that creatinine clearance (p = 0.004, OR 0.98, 95% CI 0.97–0.99), pulmonary disease (p = 0.018, OR 4.42, 95% CI 1.29–15.15) and pre-VA-ECMO blood lactate (p = 0.015, OR 1.10, 95% CI 1.02–1.18) were independent baseline predictors of in-hospital mortality. One-, 2-, and 3-year survival was 31.0%, 27.9%, and 26.1%, respectively.
Conclusions: One third of patients with need for VA-ECMO after CABG survive to discharge. In view of the burden of resources associated with VA-ECMO treatment and the limited number of patients surviving to discharge, further studies are needed to identify patients who may benefit the most from this treatment.
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