Mariani, Silvia and Schaefer, Anne-Kristin and van Bussel, Bas C. T. and Di Mauro, Michele and Conci, Luca and Szalkiewicz, Philipp and De Piero, Maria Elena and Heuts, Samuel and Ravaux, Justine and van der Horst, Iwan C. C. and Saeed, Diyar and Pozzi, Matteo and Loforte, Antonio and Boeken, Udo and Samalavicius, Robertas and Bounader, Karl and Hou, Xiaotong and Bunge, Jeroen J. H. and Buscher, Hergen and Salazar, Leonardo and Meyns, Bart and Herr, Daniel and Matteucci, Sacha and Sponga, Sandro and MacLaren, Graeme and Russo, Claudio and Formica, Francesco and Sakiyalak, Pranya and Fiore, Antonio and Camboni, Daniele and Raffa, Giuseppe Maria and Diaz, Rodrigo and Wang, I-wen and Jung, Jae-Seung and Belohlavek, Jan and Pellegrino, Vin and Bianchi, Giacomo and Pettinari, Matteo and Barbone, Alessandro and Garcia, Jose P. and Whitman, Glenn and Shekar, Kiran and Wiedemann, Dominik and Lorusso, Roberto and PELS Investigators, (2023) On-Support and Postweaning Mortality in Postcardiotomy Extracorporeal Membrane Oxygenation. ANNALS OF THORACIC SURGERY, 116 (5). pp. 1079-1089. ISSN 0003-4975, 1552-6259
Full text not available from this repository.Abstract
BACKGROUND Postcardiotomy venoarterial extracorporeal membrane oxygenation (VA ECMO) is characterized by discrepancies between weaning and survival-to-discharge rates. This study analyzes the differences between post-cardiotomy VA ECMO patients who survived, died on ECMO, or died after ECMO weaning. Causes of death and vari-ables associated with mortality at different time points are investigated.METHODS The retrospective, multicenter, observational Postcardiotomy Extracorporeal Life Support Study (PELS) includes adults requiring postcardiotomy VA ECMO between 2000 and 2020. Variables associated with on-ECMO mortality and postweaning mortality were modeled using mixed Cox proportional hazards, including random effects for center and year.RESULTS In 2058 patients (men, 59%; median age, 65 years; interquartile range [IQR], 55-72 years), weaning rate was 62.7%, and survival to discharge was 39.6%. Patients who died (n = 1244) included 754 on-ECMO deaths (36.6%; median support time, 79 hours; IQR, 24-192 hours), and 476 postweaning deaths (23.1%; median support time, 146 hours; IQR, 96-235.5 hours). Multiorgan (n = 431 of 1158 [37.2%]) and persistent heart failure (n = 423 of 1158 [36.5%]) were the main causes of death, followed by bleeding (n = 56 of 754 [7.4%]) for on-ECMO mortality and sepsis (n = 61 of 401 [15.4%]) for postweaning mortality. On-ECMO death was associated with emergency surgery, preoperative cardiac arrest, cardiogenic shock, right ventricular failure, cardiopulmonary bypass time, and ECMO implantation timing. Dia-betes, postoperative bleeding, cardiac arrest, bowel ischemia, acute kidney injury, and septic shock were associated with postweaning mortality.CONCLUSIONS A discrepancy exists between weaning and discharge rate in postcardiotomy ECMO. Deaths occurred during ECMO support in 36.6% of patients, mostly associated with unstable preoperative hemodynamics. Another 23.1% of patients died after weaning in association with severe complications. This underscores the importance of postweaning care for postcardiotomy VA ECMO patients. (Ann Thorac Surg 2023;116:1079-90)(c) 2023 by The Society of Thoracic Surgeons. Published by Elsevier Inc.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | GUIDELINES; OUTCOMES; |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Herz-, Thorax- und herznahe Gefäßchirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 30 Jan 2024 07:14 |
| Last Modified: | 30 Jan 2024 07:14 |
| URI: | https://pred.uni-regensburg.de/id/eprint/60967 |
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