Mariani, Silvia and Heuts, Samuel and van Bussel, Bas C. T. and Di Mauro, Michele and Wiedemann, Dominik 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, Marco L. 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 Shekar, Kiran and Whitman, Glenn J. R. and Lorusso, Roberto (2023) Patient and Management Variables Associated With Survival After Postcardiotomy Extracorporeal Membrane Oxygenation in Adults: The PELS-1 Multicenter Cohort Study. JOURNAL OF THE AMERICAN HEART ASSOCIATION, 12 (14): e029609. ISSN , 2047-9980
Full text not available from this repository. (Request a copy)Abstract
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been increasingly used for postcardiotomy cardiogenic shock, but without a concomitant reduction in observed in-hospital mortality. Long-term outcomes are unknown. This study describes patients' characteristics, in-hospital outcome, and 10-year survival after postcardiotomy ECMO. Variables associated with in-hospital and postdischarge mortality are investigated and reported. METHODS AND RESULTS: The retrospective international multicenter observational PELS-1 (Postcardiotomy Extracorporeal Life Support) study includes data on adults requiring ECMO for postcardiotomy cardiogenic shock between 2000 and 2020 from 34 centers. Variables associated with mortality were estimated preoperatively, intraoperatively, during ECMO, and after the occurrence of any complications, and then analyzed at different time points during a patient's clinical course, through mixed Cox proportional hazards models containing fixed and random effects. Follow-up was established by institutional chart review or contacting patients. This analysis included 2058 patients (59% were men; median [interquartile range] age, 65.0 [55.0-72.0] years). In-hospital mortality was 60.5%. Independent variables associated with in-hospital mortality were age (hazard ratio [HR], 1.02 [95% CI, 1.01-1.02]) and preoperative cardiac arrest (HR, 1.41 [95% CI, 1.15-1.73]). In the subgroup of hospital survivors, the overall 1-, 2-, 5-, and 10-year survival rates were 89.5% (95% CI, 87.0%-92.0%), 85.4% (95% CI, 82.5%-88.3%), 76.4% (95% CI, 72.5%-80.5%), and 65.9% (95% CI, 60.3%-72.0%), respectively. Variables associated with postdischarge mortality included older age, atrial fibrillation, emergency surgery, type of surgery, postoperative acute kidney injury, and postoperative septic shock. CONCLUSIONS: In adults, in-hospital mortality after postcardiotomy ECMO remains high; however, two-thirds of those who are discharged from hospital survive up to 10 years. Patient selection, intraoperative decisions, and ECMO management remain key variables associated with survival in this cohort.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | LONG-TERM OUTCOMES; EUROPEAN-SOCIETY; ESC GUIDELINES; HEART-FAILURE; DEFINITION; SUPPORT; DYSFUNCTION; MORTALITY; STATEMENT; DIAGNOSIS; acute heart failure; cardiac surgery; extracorporeal membrane oxygenation; mechanical circulatory support; postcardiotomy cardiogenic shock |
| 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 07:01 |
| Last Modified: | 30 Jan 2024 07:01 |
| URI: | https://pred.uni-regensburg.de/id/eprint/60976 |
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