Peripheral versus central extracorporeal membrane oxygenation for postcardiotomy shock: Multicenter registry, systematic review, and meta-analysis.

Adult Aged Aged, 80 and over Cardiac Surgical Procedures / adverse effects Extracorporeal Membrane Oxygenation / adverse effects Female Humans Male Middle Aged Postoperative Complications / surgery Shock / surgery

ECMO cardiac surgery extracorporeal membrane oxygenation postcardiotomy

Journal

The Journal of thoracic and cardiovascular surgery

ISSN: 1097-685X

Titre abrégé: J Thorac Cardiovasc Surg

Pays: United States

ID NLM: 0376343

Informations de publication

Date de publication:
11 2020

Historique:

received: 08 05 2019

revised: 04 10 2019

accepted: 04 10 2019

pubmed: 23 12 2019

medline: 24 11 2020

entrez: 23 12 2019

Statut: ppublish

Résumé

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. 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. 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. In patients with postcardiotomy shock treated with VA-ECMO, central cannulation was associated with greater in-hospital mortality than peripheral cannulation.

Sections du résumé

BACKGROUND

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.

Identifiants

DOI: 10.1016/j.jtcvs.2019.10.078 PMID: 31864699

pubmed: 31864699

pii: S0022-5223(19)32376-1

doi: 10.1016/j.jtcvs.2019.10.078

pii:

doi:

Types de publication

Journal Article Meta-Analysis Systematic Review

Langues

eng

Sous-ensembles de citation

Pagination

1207-1216.e44

Investigateurs

Susan Dashey (S)

Hakeem Yusuff (H)

Richard Porter (R)

Caroline Sampson (C)

Chris Harvey (C)

Nicla Settembre (N)

Thomas Fux (T)

Gilles Amr (G)

Artur Lichtenberg (A)

Anders Jeppsson (A)

Marco Gabrielli (M)

Daniel Reichart (D)

Henryk Welp (H)

Sidney Chocron (S)

Mariafrancesca Fiorentino (M)

Andrea Lechiancole (A)

Ivan Netuka (I)

Dieter De Keyzer (D)

Maarten Strauven (M)

Kristiina Pälve (K)

Commentaires et corrections

Type : CommentIn