Outcomes of noncardiotomy patients requiring postoperative extracorporeal membrane oxygenation.
Adult
Aged
Cohort Studies
Extracorporeal Membrane Oxygenation
/ mortality
Female
Heart Arrest
/ mortality
Humans
Liver Transplantation
Male
Middle Aged
Postoperative Complications
/ mortality
Respiratory Insufficiency
/ mortality
Retrospective Studies
Shock, Cardiogenic
/ mortality
Survival Rate
Thoracic Surgical Procedures
Treatment Outcome
Young Adult
cardiovascular research
perfusion
Journal
Journal of cardiac surgery
ISSN: 1540-8191
Titre abrégé: J Card Surg
Pays: United States
ID NLM: 8908809
Informations de publication
Date de publication:
Jul 2020
Jul 2020
Historique:
pubmed:
10
5
2020
medline:
3
11
2020
entrez:
9
5
2020
Statut:
ppublish
Résumé
The use of extracorporeal membrane oxygenation (ECMO) in the postoperative period has expanded to include a variety of noncardiotomy procedures. It is important to investigate outcomes for this uniquely ill subset of patients as currently published data on this subject is limited. All ECMO events at our institution from 2006 to 2017 were retrospectively considered. Patients were grouped into a postoperative noncardiotomy (PNC) cohort (n = 20) and a larger control cohort (n = 220). For additional analysis, the PNC cohort was further split into a liver transplant group (n = 4) and thoracic surgery group (n = 10). Basic demographics, medical history, type of operation performed, indication for support, and survival data were collected on all patients. Appropriate statistical analyses were performed and a P < .05 was considered statistically significant. Twenty PNC-ECMO patients were identified. The indications for support were respiratory failure, cardiac arrest, and cardiogenic shock. PNC patient survival was similar to our control cohort, as well as extracorporeal life support organization (ELSO) published data with 55% weaning off ECMO and 50% surviving to discharge. Twelve-month predicted survival was 40%. Post thoracic surgical patients were reviewed, and their survival rates were similar to the larger control cohort as well. There were no survivors in the liver transplant group. Despite recent noncardiotomy surgery, patients who required ECMO for salvage in the postoperative period showed similar outcomes compared to our larger cohort and to published ELSO data, and reasonable long-term survival outcomes. This suggests that ECMO may be applied to a variety of postoperative settings with outcomes on par with nationally published results.
Sections du résumé
BACKGROUND
BACKGROUND
The use of extracorporeal membrane oxygenation (ECMO) in the postoperative period has expanded to include a variety of noncardiotomy procedures. It is important to investigate outcomes for this uniquely ill subset of patients as currently published data on this subject is limited.
METHODS
METHODS
All ECMO events at our institution from 2006 to 2017 were retrospectively considered. Patients were grouped into a postoperative noncardiotomy (PNC) cohort (n = 20) and a larger control cohort (n = 220). For additional analysis, the PNC cohort was further split into a liver transplant group (n = 4) and thoracic surgery group (n = 10). Basic demographics, medical history, type of operation performed, indication for support, and survival data were collected on all patients. Appropriate statistical analyses were performed and a P < .05 was considered statistically significant.
RESULTS
RESULTS
Twenty PNC-ECMO patients were identified. The indications for support were respiratory failure, cardiac arrest, and cardiogenic shock. PNC patient survival was similar to our control cohort, as well as extracorporeal life support organization (ELSO) published data with 55% weaning off ECMO and 50% surviving to discharge. Twelve-month predicted survival was 40%. Post thoracic surgical patients were reviewed, and their survival rates were similar to the larger control cohort as well. There were no survivors in the liver transplant group.
CONCLUSIONS
CONCLUSIONS
Despite recent noncardiotomy surgery, patients who required ECMO for salvage in the postoperative period showed similar outcomes compared to our larger cohort and to published ELSO data, and reasonable long-term survival outcomes. This suggests that ECMO may be applied to a variety of postoperative settings with outcomes on par with nationally published results.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1444-1451Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 Wiley Periodicals, Inc.
Références
Extracorporeal Life Support Organization. ECLS Registry Report International Summary. 2019. https://www.elso.org/Portals/0/Files/Reports/2019/International%20Summary%20January%202019%20page%201.pdf. Accessed 8 November 2019.
Meta H, Eisen HJ, Cleveland JC. Expert analysis: indications and complications for VA-ECMO for cardiac failure. American College of Cardiology. 2015.
Hartwig MG, Walczak R, Lin SS, Davis D. Improved survival but marginal allograft function in patients treated with extracorporeal membrane oxygenation after lung transplantation. Ann Thorac Surg. 2012;93(2):366-371.
Mokashi S, Rajab TK, Lee LY, McCain DA, Abdel-Razek AM, Elmann EM. Extracorporeal membrane oxygenation support after Ivor-Lewis esophagectomy for esophageal adenocarcinoma. Ann Thorac Surg. 2014;97(3):1073-1075.
Park YH, Hwang S, Park HW, et al. Effect of pulmonary support using extracorporeal membrane oxygenation for adult liver transplant recipients with respiratory failure. Transplant Proc. 2012;44(3):757-761.
Meani P, Matteucci M, Jiritano F, et al. Long-term survival and major outcomes in post-cardiotomy extracorporeal membrane oxygenation for adult patients in cardiogenic shock. Ann Cardiothorac Surg. 2019;8(1):116-122.
Braun HJ, Pulcrano ME, Weber DJ, Padilla BE, Ascher NJ. The utility of ECMO after liver transplantation experience at a high-volume transplant center and review of the literature. Transplantation. 2019;103(8):1568-1573.
Taghavi S, Jayarajan SN, Mangi AA, et al. Examining noncardiac surgical procedures in patients on extracorporeal membrane oxygenation. ASAIO J. 2015;61(5):520-525.
Ghodsizad A, Koerner MM, Brehm CE, El-Banayosy A. The role of extracorporeal membrane oxygenation circulatory support in the 'crash and burn' patient: from implantation to weaning. Curr Opin Cardiol. 2014;29(3):275-280.