Venoarterial Extracorporeal Membrane Oxygenation for Postcardiotomy Shock-Analysis of the Extracorporeal Life Support Organization Registry.

Refractory postcardiotomy cardiogenic shock complicating cardiac surgery yields nearly 100% mortality when untreated. Use of venoarterial extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock has increased worldwide recently. The aim of the current analysis was to outline the trends in use, changing patient profiles, and in-hospital outcomes including complications in patients undergoing venoarterial extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock. Analysis of extracorporeal life support organization registry from January 2010 to December 2018. Multicenter worldwide registry. Seven-thousand one-hundred eighty-five patients supported with venoarterial extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock. Venoarterial extracorporeal membrane oxygenation. Hospital death, weaning from extracorporeal membrane oxygenation, hospital complications. Mortality predictors were assessed by multivariable logistic regression. Propensity score matching was performed for comparison of peripheral and central cannulation for extracorporeal membrane oxygenation. A significant trend toward more extracorporeal membrane oxygenation use in recent years (coefficient, 0.009; p < 0.001) was found. Mean age was 56.3 ± 14.9 years and significantly increased over time (coefficient, 0.513; p < 0.001). Most commonly, venoarterial extracorporeal membrane oxygenation was instituted after coronary artery bypass surgery (26.8%) and valvular surgery (25.6%), followed by heart transplantation (20.7%). Overall, successful extracorporeal membrane oxygenation weaning was possible in 4,520 cases (56.4%), and survival to hospital discharge was achieved in 41.7% of cases. In-hospital mortality rates remained constant over time (coefficient, -8.775; p = 0.682), whereas complication rates were significantly reduced (coefficient, -0.009; p = 0.003). Higher mortality was observed after coronary artery bypass surgery (65.4%), combined coronary artery bypass surgery with valve (68.4%), and aortic (69.6%) procedures than other indications. Lower mortality rates were observed in heart transplantation recipients (46.0%). Age (p < 0.001), central cannulation (p < 0.001), and occurrence of complications while on extracorporeal membrane oxygenation were independently associated with poorer prognosis. The analysis confirmed increased use of venoarterial extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock. Mortality rates remained relatively constant over time despite a decrease in complications, in the setting of supporting older patients.

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Déclaration de conflit d'intérêts

Dr. Brodie’s institution received funding from ALung Technologies; he received funding from Baxter, Xenios, Hemovent, and Abiomed; he receives research support from ALung Technologies; he was previously on their medical advisory board; and he has been on the medical advisory boards for Baxter, BREETHE, Xenios, and Hemovent. Dr. MacLaren disclosed that he serves on the Board of Directors for the Extracorporeal Life Support Organization (ELSO). Dr. D’Alessandro received funding from Abiomed. Dr. Alexander’s institution received funding from Novartis and Tenax Therapeutics; she received funding from Instrumentation Laboratory; she disclosed the off-label product use of extracorporeal membrane oxygenation (ECMO). Dr. Barbaro’s institution received funding from Training to Advance Care Through Implementation science in Cardiac And Lung illnesses National Heart, Lung, and Blood Institute, National Institutes of Health (NIH) K12 HL138039; he disclosed that he serves on the ELSO Registry Chair; he received support for article research from the NIH; and he disclosed the off-label product use of ECMO. Dr. Lorusso is consultant and conducts clinical trial for LivaNova (London, United Kingdom), is consultant for Medtronic (Minneapolis, MN), and an Advisory Board member of PulseCath (Arnhem, The Netherlands), and Eurosets (Medolla, Italy). The remaining authors have disclosed that they do not have any potential conflicts of interest.