Background: Post-cardiotomy veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is characterized by discrepancies between weaning and survival-to-discharge rates. This study analyzes the differences between post-cardiotomy V-A ECMO patients who survived, died on ECMO, or died after ECMO weaning. Causes of death and variables associated with mortality at different time points are investigated. Methods: The retrospective, multicenter, observational Post-cardiotomy Extracorporeal Life Support Study includes adults requiring post-cardiotomy V-A ECMO between 2000 and 2020. Variables associated with on-ECMO mortality and post-weaning mortality were modeled using mixed-Cox proportional hazards including random effects for center. Results: In 2058 patients [males:59%; median age:65 (IQR:55-72 years)], weaning rate was 62.7%, while survival-to-discharge was 39.6%. Deceased patients (n=1244) included 754 on-ECMO deaths [(36.6%; median support time:79 (IQR:24-192 hours)], and 476 post-weaning deaths [(23.1%; median support time:146 (IQR:96-235.5 hours)]. Multi-organ (n=431/1158, 37.2%) and persistent heart failure (n=423/1158, 36.5%) were the main causes of death, followed by bleeding (n=56/754, 7.4%) for on-ECMO mortality and sepsis (n=61/401, 15.4%) for post-weaning mortality. On-ECMO death was associated with emergency surgery, preoperative cardiac arrest, cardiogenic shock, right ventricular failure, cardiopulmonary bypass time, ECMO implantation timing. Diabetes, post-operative bleeding, cardiac arrest, bowel ischemia, acute kidney injury, and septic shock were associated with post-weaning mortality. Conclusions: A discrepancy exists between weaning and discharge rate in post-cardiotomy ECMO. Deaths occurred during ECMO support in 36.6% of patients, mostly associated with unstable pre-operative hemodynamics. Another 23.1% of patients died after weaning in association with severe complications. This underscores the importance of post-weaning care for post-cardiotomy V-A ECMO patients.
On-Support and Post-Weaning Mortality in Post-Cardiotomy Extracorporeal Membrane Oxygenation / Mariani, Silvia; Schaefer, Anne-Kristin; van Bussel, Bas C T; Di Mauro, Michele; Conci, Luca; Szalkiewicz, Philipp; De Piero, Maria Elena; Heuts, Samuel; Ravaux, Justine; van der Horst, Iwan C C; Saeed, Diyar; Pozzi, Matteo; Loforte, Antonio; Boeken, Udo; Samalavicius, Robertas; Bounader, Karl; Hou, Xiaotong; Bunge, Jeroen J H; Buscher, Hergen; Salazar, Leonardo; Meyns, Bart; Herr, Daniel; Matteucci, Sacha; Sponga, Sandro; Maclaren, Graeme; Russo, Claudio; Formica, Francesco; Sakiyalak, Pranya; Fiore, Antonio; Camboni, Daniele; Raffa, Giuseppe Maria; Diaz, Rodrigo; Wang, I-Wen; Jung, Jae-Seung; Belohlavek, Jan; Pellegrino, Vin; Bianchi, Giacomo; Pettinari, Matteo; Barbone, Alessandro; Garcia, José P; Whitman, Glenn; Shekar, Kiran; Wiedemann, Dominik; Lorusso, Roberto. - In: ANNALS OF THORACIC SURGERY. - ISSN 0003-4975. - (2023). [10.1016/j.athoracsur.2023.05.045]
On-Support and Post-Weaning Mortality in Post-Cardiotomy Extracorporeal Membrane Oxygenation
Formica, Francesco;
2023-01-01
Abstract
Background: Post-cardiotomy veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is characterized by discrepancies between weaning and survival-to-discharge rates. This study analyzes the differences between post-cardiotomy V-A ECMO patients who survived, died on ECMO, or died after ECMO weaning. Causes of death and variables associated with mortality at different time points are investigated. Methods: The retrospective, multicenter, observational Post-cardiotomy Extracorporeal Life Support Study includes adults requiring post-cardiotomy V-A ECMO between 2000 and 2020. Variables associated with on-ECMO mortality and post-weaning mortality were modeled using mixed-Cox proportional hazards including random effects for center. Results: In 2058 patients [males:59%; median age:65 (IQR:55-72 years)], weaning rate was 62.7%, while survival-to-discharge was 39.6%. Deceased patients (n=1244) included 754 on-ECMO deaths [(36.6%; median support time:79 (IQR:24-192 hours)], and 476 post-weaning deaths [(23.1%; median support time:146 (IQR:96-235.5 hours)]. Multi-organ (n=431/1158, 37.2%) and persistent heart failure (n=423/1158, 36.5%) were the main causes of death, followed by bleeding (n=56/754, 7.4%) for on-ECMO mortality and sepsis (n=61/401, 15.4%) for post-weaning mortality. On-ECMO death was associated with emergency surgery, preoperative cardiac arrest, cardiogenic shock, right ventricular failure, cardiopulmonary bypass time, ECMO implantation timing. Diabetes, post-operative bleeding, cardiac arrest, bowel ischemia, acute kidney injury, and septic shock were associated with post-weaning mortality. Conclusions: A discrepancy exists between weaning and discharge rate in post-cardiotomy ECMO. Deaths occurred during ECMO support in 36.6% of patients, mostly associated with unstable pre-operative hemodynamics. Another 23.1% of patients died after weaning in association with severe complications. This underscores the importance of post-weaning care for post-cardiotomy V-A ECMO patients.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
