학술논문
Peripheral versus central extracorporeal membrane oxygenation for postcardiotomy shock: Multicenter registry, systematic review, and meta-analysis
Document Type
Report
Author
Mariscalco, Giovanni; Salsano, Antonio; Fiore, Antonio; Dalen, Magnus; Ruggieri, Vito G.; Saeed, Diyar; Jonsson, Kristjan; Gatti, Giuseppe; Zipfel, Svante; Dell'Aquila, Angelo M.; Perrotti, Andrea; Loforte, Antonio; Livi, Ugolino; Pol, Marek; Spadaccio, Cristiano; Pettinari, Matteo; Ragnarsson, Sigurdur; Alkhamees, Khalid; El-Dean, Zein; Bounader, Karl; Biancari, Fausto; Dashey, Susan; Yusuff, Hakeem; Porter, Richard; Sampson, Caroline; Harvey, Chris; Settembre, Nicla; Fux, Thomas; Amr, Gilles; Lichtenberg, Artur; Jeppsson, Anders; Gabrielli, Marco; Reichart, Daniel; Welp, Henryk; Chocron, Sidney; Fiorentino, Mariafrancesca; Lechiancole, Andrea; Netuka, Ivan; De Keyzer, Dieter; Strauven, Maarten; Palve, Kristiina
Source
Journal of Thoracic and Cardiovascular Surgery. Nov 2020, Vol. 160 Issue 5, 1207
Subject
Language
English
ISSN
0022-5223
Abstract
Key Words extracorporeal membrane oxygenation; ECMO; postcardiotomy; cardiac surgery Abstract Background 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. 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. Abbreviations and Acronyms CI, confidence interval; CPB, cardiopulmonary bypass; ECMO, extracorporeal membrane oxygenation; IQR, interquartile range; OR, odds ratio; PC-ECMO, Postcardiotomy Veno-arterial Extracorporeal Membrane Oxygenation study; PCS, postcardiotomy cardiogenic shock; RBC, red blood cell; RR, risk ratio; VA, venoarterial