TY - JOUR
T1 - Venoarterial extracorporeal membrane oxygenation after coronary artery bypass grafting
T2 - Results of a multicenter study
AU - Biancari, Fausto
AU - Dalén, Magnus
AU - Perrotti, Andrea
AU - Fiore, Antonio
AU - Reichart, Daniel
AU - Khodabandeh, Sorosh
AU - Gulbins, Helmut
AU - Zipfel, Svante
AU - Al Shakaki, Mosab
AU - Welp, Henryk
AU - Vezzani, Antonella
AU - Gherli, Tiziano
AU - Lommi, Jaakko
AU - Juvonen, Tatu
AU - Svenarud, Peter
AU - Chocron, Sidney
AU - Verhoye, Jean Philippe
AU - Bounader, Karl
AU - Gatti, Giuseppe
AU - Gabrielli, Marco
AU - Saccocci, Matteo
AU - Kinnunen, Eeva Maija
AU - Onorati, Francesco
AU - Santarpino, Giuseppe
AU - Alkhamees, Khalid
AU - Ruggieri, Vito G.
AU - Dell'Aquila, Angelo M.
PY - 2017/8/15
Y1 - 2017/8/15
N2 - Background The evidence of the benefits of using venoarterial extracorporeal membrane oxygenation (VA-ECMO) after coronary artery bypass grafting (CABG) is scarce. Methods We analyzed the outcomes of patients who received VA-ECMO therapy due to cardiac or respiratory failure after isolated CABG in 12 centers between 2005 and 2016. Patients treated preoperatively with ECMO were excluded from this study. Results VA-ECMO was employed in 148 patients after CABG for median of 5.0 days (mean, 6.4, SD 5.6 days). In-hospital mortality was 64.2%. Pooled in-hospital mortality was 65.9% without significant heterogeneity between the centers (I2 8.6%). The proportion of VA-ECMO in each center did not affect in-hospital mortality (p = 0.861). No patients underwent heart transplantation and six patients received a left ventricular assist device. Logistic regression showed that creatinine clearance (p = 0.004, OR 0.98, 95% CI 0.97–0.99), pulmonary disease (p = 0.018, OR 4.42, 95% CI 1.29–15.15) and pre-VA-ECMO blood lactate (p = 0.015, OR 1.10, 95% CI 1.02–1.18) were independent baseline predictors of in-hospital mortality. One-, 2-, and 3-year survival was 31.0%, 27.9%, and 26.1%, respectively. Conclusions One third of patients with need for VA-ECMO after CABG survive to discharge. In view of the burden of resources associated with VA-ECMO treatment and the limited number of patients surviving to discharge, further studies are needed to identify patients who may benefit the most from this treatment.
AB - Background The evidence of the benefits of using venoarterial extracorporeal membrane oxygenation (VA-ECMO) after coronary artery bypass grafting (CABG) is scarce. Methods We analyzed the outcomes of patients who received VA-ECMO therapy due to cardiac or respiratory failure after isolated CABG in 12 centers between 2005 and 2016. Patients treated preoperatively with ECMO were excluded from this study. Results VA-ECMO was employed in 148 patients after CABG for median of 5.0 days (mean, 6.4, SD 5.6 days). In-hospital mortality was 64.2%. Pooled in-hospital mortality was 65.9% without significant heterogeneity between the centers (I2 8.6%). The proportion of VA-ECMO in each center did not affect in-hospital mortality (p = 0.861). No patients underwent heart transplantation and six patients received a left ventricular assist device. Logistic regression showed that creatinine clearance (p = 0.004, OR 0.98, 95% CI 0.97–0.99), pulmonary disease (p = 0.018, OR 4.42, 95% CI 1.29–15.15) and pre-VA-ECMO blood lactate (p = 0.015, OR 1.10, 95% CI 1.02–1.18) were independent baseline predictors of in-hospital mortality. One-, 2-, and 3-year survival was 31.0%, 27.9%, and 26.1%, respectively. Conclusions One third of patients with need for VA-ECMO after CABG survive to discharge. In view of the burden of resources associated with VA-ECMO treatment and the limited number of patients surviving to discharge, further studies are needed to identify patients who may benefit the most from this treatment.
KW - CABG
KW - Coronary artery bypass
KW - ECLS
KW - ECMO
KW - Extracorporeal life support
KW - Extracorporeal membrane oxygenation
KW - Heart failure
KW - Post-cardiotomy
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U2 - 10.1016/j.ijcard.2017.03.120
DO - 10.1016/j.ijcard.2017.03.120
M3 - Article
AN - SCOPUS:85017102336
VL - 241
SP - 109
EP - 114
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
ER -