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Duration of Veno-Arterial Extracorporeal Membrane and Mortality in Postcardiotomy Cardiogenic Shock
  • +23
  • Giovanni Mariscalco,
  • Zein El-Dean,
  • Tomas Fux,
  • Angelo Dell'Aquila,
  • Kristjan Jonsson,
  • Sigurdur Ragnarsson,
  • Antonio Fiore,
  • Magnus Dalen,
  • Dario Di Perna,
  • Giuseppe Gatti,
  • Tatu Juvonen,
  • Svante Zipfel,
  • Andrea Perrotti,
  • Karl Bounder,
  • Khalid Alkhamees,
  • Antonio Loforte,
  • Andrea Lechiancole,
  • Marek Pol,
  • Cristiano Spadaccio,
  • Matteo Pettinari,
  • Dieter De Keyzer,
  • Henryk Welp,
  • Daniele Maselli,
  • Artur Lichtenberg,
  • Vito Ruggieri,
  • Fausto Biancari
Giovanni Mariscalco
Department of Surgical Sciences, Varese University Hospital, University of Insubria
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Zein El-Dean
Glenfield Hospital
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Tomas Fux
Karolinska Institute
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Angelo Dell'Aquila
University Hospital Münster
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Kristjan Jonsson
Sahlgrenska University Hospital
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Sigurdur Ragnarsson
Lund University
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Antonio Fiore
Henri Mondor Hospital Department of Orthopedic and Traumatological Surgery
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Magnus Dalen
Karolinska University Hospital
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Dario Di Perna
7Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital
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Giuseppe Gatti
Ospedali Riuniti and University of Trieste
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Tatu Juvonen
Oulu University Hospital
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Svante Zipfel
Hamburg University Heart Centre
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Andrea Perrotti
Centre Hospitalier Universitaire de Besancon
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Karl Bounder
Hopital Pontchaillou
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Khalid Alkhamees
Prince Sultan Cardiac Center Al Hassa
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Antonio Loforte
S. Orsola-Malpighi Hospital, Bologna University
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Andrea Lechiancole
University Hospital of Udine
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Marek Pol
PRAGUE INSTITUTE Jazykova skola
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Cristiano Spadaccio
Golden Jubilee National Hospital
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Matteo Pettinari
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Dieter De Keyzer
Ziekenhuis Oost-Limburg
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Henryk Welp
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Daniele Maselli
St. Anna Hospital
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Artur Lichtenberg
Universitätsklinikum Düsseldorf
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Vito Ruggieri
Centre Hospitalier Universitaire de Reims
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Fausto Biancari
TYKS
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Abstract

Background and Aim: The optimal duration of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients affected by postcardiotomy cardiogenic shock (PCS) remains controversial. We aimed to investigate the impact of VA-ECMO duration on hospital outcomes. Methods: Data on PCS patients receiving VA-ECMO were retrieved from the multicentre PC-ECMO registry. Patients were stratified according to different duration of VA-ECMO therapy: ≤3 days, 4-7 days, 8-10 days, and >10 days. Results: A total of 725 patients with a mean age of 62.9±12.9 years were included. The mean duration of VA-ECMO was 7.1±6.3 days (range: 0-39 days), and 39.4% patients were supported for ≤3 days, 29.1% for 4-7 days, 15.3% for 8-10 days, and finally 20.7% for >10 days. A total of 391 (53.9%) patients were successfully weaned from VA-ECMO while 134 (34.3%) died prior to discharge. Multivariable logistic regression showed that prolonged duration of VA-ECMO therapy (4-7 days, adjusted rate 53.6%, odds ratio [OR] 0.28, 95% confidence interval [CI] 0.18-0.44; 8-10 days, adjusted rate 61.3%,OR 0.51, 95% CI 0.29-0.87; and >10 days, adjusted rate 59.3%,OR 0.49, 95% CI 0.31-0.81) was associated with lower risk of mortality compared with VA-ECMO lasting ≤3 days (adjusted rate 78.3%). Patients requiring VA-ECMO therapy for 8-10 days (OR 1.96, 95% CI 1.15-3.33) and >10 days (OR 1.85, 95% CI 1.14-3.02) had significantly higher mortality compared to those on VA-ECMO for 4-7 days. Conclusions: PCS patients weaned from VA-ECMO after 4 to 7 days of support had significantly lower mortality compared with those with shorter or longer mechanical support.