loading page

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

Corresponding Author:[email protected]

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

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.