Current aspects of extracorporeal membrane oxygenation in a tertiary referral centre: determinants of survival at follow-up

Flécher, Erwan; Anselmi, Amédéo; Corbineau, Hervé; Langanay, Thierry; Verhoye, Jean‐Philippe; Felix, Carol; Leurent, Guillaume; Tulzo, Yves Le; Malledant, Yannick; Leguerrier, Alain

doi:10.1093/ejcts/ezu029

Cited by 56 publications

(60 citation statements)

References 19 publications

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“…24 Comparing these outcome data is complicated because of differences in patient demographic characteristics and acuity of illness. For instance, the percentage of the patients who were undergoing active cardiopulmonary resuscitation at the time of VA ECMO insertion was 15% in the Fletcher and colleagues series, 23 whereas that was 31% in our series. Analysis is further complicated by the lack of uniform definitions or classifications of refractory cardiogenic shock.…”

Section: Discussioncontrasting

confidence: 67%

Feasibility of smaller arterial cannulas in venoarterial extracorporeal membrane oxygenation

Takayama

Landes

Truby

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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Section: Discussioncontrasting

confidence: 67%

Feasibility of smaller arterial cannulas in venoarterial extracorporeal membrane oxygenation

Takayama

Landes

Truby

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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“…Belle et al 12 described a similar cohort of 51 patients and reported only a 27.5% survival to discharge, likely due to the high percentage of patients cannulated in the setting of refractory cardiac arrest (47.1%). Flécher et al 13 recently published one of the largest series reporting outcomes of VA-ECMO for RCS with 260 patients. He reported a 41% survival rate to 30 days with only 15% of patients receiving CPR at the time of cannulation.…”

Section: Discussionmentioning

confidence: 99%

“…17 In contract, PCS has historically been associated with poor outcomes, with outcomes at 30 days reported as ranging from 11% to 38%. 6,13,18 In contrast to PCS, VA-ECMO utilization for primary graft failure is associated with high rates of survival to discharge and to 30 days. 13 In this study, both AMI and primary graft failure trended toward better outcomes when compared with PCS (Figures 2, 3; Table 5).…”

Section: Discussionmentioning

confidence: 99%

“…6,13,18 In contrast to PCS, VA-ECMO utilization for primary graft failure is associated with high rates of survival to discharge and to 30 days. 13 In this study, both AMI and primary graft failure trended toward better outcomes when compared with PCS (Figures 2, 3; Table 5). Our experience reveals a 48% survival to discharge among AMI patients, which appears lower than other centers' experience despite a similar percentage of patients undergoing active CPR before VA-ECMO cannulation.…”

Section: Discussionmentioning

confidence: 99%

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Contemporary Outcomes of Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock at a Large Tertiary Care Center

et al. 2015

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Refractory cardiogenic shock (RCS) is associated with significant morbidity and mortality, and current mainstays of medical therapy appear inadequate. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) represents an increasingly accepted therapy for RCS. Demographics, past medical history, preoperative characteristics, outcomes, and adverse events were collected for consecutive patients who received VA-ECMO support for RCS at our institution from March 2007 to December 2013. One hundred and seventy-nine patients with a mean age of 56.9 ± 16.1 years were included. Etiologies of RCS included postcardiotomy shock in 70 patients (39%), acute myocardial infarction in 46 patients (26%), primary graft failure in 17 patients (10%), and acute decompensated heart failure in 24 patients (13%). Mean arterial pressure before VA-ECMO support was 59.4 ± 22.8 mm Hg and 30.7% (n = 55) were undergoing active cardiopulmonary resuscitation at the time of cannulation. Overall, 38.6% of patients (n = 69) survived to discharge and 44.7% of patients (n = 80) survived to 30 days. Myocardial recovery was achieved in 79.7% of survivors (n = 55) and 39.1% were transitioned to a more durable device. Univariate analysis identified age (p = 0.002) and etiology of RCS (p = 0.041) as the most significant predictors of in-hospital mortality. Venoarterial extracorporeal membrane oxygenation for RCS appears successful as salvage therapy. Age and etiology should be considered when evaluating patients for VA-ECMO.

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“…Age has previously been shown to be an independent risk factor for increased mortality after ECMO, which we confirmed in this analysis. 8,16,17 Mortality was particularly high in the small group of patients aged ≥75 years. Clearly, significant questions surround the expanded use of this highly invasive and resource intensive modality in a patient group for whom the intervention seems futile.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation in New York State

Batra

Toyoda

Goldstone

et al. 2016

Circ: Heart Failure

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Background— Utilization of extracorporeal membrane oxygenation (ECMO) is expanding despite limited outcome data defining appropriate use. Methods and Results— To quantify determinants of early and 1-year survival after ECMO in adult patients, we conducted a retrospective cohort analysis of 1286 patients aged ≥18 years who underwent ECMO in New York State from 2003 to 2014. Median follow-up time was 4.9 months (range, 0–12 months). ECMO utilization increased from 13 patients in 8 hospitals in 2003 to 330 patients in 30 hospitals in 2014. Compared with patients undergoing ECMO before 2009, later patients were older (54.4 versus 52.3 years; P =0.013) and more likely to have major comorbidity including chronic kidney disease (25.2% versus 13.2%; P =0.02) and liver disease (20.0% versus 10.7%; P =0.001). In the overall cohort, 30-day mortality was 52.2% (95% confidence interval, 49.5–54.9). Mortality at 30 days was 65.2% for patients aged ≥75 years (n=73/112) and 74.6% in patients who required cardiopulmonary resuscitation (n=91/122). Survival at 1 year was 38.4% (95% confidence interval, 35.7–41.0). The 30-day mortality and 1-year survival improved across the study period. In multivariable analysis, earlier year of ECMO, lower hospital volume, indication for ECMO after a cardiac procedure, cardiopulmonary resuscitation before ECMO placement, and age >65 years were independent predictors of worse survival. Conclusions— Outcomes of ECMO have improved despite increasing comorbidity. Extreme mortality after ECMO in elderly patients and patients requiring cardiopulmonary resuscitation indicates that less invasive therapeutic or palliative modalities may be more appropriate in this end-of-life setting.

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Current aspects of extracorporeal membrane oxygenation in a tertiary referral centre: determinants of survival at follow-up

Cited by 56 publications

References 19 publications

Feasibility of smaller arterial cannulas in venoarterial extracorporeal membrane oxygenation

Feasibility of smaller arterial cannulas in venoarterial extracorporeal membrane oxygenation

Contemporary Outcomes of Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock at a Large Tertiary Care Center

Extracorporeal Membrane Oxygenation in New York State

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