Evaluation of risk factors for adverse outcome in extracorporeal membrane oxygenation–supported elderly postcardiotomy patients

Samalavičius, Robertas; Norkienė, Ieva; Ščupakova, Nadežda; Sabliauskas, Jurij; Urbonas, Karolis; Andrijauskas, Paulius; Jankuvienė, Agnė; Puodžiukaitė, Lina; Zorinas, Aleksejus; Janušauskas, Vilius; Ručinskas, Kęstutis; Laurušonis, Kęstutis; Šerpytis, Pranas

doi:10.1177/0267659120907746

Cited by 8 publications

(7 citation statements)

References 21 publications

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“…A total of 273 articles were yielded from a systematic review of the literature and 31 studies were considered suitable for the present analysis. The investigators of 10 studies 2,[8][9][10][11][12][13][14][15][16] provided data for the present analysis. The types and quality of the included studies are summarized in Table 2.…”

Section: Resultsmentioning

confidence: 99%

Inter-institutional analysis of the outcome after postcardiotomy veno-arterial extracorporeal membrane oxygenation

Biancari,

Mäkikallio,

Loforte

et al. 2023

Int J Artif Organs

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Introduction: Patients requiring postcardiotomy veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) have a high risk of early mortality. In this analysis, we evaluated whether any interinstitutional difference exists in the results of postcardiotomy V-A-ECMO. Methods: Studies on postcardiotomy V-A-ECMO were identified through a systematic review for individual patient data (IPD) meta-analysis. Analysis of interinstitutional results was performed using direct standardization, estimation of observed/expected in-hospital mortality ratio and propensity score matching. Results: Systematic review of the literature yielded 31 studies. Data from 10 studies on 1269 patients treated at 25 hospitals were available for the present analysis. In-hospital mortality was 66.7%. The relative risk of in-hospital mortality was significantly higher in six hospitals. Observed versus expected in-hospital mortality ratio showed that four hospitals were outliers with significantly increased mortality rates, and one hospital had significantly lower in-hospital mortality rate. Participating hospitals were classified as underperforming and overperforming hospitals if their observed/expected in-hospital mortality was higher or lower than 1.0, respectively. Among 395 propensity score matched pairs, the overperforming hospitals had significantly lower in-hospital mortality (60.3% vs 71.4%, p = 0.001) than underperforming hospitals. Low annual volume of postcardiotomy V-A-ECMO tended to be predictive of poor outcome only when adjusted for patients’ risk profile. Conclusions: In-hospital mortality after postcardiotomy V-A-ECMO differed significantly between participating hospitals. These findings suggest that in many centers there is room for improvement of the results of postcardiotomy V-A-ECMO.

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Section: Resultsmentioning

confidence: 99%

Inter-institutional analysis of the outcome after postcardiotomy veno-arterial extracorporeal membrane oxygenation

Biancari,

Mäkikallio,

Loforte

et al. 2023

Int J Artif Organs

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“…A total of 16 patients (80.0%) who underwent reoperation survived to discharge. Patients undergoing elective surgery had a significantly shorter duration of postoperative mechanical ventilation (PMV) (14 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] vs. 24 hours, p < 0.001) and length of intensive care unit stay (3 [2-6] vs. 5 [3][4][5][6][7][8] days, p ¼ 0.001).…”

Section: Resultsmentioning

confidence: 99%

“…16 Although current literature suggests that the age itself does not affect the outcomes of extracorporeal life support (ECLS) in the older patients, the baseline condition is what influences the survival after ECLS therapy in older patients. 17,18 In the unmatched cohort, a total of 12 patients (1.7%) required ECLS postoperatively. Among these patients, only one patient survived to discharge.…”

Section: Discussionmentioning

confidence: 99%

Clinical Results and Quality of Life after Nonelective Cardiac Surgery in Octogenarians

Saha

Lang

Linden

et al. 2021

Thorac Cardiovasc Surg

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Background We analyzed the short-term and mid-term outcomes as well as the health-related quality of life (HRQOL) of octogenarians undergoing elective and urgent cardiac surgery. Patients and Methods We retrospectively identified 688 consecutive octogenarians who underwent cardiac surgery at our center between January 2012 and December 2019. A propensity score matching was performed which resulted in the formation of 80 matched pairs. The patients were interviewed and the Short Form-36 survey was used to assess the HRQOL of survivors. Multivariable analysis incorporated binary logistic regression using a forward stepwise (conditional) model. Results The median age of the matched cohort was 82 years (p = 0.937), among whom, 38.8% of patients were female (p = 0.196). The median EuroSCORE II of the matched cohort was 19.4% (10.1–39.1%). The duration of postoperative mechanical ventilation was found to be independently associated with in-hospital mortality (odds ratio: 1.01 [95% confidence interval: 1.0–1.02], p = 0.038). The survival rates at 1, 2, and 5 years was 75.0, 72.0, and 46.0%, respectively. There was no difference in the total survival between the groups (p = 0.080). The physical health summary score was 41 (30–51) for the elective patients and 42 (35–49) for the nonelective octogenarians (p = 0.581). The median mental health summary scores were 56 (48–60) and 58 (52–60), respectively (p = 0.351). Conclusion Cardiac surgery can be performed in octogenarians with good results and survivors enjoy a good quality of life; however, the indication for surgery or especially for escalation of therapy should always be made prudently, reserved, and in consideration of patient expectations.

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“…Statistically significant higher lactate level before ECMO initiation was found in the septuagenarian patient group. High lactate level before the initiation of ECMO support was shown to be an important prognostic factor of unfavorable outcomes in the elderly population [ 17 , 18 ]. Multivariate analysis revealed that intubation time before ECMO initiation was a significant predictor of hospital survival.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Life Support for Cardiogenic Shock in Octogenarians: Single Center Experience

Ščupakova

Urbonas

Jankuvienė

et al. 2023

JCM

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Background: The age limit for the use of extracorporeal membrane oxygenation (ECMO) support for post-cardiotomy cardiac failure is not defined. The aim of the study was to evaluate the outcomes of octogenarians supported with ECMO due to cardiogenic shock. Methods: A retrospective review of consecutive elderly patients supported with ECMO during a 13-year period in a tertiary care center. Patient’s demographic variables, comorbidities, perioperative data and outcomes were collected from patient medical records. Data of octogenarian patients were compared with the septuagenarian group. The main outcomes of the study was in hospital mortality, 6-month survival and 1-year survival after hospital discharge and discharge options. Multivariate logistic regression analysis was performed to identify the factors associated with hospital survival. Results: Eleven patients (18.3%) in the elderly group were octogenarians (aged 80 years or above), and forty-nine (81.7%) were septuagenarians (aged 70–79 years). There were no differences except age in demographic and preoperative variables between groups. Pre ECMO SAVE, SOFA, SAPS—II and inotropic scores were significantly higher in septuagenarians than octogenarians. There was no statistically significant difference in hospital mortality, 6-month survival, 1 year survival or discharge options between groups. Conclusions: ECMO could be successfully used in selected octogenarian patients undergoing cardiac surgery to support a failing heart. An early decision to initiate ECMO therapy in elderly post-cardiotomy shock patients is associated with favorable outcomes.

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Evaluation of risk factors for adverse outcome in extracorporeal membrane oxygenation–supported elderly postcardiotomy patients

Cited by 8 publications

References 21 publications

Inter-institutional analysis of the outcome after postcardiotomy veno-arterial extracorporeal membrane oxygenation

Inter-institutional analysis of the outcome after postcardiotomy veno-arterial extracorporeal membrane oxygenation

Clinical Results and Quality of Life after Nonelective Cardiac Surgery in Octogenarians

Extracorporeal Life Support for Cardiogenic Shock in Octogenarians: Single Center Experience

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