Is Extracorporeal Life Support Contraindicated in Elderly Patients?

Saito, Shunsuke; Nakatani, Takeshi; Kobayashi, Junjiro; Tagusari, Osamu; Bando, Ko; Niwaya, Kazuo; Nakajima, Hiroyuki; Miyazaki, Shunichi; Yagihara, Toshikatsu; Kitamura, Soichiro

doi:10.1016/j.athoracsur.2006.08.006

Cited by 56 publications

(43 citation statements)

References 13 publications

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“…We reported an overall mortality of 35.6% and an overall survival rate on ECMO of 64.3% (Table 3), which are similar to other reports (7,12,13,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27), but with a longer time of ECMO duration. This could have different interpretations.…”

Section: Peripheral Ecmo Support In Cardiogenic Shock E59supporting

confidence: 89%

“…Several studies reported the mean time of ECMO duration ranging between 1.7 and 7.1 days (7,12,13,18–27). In our experience, the mean time of ECMO duration was 10.2 ± 7.3 days (range, 2–34 days).…”

Section: Discussionmentioning

confidence: 49%

“…Several studies (7,12,13,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) reported the use of ECMO with the combination of a hollow-fiber microporous oxygenator and a centrifugal pump with described periodical change of both oxygenator and pump. In 2004, the ELSO registry (28) already reported a 27% oxygenator failure and a 36% pump malfunction in patients above 16 years.…”

Section: Discussionmentioning

confidence: 99%

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Peripheral Extracorporeal Membrane Oxygenation System as Salvage Treatment of Patients With Refractory Cardiogenic Shock: Preliminary Outcome Evaluation

et al. 2012

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The novel Permanent Life Support (PLS; Maquet, Jostra Medizintechnik AG, Hirrlingen, Germany) as peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) support system has been investigated as treatment for patients with refractory cardiogenic shock (CS). Between January 2007 and July 2011, 73 consecutive adult patients were supported on peripheral PLS ECMO system at our institution (55 men; age 60.3 ± 11.6 years, range: 23-84 years). Indications for support were failure to wean from cardiopulmonary bypass in the setting of postcardiotomy (n = 50) and primary donor graft failure (n = 8), post-acute myocardial infarction CS (n = 12), and CS on chronic heart failure (n = 3). Mean support time was 10.9 ± 7.6 days (range: 2-34 days). Overall, 26 (35.6%) patients died on ECMO. Among survivors on ECMO, 44 (60.2%) patients were successfully weaned from support, and three (4.1%) were switched to a mid-long-term ventricular assist device. Thirty-three (45.2%) were successfully discharged. The following variables were significantly different if survivors and nonsurvivors on ECMO were compared: age (P = 0.04), female gender (P < 0.01), cardiopulmonary resuscitation before ECMO (P < 0.01), lactate level before ECMO (P = 0.01), number of platelets, fresh frozen plasma units, and packed red blood cells (PRBCs) transfused during ECMO support (P = 0.03, P = 0.02, and P < 0.01), blood lactate level (P = 0.01), and creatine kinase isoenzyme MB (CK-MB) relative index 72 h after ECMO initiation (P < 0.001), and multiple organ failure on ECMO (P < 0.01). Stepwise logistic regression identified blood lactate level and CK-MB relative index at 72 h after ECMO initiation, and number of PRBCs transfused on ECMO as significant predictors of mortality on ECMO (P = 0.011, odds ratio [OR] = 2.48; 95% confidence interval [CI] = 1.11-3.12; P = 0.012, OR = 2.81, 95% CI = 1.026-2.531; and P = 0.012, OR = 1.94, 95% CI = 1.02-5.21; respectively). Patients with an initial poor hemodynamic status could benefit by rapid peripheral installation of PLS ECMO. The blood lactate level, CK-MB relative index, and PRBCs transfused should be strictly monitored during ECMO support.

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Section: Peripheral Ecmo Support In Cardiogenic Shock E59supporting

confidence: 89%

Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 99%

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Peripheral Extracorporeal Membrane Oxygenation System as Salvage Treatment of Patients With Refractory Cardiogenic Shock: Preliminary Outcome Evaluation

et al. 2012

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“…As ECMO is a resource-consuming and highly invasive treatment, the outcome and associated complications deserve extensive research (2,(5)(6)(7)(8)(9). Prognostic factors, including age, gender, pre-ECMO comorbidity, and ECMO-related complications, were investigated in this study based on the 14 years of experience at our institution.…”

Section: Extracorporeal Membrane Oxygenation (Ecmo)mentioning

confidence: 99%

“…However, our analysis yielded the odds ratio of age as only 1.04. A study in Japan of 91 patients concluded that elderly patients did as well as younger counterparts (9). A plausible explanation is that selection bias is always a factor when dealing with old patients.A senior citizen will be recommended to undergo an invasive procedure only if he or she has relatively less underlying disease.…”

Section: Lan Et Al E62mentioning

confidence: 99%

Prognostic Factors for Adult Patients Receiving Extracorporeal Membrane Oxygenation as Mechanical Circulatory Support—A 14‐Year Experience at a Medical Center

et al. 2010

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Extracorporeal membrane oxygenation (ECMO) is a resource-consuming and highly invasive treatment. There were 1100 ECMO cases at the National Taiwan University Hospital between August 1994 and November 2008. Of these, 607 were adults (>18 years old) who received ECMO as mechanical circulatory support. In this study, patient characteristics and complications during the ECMO course were evaluated for their correlation with prognosis. The following factors were significantly different between survivors and nonsurvivors: age, coronary artery disease, diabetes mellitus, brain death, stroke during ECMO, the need for dialysis during ECMO, pre-ECMO infection, hypoglycemia, acidosis, alkalosis, the need for a distal perfusion catheter, and the amount of red blood cells transfused. Six independent predictors of mortality were identified: age, stroke, the need for dialysis during ECMO, pre-ECMO infection, hypoglycemia, and alkalosis. Our institution has comparatively extensive experience with adult patients, which may be quite different from other medical centers with respect to distribution of patient age. The findings should lead to better utilization of ECMO for adult patients in the future.

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Cardiac Arrest and Refractory Cardiogenic Shock

Decker¹

2013

Translational Approach to Heart Failure

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Is Extracorporeal Life Support Contraindicated in Elderly Patients?

Cited by 56 publications

References 13 publications

Peripheral Extracorporeal Membrane Oxygenation System as Salvage Treatment of Patients With Refractory Cardiogenic Shock: Preliminary Outcome Evaluation

Peripheral Extracorporeal Membrane Oxygenation System as Salvage Treatment of Patients With Refractory Cardiogenic Shock: Preliminary Outcome Evaluation

Prognostic Factors for Adult Patients Receiving Extracorporeal Membrane Oxygenation as Mechanical Circulatory Support—A 14‐Year Experience at a Medical Center

Cardiac Arrest and Refractory Cardiogenic Shock

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