Peripheral versus central extracorporeal membrane oxygenation for postcardiotomy shock: Multicenter registry, systematic review, and meta-analysis

Mariscalco, Giovanni; Salsano, Antonio; Fiore, Antonio; Dalén, Magnus; Ruggieri, Vito Giovanni; Saeed, Diyar; Jónsson, Kristján; Gatti, Giuseppe; Zipfel, S.; Dell’Aquila, Angelo M.; Perrotti, Andréa; Loforte, Antonio; Livi, Ugolino; Pol, Marek; Spadaccio, Cristiano; Pettinari, Matteo; Ragnarsson, Sigurður; Alkhamees, Khalid; El-Dean, Zein; Bounader, Karl; Biancari, Fausto

doi:10.1016/j.jtcvs.2019.10.078

Cited by 87 publications

(79 citation statements)

References 94 publications

(139 reference statements)

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“…Our results were going with Mariscalco et al recent study of 718 adult patients with postcardiotomy shock on VA-ECMO support from 19 cardiac surgical centers. Mariscalco et al concluded that central VA-ECMO was associated with more hospital mortality, more bleeding, and excess blood products transfusions compared to peripheral VA-ECMO [ 23 ]. On the contrary, Djordjevic et al retrospectively analysed 156 patients with postcardiotomy cardiogenic shock on VA-ECMO support and excluded significant 30 days mortality differences between central and peripheral VA-ECMO groups, but the patients with peripheral ECMO had significantly less mediastinal bleeding, less fresh frozen plasma transfusions, and less mediastinal explorations compared to those with central VA-ECMO support [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

The Validity of SOFA Score to Predict Mortality in Adult Patients with Cardiogenic Shock on Venoarterial Extracorporeal Membrane Oxygenation

Laimoud

Alanazi

2020

Critical Care Research and Practice

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Background. Venoarterial ECMO is increasingly used in resuscitation of adult patients with cardiogenic shock with variable mortality reports worldwide. Our objectives were to study the variables associated with hospital mortality in adult patients supported with VA-ECMO and to determine the validity of repeated assessments of those patients by the Sequential Organ Failure Assessment (SOFA) score for prediction of hospital mortality. We retrospectively studied adult patients admitted to the cardiac surgical critical care unit with cardiogenic shock supported with VA-ECMO from January 2015 to August 2019 in our tertiary care hospital. Results. One hundred and six patients supported with VA-ECMO were included in our study with in-hospital mortality of 56.6%. The mean age of studied patients was 40.2 ± 14.4 years, and the patients were mostly males (69.8%) with a mean BMI of 26.5 ± 7 without statistically significant differences between survivors and nonsurvivors. Presence of CKD, chronic atrial fibrillation, and cardiac surgeries was significantly more frequent in the nonsurvivors group. The nonsurvivors had more frequent AKI (p<0.001), more haemodialysis use (p<0.001), more gastrointestinal bleeding (p=0.039), more ICH (p=0.006), and fewer ICU days (p=0.002) compared to the survivors group. The mean peak blood lactate level was 11 ± 3 vs 16.7 ± 3.3, p<0.001, and the mean lactate level after 24 hours of ECMO initiation was 2.2 ± 0.9 vs 7.9 ± 5.7, p<0.001, in the survivors and nonsurvivors, respectively. Initial SOFA score ≥13 measured upon ICU admission had a 85% sensitivity and 73.9% specificity for predicting hospital mortality [AUROC = 0.862, 95% CI: 0.791–0.932; p<0.001] with 81% PPV, 79.1% NPV, and 80.2% accuracy while SOFA score ≥13 at day 3 had 100% sensitivity and 91.3% specificity for predicting mortality with 93.8% PPV, 100% NPV, and 96.2% accuracy [AUROC = 0.995, 95% CI: 0.986–1; p<0.001]. The ∆1 SOFA (3-1) ≥2 had 95% sensitivity and 93.5% specificity for predicting hospital mortality [AUROC = 0.958, 95% CI: 0.913–1; p<0.001] with 95% PPV, 93.5% NPV, and 94.3% accuracy. SOFA score ≥15 at day 5 had 98% sensitivity and 100% specificity for predicting mortality with 99% accuracy [AUROC = 0.994, 95% CI: 0.982–1; p<0.001]. The ∆2 SOFA (5-1) ≥2 had 90% sensitivity and 97.8% specificity for predicting hospital mortality [AUROC = 0.958, 95% CI: 0.909–1; p<0.001] with 97.8% PPV, 90% NPV, and 94.8% accuracy. Multivariable regression analysis revealed that increasing ∆1 SOFA score (OR = 2.506, 95% CI: 1.681–3.735, p<0.001) and increasing blood lactate level (OR = 1.388, 95% CI: 1.015–1.898, p=0.04) were significantly associated with hospital mortality after VA-ECMO support for adults with cardiogenic shock. Conclusion. The use of VA-ECMO in adult patients with cardiogenic shock is still associated with high mortality. Serial evaluation of those patients with SOFA score during the first few days of ECMO support is a good predictor of hospital mortality. Increase in SOFA score after 48 hours and hyperlactataemia are significantly associated with increased hospital mortality.

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Section: Discussionmentioning

confidence: 99%

The Validity of SOFA Score to Predict Mortality in Adult Patients with Cardiogenic Shock on Venoarterial Extracorporeal Membrane Oxygenation

Laimoud

Alanazi

2020

Critical Care Research and Practice

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“…In contrast, Mariscalco et al 12 observed an advantage towards peripheral cannulation in their study with in‐hospital mortality of 61% compared with a 71.8% ( P = .004) mortality in patients undergoing central cannulation. Lower risk of reoperation for bleeding, perioperative bleeding, and blood transfusion requirements were also observed in the peripheral cannulated cohort.…”

Section: Discussionmentioning

confidence: 70%

“…Mariscalco et al 12 described the 30‐day mortality of va ECMO treatment after PCS to be nearly 70% in their systematic review. Although va ECMO treatment after PCS is presenting considerably high mortality, all patients would have very likely faced certain death.…”

Section: Discussionmentioning

confidence: 99%

Central vs peripheral venoarterial ECMO in postcardiotomy cardiogenic shock

et al. 2020

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Objectives: Central or peripheral venoarterial extracorporeal membrane oxygenation (va ECMO) is widely used in postcardiotomy cardiogenic shock (PCS). Available data suggest controversial results for both types. Our aim was to investigate PCS patients treated with either peripheral (pECMO) or central ECMO (cECMO) concerning their outcome. Methods: Between April 2006 and October 2016, 156 consecutive patients with va ECMO therapy due to PCS were identified and included in this retrospective analysis. Patients were divided into cECMO and pECMO groups. Statistical analysis of risk factors concerning 30-day mortality of the mentioned patient cohort was performed using IBM SPSS Statistics.Results: Fifty-six patients received cECMO and 100 patients were treated with pECMO due to PCS. In the group of cECMO peripheral vascular disease was significantly more present (cECMO 19 [34%] vs pECMO 14 [14%]; P < .01). On-site ECMO complications occurred significantly more frequent in patients treated with cECMO (cECMO 44 [79%] vs pECMO 54 [54%] g/dL; P < 0.01). More often cECMO patients required a second look operation due to mediastinal bleeding (cECMO 52 [93%] vs pECMO 61 [61%] g/dL; P < .01). Thirty-day mortality was comparable with nearly 70% in both cohorts (cECMO 39 [70%] vs pECMO 69 [69%]; P = .93).Conclusion: Patients supported by cECMO or pECMO due to refractory PCS did not show significant differences in 30-day mortality, despite a lower incidence of on-site ECMO complications and re-exploration in pECMO patients. PCS itself is associated with high mortality and peripheral cannulation might help to save resources compared with central cannulation. K E Y W O R D S central ECMO, peripheral ECMO, postcardiotomy cardiogenic shock, va ECMO Ilija Djordjevic and Kaveh Eghbalzadeh contributed equally to this study.

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“…He has been guest editor‐in‐chief of books and international focused issues on ECLS, durable MCS, and heart transplantation (Htx) 1‐4 . He is active in numerous clinical and experimental international research projects, registries, task forces, guidelines, and multidisciplinary committees mainly focusing on Htx and MCS 5‐17 …”

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confidence: 99%

Antonio Loforte to serve as an Associate Editor of Artificial Organs

Tchantchaleishvili

2021

Artificial Organs

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Dr. Loforte is member of a number of professional organizations including the prestigious STS, ISHLT, ASAIO, EACTS, ISMCS (ISRBP), ELSO, RHICS, SICCH, SITO, among others. He has lectured worldwide and has written >400 articles including peer-reviewed original articles, abstracts, conference proceedings, book chapters, and manuals. He has been guest editor-in-chief of books and international focused issues on ECLS, durable MCS, and heart transplantation (Htx). 1-4 He is active in numerous clinical and experimental international research projects, registries, task forces, guidelines, and multidisciplinary committees mainly focusing on Htx and MCS. 5-17 His research focus is in experimental and clinical studies on physiologic response to innovative and alternative treatment strategies for pediatric and adult patients suffering from advanced heart failure. 5-17 He serves as a reviewer for 25 international journals including the

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Peripheral versus central extracorporeal membrane oxygenation for postcardiotomy shock: Multicenter registry, systematic review, and meta-analysis

Cited by 87 publications

References 94 publications

The Validity of SOFA Score to Predict Mortality in Adult Patients with Cardiogenic Shock on Venoarterial Extracorporeal Membrane Oxygenation

The Validity of SOFA Score to Predict Mortality in Adult Patients with Cardiogenic Shock on Venoarterial Extracorporeal Membrane Oxygenation

Central vs peripheral venoarterial ECMO in postcardiotomy cardiogenic shock

Antonio Loforte to serve as an Associate Editor of Artificial Organs

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