Postcardiotomy extracorporeal membrane oxygenator: No longer a bridge to no where?

Merritt-Genore, HelenMari; Schwabe, Michael; Luksan, Abel; Ryan, Timothy; Lyden, Elizabeth; Moulton, Michael J.

doi:10.1111/jocs.14715

Cited by 3 publications

(4 citation statements)

References 8 publications

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“…One recent study by Radakovic et al [22] showed that central arterial cannulation was associated with improved survival compared to peripheral cannulation. A series of small sample size by Merritt-Genore et al [23] confirmed that central arterial cannulation was associated with improved survival after postcardiotomy VA-ECMO. However, neither study was adjusted for potentially relevant risk factors, and they were not adequately powered.…”

Section: Discussionmentioning

confidence: 95%

Central versus Peripheral Postcardiotomy Veno-Arterial Extracorporeal Membrane Oxygenation: Systematic Review and Individual Patient Data Meta-Analysis

Biancari

Kaserer

Perrotti

et al. 2022

JCM

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Background: It is unclear whether peripheral arterial cannulation is superior to central arterial cannulation for postcardiotomy veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Methods: A systematic review was conducted using PubMed, Scopus, and Google Scholar to identify studies on postcardiotomy VA-ECMO for the present individual patient data (IPD) meta-analysis. Analysis was performed according to the intention-to-treat principle. Results: The investigators of 10 studies agreed to participate in the present IPD meta-analysis. Overall, 1269 patients were included in the analysis. Crude rates of in-hospital mortality after central versus peripheral arterial cannulation for VA-ECMO were 70.7% vs. 63.7%, respectively (adjusted OR 1.38, 95% CI 1.08–1.75). Propensity score matching yielded 538 pairs of patients with balanced baseline characteristics and operative variables. Among these matched cohorts, central arterial cannulation VA-ECMO was associated with significantly higher in-hospital mortality compared to peripheral arterial cannulation VA-ECMO (64.5% vs. 70.8%, p = 0.027). These findings were confirmed by aggregate data meta-analysis, which showed that central arterial cannulation was associated with an increased risk of in-hospital mortality compared to peripheral arterial cannulation (OR 1.35, 95% CI 1.04–1.76, I2 21%). Conclusions: Among patients requiring postcardiotomy VA-ECMO, central arterial cannulation was associated with an increased risk of in-hospital mortality compared to peripheral arterial cannulation. This increased risk is of limited magnitude, and further studies are needed to confirm the present findings and to identify the mechanisms underlying the potential beneficial effects of peripheral VA-ECMO.

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Section: Discussionmentioning

confidence: 95%

Central versus Peripheral Postcardiotomy Veno-Arterial Extracorporeal Membrane Oxygenation: Systematic Review and Individual Patient Data Meta-Analysis

Biancari

Kaserer

Perrotti

et al. 2022

JCM

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“…The reports that support a benefit to central cannulation have low sample sizes. 8 , 11 The studies that show improved outcomes with peripheral cannulation include more patients, and include a meta-analysis, but are still retrospective. 9 , 12 , 13 Mariscalco and colleagues 9 published the largest study (apart from meta-analyses) and showed that peripherally cannulated patients had a lower in-hospital mortality.…”

Section: Discussionmentioning

confidence: 99%

“…In a second study data on 31 patients requiring ECMO cannulation within 72 hours of a cardiac operation were reviewed and the authors showed that centrally cannulated patients were more likely to wean from ECMO and more likely to survive the hospitalization. 11 …”

Section: Central Ecmomentioning

confidence: 99%

Postcardiotomy shock extracorporeal membrane oxygenation: Peripheral or central?

Bowles

Hiesinger

2021

JTCVS Open

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Postcardiotomy shock (PCS) is poorly defined in the literature, but is broadly understood to mean circulatory failure after cardiac surgery necessitating mechanical circulatory support and high-dose inotropes. PCS occurs in 0.5% to 1.5% of all cardiac surgeries and is important to better understand because it has an in-hospital mortality rate >50%. 1,2 In the past there were a limited number of ways to support a patient in such profound cardiogenic shock, but today there are multiple mechanical circulatory support devices available. These include extracorporeal membrane oxygenation (ECMO), and several distinct technologies that fall into the category of ventricular assist device (VAD). VADs can be further classified by whether they provide short-term or long-term support, and percutaneous versus open insertion. 2 ECMO has become the most widely used support system for PCS. 3 Relative ease of ECMO cannulation and ability to deploy ECMO quickly in an emergency likely contribute to widespread use. Over the past 2 decades there has been a large increase in use of ECMO for all underlying etiologies, and a fivefold increase in the use of ECMO specifically for PCS. Unfortunately, the increase in use has not been paralleled by improved survival for patients in whom it is used. 3,4 The percentage of PCS patients treated with ECMO who survive to hospital discharge varies on the basis of source, but ranges from approximately 30% to 60%. [4][5][6] Several retrospective analyses have attempted to identify patient-specific characteristics associated with mortality in PCS patients. 3,6,7 A variety of factors have been identified in at least 1 study including age older than 70 years, preoperative renal insufficiency, obesity, female sex, and type of cardiac surgery among others. 1,3,6 In a recent analysis patients in two 5-year time periods (2007( -2012( and 2013

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“…The mortality rate of postoperative cardiogenic shock remains high [1,[10][11][12]. Based on data from smaller, contemporary studies, the rate has possibly improved due to the evolution of ECMO technology over the last two decades and the innovations of MCS devices [13,14]. Cardiogenic shock still represents a challenging spectrum of cardiac surgery, and smaller cardiac centers find it difficult to manage this patient population.…”

Section: Commentmentioning

confidence: 99%

Veno-arterial extracorporeal membrane oxygenation for post-infarction ventricular septal defect in a low-volume center

Antonic¹,

Djordjevic²,

Podlesnikar³

et al. 2023

J Extra Corpor Technol

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Managing patients with post-ischaemic ventricular septal defects (VSD) and postcardiotomy cardiogenic shock can be extremely challenging in a low-volume cardiac surgery unit. We present a case of a 68-year-old patient who received veno-arterial extracorporeal membrane oxygenation support due to cardiogenic shock after VSD repair. The patient was successfully weaned off support after 86 hours. In the postoperative period, mediastinitis occurred, and negative pressure wound therapy was instituted.

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Postcardiotomy extracorporeal membrane oxygenator: No longer a bridge to no where?

Cited by 3 publications

References 8 publications

Central versus Peripheral Postcardiotomy Veno-Arterial Extracorporeal Membrane Oxygenation: Systematic Review and Individual Patient Data Meta-Analysis

Central versus Peripheral Postcardiotomy Veno-Arterial Extracorporeal Membrane Oxygenation: Systematic Review and Individual Patient Data Meta-Analysis

Postcardiotomy shock extracorporeal membrane oxygenation: Peripheral or central?

Veno-arterial extracorporeal membrane oxygenation for post-infarction ventricular septal defect in a low-volume center

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