Variables associated with in-hospital and postdischarge outcomes after postcardiotomy extracorporeal membrane oxygenation: Netherlands Heart Registration Cohort

Mariani, Silvia; Bussel, Bas C.T. van; Ravaux, Justine M.; Roefs, Maaike M.; Piero, Maria Elena De; Mauro, Michele Di; Willers, Anne; Segers, Patrique; Delnoij, Thijs; Horst, Iwan C. C. van der; Lorusso, Roberto; Bekkers, Jos A.; Gründeman, Paul F.; Brakel, Thomas J. van; Bramer, Sander; Daeter, Edgar J.; Hoohenkerk, Gerard JF.; Kaaij, Niels P. van der; Koene, Bart MJA.; Li, Wilson WL.; Markou, Thanasie ALP.; Douglas, Yvonne L.; Porta, Fabiano; Speekenbrink, Ron GH.; Stooker, Wim; Vonk, Alexander BA.

doi:10.1016/j.jtcvs.2022.08.024

Cited by 10 publications

(9 citation statements)

References 26 publications

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“…Even if the number of respondents is still considered to be small, data suggest an apparent variability of PC‐ECLS practice that may, in and of itself, minimize nonresponse bias 25 . Finally, there might be variations in ECLS management modalities due to nonclinical factors, including financial, historical, cultural, and ethical factors 26 . However, exploring these was beyond the scope of this survey.…”

Section: Discussionmentioning

confidence: 97%

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Heterogeneity in clinical practices for post‐cardiotomy extracorporeal life support: A pilot survey from the PELS‐1 multicenter study

et al. 2023

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BackgroundHigh‐quality evidence for post‐cardiotomy extracorporeal life support (PC‐ECLS) management is lacking. This study investigated real‐world PC‐ECLS clinical practices.MethodsThis cross‐sectional, multi‐institutional, international pilot survey explored center organization, anticoagulation management, left ventricular unloading, distal limb perfusion, PC‐ECLS monitoring, and transfusion practices. Twenty‐nine questions were distributed among 34 hospitals participating in the Post‐cardiotomy Extra‐Corporeal Life Support Study.ResultsOf the 32 centers [16 low‐volume (50%); 16 high‐volume (50%)] that responded, 16 (50%) had dedicated ECLS specialists. Twenty‐six centers (81.3%) reported using additional mechanical circulatory supports. Anticoagulation practices were highly heterogeneous: 24 hospitals (75%) reported using patients bleeding status as a guide, without a specific threshold in 54.2% of cases. Transfusion targets ranged from 7 to 10 g/dL. Most centers used cardiac venting on a case‐by‐case basis (78.1%) and regular distal limb perfusion (84.4%). Nineteen (54.9%) centers reported dedicated monitoring protocols, including daily echocardiography (87.5%), Swan‐Ganz catheterization (40.6%), cerebral near‐infrared spectroscopy (53.1%), and multimodal assessment of limb ischemia. Inspection of the circuit (71.9%), oxygenator pressure drop (68.8%), plasma free hemoglobin (75%), d‐dimer (59.4%), lactate dehydrogenase (56.3%), and fibrinogen (46.9%) are used to diagnose hemolysis and thrombosis.ConclusionsThis study shows remarkable heterogeneity in clinical practices for PC‐ECLS management. More standardized protocols and better implementation of the available evidence are recommended.

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Section: Discussionmentioning

confidence: 97%

“…25 Finally, there might be variations in ECLS management modalities due to nonclinical factors, including financial, historical, cultural, and ethical factors. 26 However, exploring these was beyond the scope of this survey.…”

Section: Overall (Nmentioning

confidence: 99%

Heterogeneity in clinical practices for post‐cardiotomy extracorporeal life support: A pilot survey from the PELS‐1 multicenter study

et al. 2023

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“…The growing experience with V-A-ECMO management and the introduction of new technologies in this field are likely of importance to prevent end-organ complications and to establish a safe weaning protocol with higher on ECMO and post-ECMO survival. 19 However, we believe that variation of mortality between hospitals may be related also to the ability to promptly recognize and treat postoperative complications. In 1992, Silber et al 20 introduced the concept of failure to rescue.…”

Section: Discussionmentioning

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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“…48 Especially in the case of intraoperative MCS initiation, central cannulation or mixed/dynamic VA-ECMO configurations are more frequently used than in other clinical scenarios. 49 In addition, the patient’s preoperative condition, use of other MCS devices and cardiopulmonary bypass, and specific procedure-related complications, as well, contribute to the complexity of this patient population. Several large retrospective studies (Table S2) have identified risk factors associated with in-hospital mortality, including age, 49,50 lactate level, 50 renal function, 50 and preoperative cardiac arrest, 49 which should be considered during the decision-making process for VA-ECMO according to the 2020 European Association for Cardio-Thoracic Surgery/ELSO/Society of Thoracic Surgeons/American Association for Thoracic Surgery consensus document.…”

Section: Va-ecmo In Csmentioning

confidence: 99%

Scrutinizing the Role of Venoarterial Extracorporeal Membrane Oxygenation: Has Clinical Practice Outpaced the Evidence?

Lüsebrink,

Binzenhöfer,

Hering

et al. 2024

Circulation

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The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) for temporary mechanical circulatory support in various clinical scenarios has been increasing consistently, despite the lack of sufficient evidence regarding its benefit and safety from adequately powered randomized controlled trials. Although the ARREST trial (Advanced Reperfusion Strategies for Patients with Out-of-Hospital Cardiac Arrest and Refractory Ventricular Fibrillation) and a secondary analysis of the PRAGUE OHCA trial (Prague Out-of-Hospital Cardiac Arrest) provided some evidence in favor of VA-ECMO in the setting of out-of-hospital cardiac arrest, the INCEPTION trial (Early Initiation of Extracorporeal Life Support in Refractory Out-of-Hospital Cardiac Arrest) has not found a relevant improvement of short-term mortality with extracorporeal cardiopulmonary resuscitation. In addition, the results of the recently published ECLS-SHOCK trial (Extracorporeal Life Support in Cardiogenic Shock) and ECMO-CS trial (Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock) discourage the routine use of VA-ECMO in patients with infarct-related cardiogenic shock. Ongoing clinical trials (ANCHOR [Assessment of ECMO in Acute Myocardial Infarction Cardiogenic Shock, NCT04184635], REVERSE [Impella CP With VA ECMO for Cardiogenic Shock, NCT03431467], UNLOAD ECMO [Left Ventricular Unloading to Improve Outcome in Cardiogenic Shock Patients on VA-ECMO, NCT05577195], PIONEER [Hemodynamic Support With ECMO and IABP in Elective Complex High-risk PCI, NCT04045873]) may clarify the usefulness of VA-ECMO in specific patient subpopulations and the efficacy of combined mechanical circulatory support strategies. Pending further data to refine patient selection and management recommendations for VA-ECMO, it remains uncertain whether the present usage of this device improves outcomes.

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Variables associated with in-hospital and postdischarge outcomes after postcardiotomy extracorporeal membrane oxygenation: Netherlands Heart Registration Cohort

Cited by 10 publications

References 26 publications

Heterogeneity in clinical practices for post‐cardiotomy extracorporeal life support: A pilot survey from the PELS‐1 multicenter study

Heterogeneity in clinical practices for post‐cardiotomy extracorporeal life support: A pilot survey from the PELS‐1 multicenter study

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

Scrutinizing the Role of Venoarterial Extracorporeal Membrane Oxygenation: Has Clinical Practice Outpaced the Evidence?

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