On-Support and Postweaning Mortality in Postcardiotomy Extracorporeal Membrane Oxygenation.
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Mariani Silvia, Schaefer Anne-Kristin, van Bussel Bas C T, Di Mauro Michele, Conci Luca, Szalkiewicz Philipp, De Piero Maria Elena, Heuts Samuel, Ravaux Justine, van der Horst Iwan C C, Saeed Diyar, Pozzi Matteo, Loforte Antonio, Boeken Udo, Samalavicius Robertas, Bounader Karl, Hou Xiaotong, Bunge Jeroen J H, Buscher Hergen, Salazar Leonardo, Meyns Bart, Herr Daniel, Matteucci Sacha, Sponga Sandro, MacLaren Graeme, Russo Claudio, Formica Francesco, Sakiyalak Pranya, Fiore Antonio, Camboni Daniele, Raffa Giuseppe Maria, Diaz Rodrigo, Wang I-Wen, Jung Jae-Seung, Belohlavek Jan, Pellegrino Vin, Bianchi Giacomo, Pettinari Matteo, Barbone Alessandro, Garcia José P, Whitman Glenn, Shekar Kiran, Wiedemann Dominik, Lorusso Roberto, PELS Investigators
Аннотация
METHODS: The retrospective, multicenter, observational Postcardiotomy Extracorporeal Life Support Study (PELS) includes adults requiring postcardiotomy VA ECMO between 2000 and 2020. Variables associated with on-ECMO mortality and postweaning mortality were modeled using mixed Cox proportional hazards, including random effects for center and year.
RESULTS: In 2058 patients (men, 59%; median age, 65 years; interquartile range [IQR], 55-72 years), weaning rate was 62.7%, and survival to discharge was 39.6%. Patients who died (n = 1244) included 754 on-ECMO deaths (36.6%; median support time, 79 hours; IQR, 24-192 hours), and 476 postweaning deaths (23.1%; median support time, 146 hours; IQR, 96-235.5 hours). Multiorgan (n = 431 of 1158 [37.2%]) and persistent heart failure (n = 423 of 1158 [36.5%]) were the main causes of death, followed by bleeding (n = 56 of 754 [7.4%]) for on-ECMO mortality and sepsis (n = 61 of 401 [15.4%]) for postweaning mortality. On-ECMO death was associated with emergency surgery, preoperative cardiac arrest, cardiogenic shock, right ventricular failure, cardiopulmonary bypass time, and ECMO implantation timing. Diabetes, postoperative bleeding, cardiac arrest, bowel ischemia, acute kidney injury, and septic shock were associated with postweaning mortality.
CONCLUSIONS: A discrepancy exists between weaning and discharge rate in postcardiotomy ECMO. Deaths occurred during ECMO support in 36.6% of patients, mostly associated with unstable preoperative hemodynamics. Another 23.1% of patients died after weaning in association with severe complications. This underscores the importance of postweaning care for postcardiotomy VA ECMO patients.