1. Venoarterial extracorporeal membrane oxygenation after coronary artery bypass grafting:results of a multicenter study
- Author
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Biancari, F. (Fausto), Dalén, M. (Magnus), Perrotti, A. (Andrea), Fiore, A. (Antonio), Reichart, D. (Daniel), Khodabandeh, S. (Sorosh), Gulbins, H. (Helmut), Zipfel, S. (Svante), Al Shakaki, M. (Mosab), Welp, H. (Henryk), Vezzani, A. (Antonella), Gherli, T. (Tiziano), Lommi, J. (Jaakko), Juvonen, T. (Tatu), Svenarud, P. (Peter), Chocron, S. (Sidney), Verhoye, J. P. (Jean Philippe), Bounader, K. (Karl), Gatti, G. (Giuseppe), Gabrielli, M. (Marco), Saccocci, M. (Matteo), Kinnunen, E.-M. (Eeva-Maija), Onorati, F. (Francesco), Santarpino, G. (Giuseppe), Alkhamees, K. (Khalid), Ruggieri, V. G. (Vito G.), and Dell'Aquila, A. M. (Angelo M.)
- Subjects
surgical procedures, operative ,Post-cardiotomy ,Extracorporeal membrane oxygenation ,Coronary artery bypass ,Heart failure ,ECMO ,ECLS ,CABG ,Extracorporeal life support - Abstract
Background: The evidence of the benefits of using venoarterial extracorporeal membrane oxygenation (VA-ECMO) after coronary artery bypass grafting (CABG) is scarce. Methods: We analyzed the outcomes of patients who received VA-ECMO therapy due to cardiac or respiratory failure after isolated CABG in 12 centers between 2005 and 2016. Patients treated preoperatively with ECMO were excluded from this study. Results: VA-ECMO was employed in 148 patients after CABG for median of 5.0 days (mean, 6.4, SD 5.6 days). In-hospital mortality was 64.2%. Pooled in-hospital mortality was 65.9% without significant heterogeneity between the centers (I2 8.6%). The proportion of VA-ECMO in each center did not affect in-hospital mortality (p = 0.861). No patients underwent heart transplantation and six patients received a left ventricular assist device. Logistic regression showed that creatinine clearance (p = 0.004, OR 0.98, 95% CI 0.97–0.99), pulmonary disease (p = 0.018, OR 4.42, 95% CI 1.29–15.15) and pre-VA-ECMO blood lactate (p = 0.015, OR 1.10, 95% CI 1.02–1.18) were independent baseline predictors of in-hospital mortality. One-, 2-, and 3-year survival was 31.0%, 27.9%, and 26.1%, respectively. Conclusions: One third of patients with need for VA-ECMO after CABG survive to discharge. In view of the burden of resources associated with VA-ECMO treatment and the limited number of patients surviving to discharge, further studies are needed to identify patients who may benefit the most from this treatment.
- Published
- 2017