PMID- 32171614
OWN - NLM
STAT- MEDLINE
DCOM- 20210325
LR  - 20210325
IS  - 1444-2892 (Electronic)
IS  - 1443-9506 (Linking)
VI  - 29
IP  - 8
DP  - 2020 Aug
TI  - 30-Day Outcomes Post Veno-Arterial Extra Corporeal Membrane Oxygenation (VA-ECMO) 
      After Cardiac Surgery and Predictors of Survival.
PG  - 1217-1225
LID - S1443-9506(20)30038-X [pii]
LID - 10.1016/j.hlc.2020.01.009 [doi]
AB  - BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is 
      sometimes needed for post-cardiotomy cardiogenic shock (PCCS). There is little 
      data regarding outcomes in the Australian context, particularly in a non-cardiac 
      transplant centre. Our aim was to report on 30-day outcomes after patients with 
      PCCS treated with VA-ECMO in an Australian non-cardiac transplant tertiary 
      centre, and to determine risk factors for non-survival in this population. 
      METHODS: A retrospective analysis was performed on all adults treated with 
      VA-ECMO for PCCS between August 2001 and September 2016 at our centre. Univariate 
      analysis with adjustment for multiplicity identified risk factors for 
      non-survival. Area under the receiver operating characteristics (AUROC) method 
      was used to assess their predictive value. RESULTS: We identified 64 patients out 
      of 5,502 open-heart surgery cases of which three patients did not meet inclusion 
      criteria. Mean (SD) age was 63 (14) years. Survival to hospital discharge or 30 
      days post VA-ECMO occurred in 27/61 (44%) patients. VA-ECMO was able to be weaned 
      in 44/61 patients (72%); 54/61 patients (89%) had at least one major 
      complication. Prior to VA-ECMO initiation, no statistically significant 
      differences between survivors and non-survivors could be determined. After 
      VA-ECMO initiation, only 24-hour nadir lactate and 48-hour nadir lactate levels 
      were significantly different between survivors and non-survivors (1.50 mmol/L vs 
      3.20 mmol/L p=0.001; and 1.20 mmol/L vs. 1.90 mmol/L p=0.001 respectively). For 
      mortality prediction, 24- and 48-hour nadir lactate levels had AUROCs of 0.775 
      and 0.782, respectively. CONCLUSIONS: VA-ECMO is associated with acceptable 
      survival rates but significant morbidity. Nadir lactate levels in the first 24 
      and 48 hours after VA-ECMO initiation may be useful in predicting early survival.
CI  - Copyright (c) 2020 Australian and New Zealand Society of Cardiac and Thoracic 
      Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). 
      All rights reserved.
FAU - Hu, Raymond T C
AU  - Hu RTC
AD  - Department of Anaesthesia, Austin Health, Melbourne, Vic, Australia. Electronic 
      address: Raymond.hu@austin.org.au.
FAU - Broad, Jeremy D
AU  - Broad JD
AD  - Department of Anaesthesia, Austin Health, Melbourne, Vic, Australia.
FAU - Osawa, Eduardo A
AU  - Osawa EA
AD  - Department of Intensive Care, Austin Health, Melbourne, Vic, Australia.
FAU - Ancona, Paolo
AU  - Ancona P
AD  - Department of Intensive Care, Austin Health, Melbourne, Vic, Australia.
FAU - Iguchi, Yoko
AU  - Iguchi Y
AD  - Department of Intensive Care, Austin Health, Melbourne, Vic, Australia.
FAU - Miles, Lachlan F
AU  - Miles LF
AD  - Department of Anaesthesia, Austin Health, Melbourne, Vic, Australia.
FAU - Bellomo, Rinaldo
AU  - Bellomo R
AD  - Department of Intensive Care, Austin Health, Melbourne, Vic, Australia.
LA  - eng
PT  - Journal Article
DEP - 20200217
PL  - Australia
TA  - Heart Lung Circ
JT  - Heart, lung & circulation
JID - 100963739
SB  - IM
MH  - Aged
MH  - Cardiac Surgical Procedures/*methods
MH  - Extracorporeal Membrane Oxygenation/*methods
MH  - Female
MH  - Follow-Up Studies
MH  - Hospital Mortality/trends
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Postoperative Care/*methods
MH  - Postoperative Complications/mortality/*prevention & control
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Shock, Cardiogenic/mortality/*prevention & control
MH  - Survival Rate/trends
MH  - Time Factors
MH  - Victoria/epidemiology
OTO - NOTNLM
OT  - Cardiac surgery
OT  - Lactate
OT  - Post-cardiotomy cardiogenic shock
OT  - Survival
OT  - Veno-arterial extracorporeal membrane oxygenation (VA-ECMO)
EDAT- 2020/03/17 06:00
MHDA- 2021/03/26 06:00
CRDT- 2020/03/16 06:00
PHST- 2019/09/17 00:00 [received]
PHST- 2020/01/09 00:00 [revised]
PHST- 2020/01/20 00:00 [accepted]
PHST- 2020/03/17 06:00 [pubmed]
PHST- 2021/03/26 06:00 [medline]
PHST- 2020/03/16 06:00 [entrez]
AID - S1443-9506(20)30038-X [pii]
AID - 10.1016/j.hlc.2020.01.009 [doi]
PST - ppublish
SO  - Heart Lung Circ. 2020 Aug;29(8):1217-1225. doi: 10.1016/j.hlc.2020.01.009. Epub 
      2020 Feb 17.