PMID- 33417704
OWN - NLM
STAT- MEDLINE
DCOM- 20211014
LR  - 20220109
IS  - 1569-9285 (Electronic)
IS  - 1569-9293 (Print)
IS  - 1569-9285 (Linking)
VI  - 32
IP  - 5
DP  - 2021 May 10
TI  - 30-Day perioperative mortality following venoarterial extracorporeal membrane 
      oxygenation for postcardiotomy cardiogenic shock in patients with normal 
      preoperative ejection fraction.
PG  - 817-824
LID - 10.1093/icvts/ivaa323 [doi]
AB  - OBJECTIVES: Assessment of early outcomes in patients with normal preoperative 
      left ventricular ejection fraction (LVEF) in whom venoarterial extracorporeal 
      membrane oxygenation (VA-ECMO) was implanted for postcardiotomy cardiogenic shock 
      (PCCS) during the first postoperative 48 h. METHODS: Retrospective single-centre 
      analysis in adult patients with normal LVEF, who received VA-ECMO support for 
      PCCS from May 1998 to May 2018. The primary outcome was 30-day perioperative 
      mortality during the index hospitalization. RESULTS: A total of 62 125 adult 
      patients underwent cardiac surgery at our institution during the study period. 
      Among them, 173 patients (0.3%) with normal preoperative LVEF required VA-ECMO 
      for PCCS. Among them, 71 (41.1%) patients presented PCCS due to coronary 
      malperfusion and in 102 (58.9%) patients, no evident cause was found for PCCS. 
      Median duration of VA-ECMO support was 5 days (interquartile range 2-8 days). A 
      total of 135 (78.0%) patients presented VA-ECMO-related complications and the 
      overall 30-day perioperative mortality was 57.8%. Independent predictors of 
      mortality were: lactate level just before VA-ECMO implantation [odds ratio (OR) 
      1.27; P < 0.001], major bleeding during VA-ECMO (OR 3.76; P = 0.001), prolonged 
      cardiopulmonary bypass time (OR 1.01; P < 0.001) and female gender (OR 4.87; 
      P < 0.001). CONCLUSIONS: Mortality rates of VA-ECMO in PCCS patients are high, 
      even in those with preoperative normal LVEF. Coronary problems are an important 
      cause of PCCS; however, the aetiology remains unknown in the vast majority of the 
      cases. The implantation of VA-ECMO before development of tissue hypoperfusion and 
      the control of VA-ECMO-associated complications are the most important prognostic 
      factors in PCCS patients. Lactate levels may help guide timing of VA-ECMO 
      implantation and define the extent of therapeutic effort.
CI  - (c) The Author(s) 2021. Published by Oxford University Press on behalf of the 
      European Association for Cardio-Thoracic Surgery. All rights reserved.
FAU - Menon, Priya R
AU  - Menon PR
AUID- ORCID: 0000-0001-5593-7130
AD  - Department of Anesthesiology and Intensive Care Medicine, Heart Center Leipzig, 
      Leipzig, Germany.
FAU - Flo Forner, Anna
AU  - Flo Forner A
AD  - Department of Anesthesiology and Intensive Care Medicine, Heart Center Leipzig, 
      Leipzig, Germany.
FAU - Marin-Cuartas, Mateo
AU  - Marin-Cuartas M
AUID- ORCID: 0000-0003-1000-4710
AD  - University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.
FAU - Lehmann, Sven
AU  - Lehmann S
AD  - University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.
FAU - Saeed, Diyar
AU  - Saeed D
AUID- ORCID: 0000-0001-7449-9455
AD  - University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.
FAU - Ginther, Andre
AU  - Ginther A
AD  - University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.
FAU - Borger, Michael A
AU  - Borger MA
AD  - University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.
FAU - Ender, Jorg
AU  - Ender J
AD  - Department of Anesthesiology and Intensive Care Medicine, Heart Center Leipzig, 
      Leipzig, Germany.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Interact Cardiovasc Thorac Surg
JT  - Interactive cardiovascular and thoracic surgery
JID - 101158399
SB  - IM
MH  - *Extracorporeal Membrane Oxygenation/adverse effects
MH  - Female
MH  - Humans
MH  - Retrospective Studies
MH  - Shock, Cardiogenic/diagnosis/etiology/therapy
MH  - Stroke Volume
MH  - Ventricular Function, Left
PMC - PMC8691502
OTO - NOTNLM
OT  - Extracorporeal life support
OT  - Extracorporeal membrane oxygenation
OT  - Postcardiotomy cardiogenic shock
EDAT- 2021/01/09 06:00
MHDA- 2021/10/15 06:00
PMCR- 2022/01/08
CRDT- 2021/01/08 17:09
PHST- 2020/04/25 00:00 [received]
PHST- 2020/10/15 00:00 [revised]
PHST- 2020/11/03 00:00 [accepted]
PHST- 2021/01/09 06:00 [pubmed]
PHST- 2021/10/15 06:00 [medline]
PHST- 2021/01/08 17:09 [entrez]
PHST- 2022/01/08 00:00 [pmc-release]
AID - 6071466 [pii]
AID - ivaa323 [pii]
AID - 10.1093/icvts/ivaa323 [doi]
PST - ppublish
SO  - Interact Cardiovasc Thorac Surg. 2021 May 10;32(5):817-824. doi: 
      10.1093/icvts/ivaa323.