Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation in Patients Aged 70 Years or Older

Result code in IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00023001%3A_____%2F19%3A00078401" target="_blank" >RIV/00023001:_____/19:00078401 - isvavai.cz</a>

Result on the web

<a href="https://reader.elsevier.com/reader/sd/pii/S0003497519308094?token=8EF35FF5BBF034B5DBB5F645B3E9F14A78308F7F44C1E0724F448EE7C52E9E0BD64F0B2264A7F8521E8CFA2364C149B0" target="_blank" >https://reader.elsevier.com/reader/sd/pii/S0003497519308094?token=8EF35FF5BBF034B5DBB5F645B3E9F14A78308F7F44C1E0724F448EE7C52E9E0BD64F0B2264A7F8521E8CFA2364C149B0</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1016/j.athoracsur.2019.04.063" target="_blank" >10.1016/j.athoracsur.2019.04.063</a>

Result language

angličtina

Original language name

Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation in Patients Aged 70 Years or Older

Original language description

Background. There is uncertainty whether venoarterial extracorporeal membrane oxygenation (VA-ECMO) should be used in older patients with cardiopulmonary failure after cardiac surgery. Methods. This was a retrospective multicenter study of 781 patients who required postcardiotomy VA-ECMO for cardiopulmonary failure after adult cardiac surgery from 2010 to 2018 at 19 cardiac surgery centers. A parallel systematic review with meta-analysis of the literature was performed. Results. The hospital mortality in the overall Post-cardiotomy Venoarterial Extracorporeal Membrane Oxygenation (PC-ECMO) series was 64.4%. A total of 255 patients were 70 years old or older (32.7%), and their hospital mortality was significantly higher than in younger patients (76.1% vs 58.7%; adjusted odds ratio, 2.199; 95% confidence interval [CI], 1.536 to 3.149). Arterial lactate level greater than 6 mmol/L before starting VA-ECMO was the only predictor of hospital mortality among patients 70 years old or older in univariate analysis (82.6% vs 70.4%; P = .029). Meta-analysis of current and previous studies showed that early mortality after postcardiotomy VA-ECMO was significantly higher in patients aged 70 years or older compared with younger patients (odds ratio, 2.09; 95% CI, 1.59 to 2.75; 5 studies including 1547 patients; I-2, 5.9%). The pooled early mortality rate among patients aged 70 years or older was 78.8% (95% CI, 74.1 to 83.5; 6 studies including 617 patients; I-2, 41.8%). Two studies reported 1-year mortality (including hospital mortality) of 79.9% and 75.6%, respectively, in patients 70 years old or older. Conclusions. Advanced age should not be considered a contraindication for postcardiotomy VA-ECMO. However, in view of the high risk of early mortality, meaningful scrutiny is needed before using VA-ECMO after cardiac surgery in older patients. (C) 2019 by The Society of Thoracic Surgeons

Czech name

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Czech description

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Type

J_imp - Article in a specialist periodical, which is included in the Web of Science database

CEP classification

—

OECD FORD branch

30201 - Cardiac and Cardiovascular systems

Project

—

Continuities

N - Vyzkumna aktivita podporovana z neverejnych zdroju

Publication year

2019

Confidentiality

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Name of the periodical

Annals of thoracic surgery

ISSN

0003-4975

e-ISSN

—

Volume of the periodical

108

Issue of the periodical within the volume

4

Country of publishing house

NL - THE KINGDOM OF THE NETHERLANDS

Number of pages

8

Pages from-to

1257-1264

UT code for WoS article

000486417700062

EID of the result in the Scopus database

2-s2.0-85071612281