Venoarterial extracorporeal membrane oxygenation for postcardiotomy shock: Risk factors for mortality

The Journal of Thoracic and Cardiovascular Surgery

Thomas Fux¹  Matthias Corbascio²  Manne Holm³  Lars H. Lund⁴ 

[1] Department of Medicine, Karolinska Institutet, Stockholm, Sweden;Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden;Division of Perioperative Medicine and Intensive Care, Section Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden;Heart and Vascular Division, Karolinska University Hospital, Stockholm, Sweden

关键词: extracorporeal life support;    extracorporeal membrane oxygenation;    ischemic heart disease;    lactate;    postcardiotomy cardiogenic shock;   

DOI  :  10.1016/j.jtcvs.2018.05.061

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

ObjectivesRefractory postcardiotomy cardiogenic shock is associated with a high mortality, and venoarterial extracorporeal membrane oxygenation can offer acute cardiopulmonary life support. The aim of this study was to identify pre–venoarterial extracorporeal membrane oxygenation risk factors of 90-day mortality.MethodsWe retrospectively analyzed 105 consecutive patients supported with venoarterial extracorporeal membrane oxygenation due to refractory postcardiotomy cardiogenic shock. The association between preimplant variables and all-cause mortality at 90 days was analyzed with univariable and multivariable logistic regression.ResultsMain surgical subgroups were single noncoronary artery bypass grafting (29%), isolated coronary artery bypass grafting (20%), and 2 and 3 concomitant surgical procedures (31% and 20%, respectively). The median age of patients was 62 years (interquartile range, 52-68 years), and 76% were men. Cardiopulmonary resuscitation was performed in 30% of patients before venoarterial extracorporeal membrane oxygenation initiation. The median duration of venoarterial extracorporeal membrane oxygenation was 7 days (interquartile range, 3-14). The 90-day overall mortality was 57%, and in-hospital mortality was 56%. Forty-seven percent of patients died on venoarterial extracorporeal membrane oxygenation, 51% of patients were successfully weaned, 1% of patients were bridged to heart transplantation, and 1% of patients were bridged to left ventricular assist device. Multivariable logistic regression analysis identified arterial lactate (odds ratio per unit, 1.22; 95% confidence interval, 1.07-14.0; P = .004) and ischemic heart disease (odds ratio, 7.87; 95% confidence interval, 2.55-24.3; P ConclusionsIn patients with postcardiotomy cardiogenic shock, ischemic heart disease and level of arterial lactate before venoarterial extracorporeal membrane oxygenation initiation were identified as independent pre–venoarterial extracorporeal membrane oxygenation risk factors of 90-day mortality. These risk factors are easily available for pre–venoarterial extracorporeal membrane oxygenation risk prediction and may improve patient selection for this resource-intensive therapy.

【 授权许可】

Unknown