TY - JOUR
T1 - Meta-Analysis of Peripheral or Central Extracorporeal Membrane Oxygenation in Postcardiotomy and Non-Postcardiotomy Shock
AU - Raffa, Giuseppe Maria
AU - Kowalewski, Mariusz
AU - Brodie, Daniel
AU - Ogino, Mark
AU - Whitman, Glenn
AU - Meani, Paolo
AU - Pilato, Michele
AU - Arcadipane, Antonio
AU - Delnoij, Thijs
AU - Natour, Eshan
AU - Gelsomino, Sandro
AU - Maessen, Jos
AU - Lorusso, Roberto
N1 - Funding Information:
Dr Brodie is currently the co-chair of the Trial Steering Committee for the VENT-AVOID trial sponsored by ALung Technologies and was previously on the medical advisory board of ALung Technologies and Kadence (Johnson & Johnson). All compensation for these activities is paid to Columbia University.
Publisher Copyright:
© 2019 The Society of Thoracic Surgeons
PY - 2019/1
Y1 - 2019/1
N2 - Background. Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) application in postcardiotomy shock (PCS) and non-PCS is increasing. VA-ECMO plays a critical role in the management of these patients, yet may be associated with serious complications.Methods. A systematic review of all available reports in the literature of patients receiving VA-ECMO, either directly or indirectly, comparing central cannulation (right atrial to ascending aorta) versus peripheral cannulation (femoral vein to femoral artery or axillary artery) were analyzed. The primary endpoint was survival. Cerebrovascular events, limb complications, bleeding requiring reoperation, sepsis, continuous venovenous hemofiltration, and transfusions were also assessed in both groups.Results. Seventeen retrospective case series clearly describing the VA-ECMO access and including 1,691 patients with PCS and non-PCS were found. The peripheral approach was more commonly used (980 patients, 57.9%) than the central one. There was no difference in the analysis between the two techniques regarding all-cause mortality risk ratio (1.00, 95% confidence interval: 0.94 to 1.08, I-2 = 0%, p = 0.92). No statistical differences were found between peripheral and central VA-ECMO with regard to cerebrovascular events, limb complications, or sepsis rates. Peripheral cannulation was associated with a significant reduction in the risk of bleeding (p = 0.02), continuous venovenous hemofiltration (p = 0.03), transfusion of red blood cells units (p <0.00001), fresh frozen plasma units (p = 0.0002), and platelets units (p <0.00001).Conclusions. Peripheral and central VA-ECMO configurations showed comparable inhospital survival for PCS and non-PCS. The risk of bleeding, continuous venovenous hemofiltration, and blood product transfusion was significantly lower with the peripheral cannulation strategy. (C) 2019 by The Society of Thoracic Surgeons
AB - Background. Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) application in postcardiotomy shock (PCS) and non-PCS is increasing. VA-ECMO plays a critical role in the management of these patients, yet may be associated with serious complications.Methods. A systematic review of all available reports in the literature of patients receiving VA-ECMO, either directly or indirectly, comparing central cannulation (right atrial to ascending aorta) versus peripheral cannulation (femoral vein to femoral artery or axillary artery) were analyzed. The primary endpoint was survival. Cerebrovascular events, limb complications, bleeding requiring reoperation, sepsis, continuous venovenous hemofiltration, and transfusions were also assessed in both groups.Results. Seventeen retrospective case series clearly describing the VA-ECMO access and including 1,691 patients with PCS and non-PCS were found. The peripheral approach was more commonly used (980 patients, 57.9%) than the central one. There was no difference in the analysis between the two techniques regarding all-cause mortality risk ratio (1.00, 95% confidence interval: 0.94 to 1.08, I-2 = 0%, p = 0.92). No statistical differences were found between peripheral and central VA-ECMO with regard to cerebrovascular events, limb complications, or sepsis rates. Peripheral cannulation was associated with a significant reduction in the risk of bleeding (p = 0.02), continuous venovenous hemofiltration (p = 0.03), transfusion of red blood cells units (p <0.00001), fresh frozen plasma units (p = 0.0002), and platelets units (p <0.00001).Conclusions. Peripheral and central VA-ECMO configurations showed comparable inhospital survival for PCS and non-PCS. The risk of bleeding, continuous venovenous hemofiltration, and blood product transfusion was significantly lower with the peripheral cannulation strategy. (C) 2019 by The Society of Thoracic Surgeons
KW - LONG-TERM OUTCOMES
KW - CARDIOGENIC-SHOCK
KW - CENTRAL CANNULATION
KW - LIMB ISCHEMIA
KW - SUPPORT
KW - ARTERY
KW - LACTATE
KW - TRENDS
KW - STRATEGIES
KW - EXPERIENCE
U2 - 10.1016/j.athoracsur.2018.05.063
DO - 10.1016/j.athoracsur.2018.05.063
M3 - (Systematic) Review article
C2 - 29959943
SN - 0003-4975
VL - 107
SP - 311
EP - 321
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 1
ER -