On-Support and Postweaning Mortality in Postcardiotomy Extracorporeal Membrane Oxygenation

Silvia Mariani; Anne-Kristin Schaefer; Bas C T van Bussel; Michele Di Mauro; Luca Conci; Philipp Szalkiewicz; Maria Elena De Piero; Samuel Heuts; Justine Ravaux; Iwan C C van der Horst; Diyar Saeed; Matteo Pozzi; Antonio Loforte; Udo Boeken; Robertas Samalavicius; Karl Bounader; Xiaotong Hou; Jeroen J H Bunge; Hergen Buscher; Leonardo Salazar; Bart Meyns; Daniel Herr; Sacha Matteucci; Sandro Sponga; Graeme MacLaren; Claudio Russo; Francesco Formica; Pranya Sakiyalak; Antonio Fiore; Daniele Camboni; Giuseppe Maria Raffa; Rodrigo Diaz; I-Wen Wang; Jae-Seung Jung; Jan Belohlavek; Vin Pellegrino; Giacomo Bianchi; Matteo Pettinari; Alessandro Barbone; José P Garcia; Glenn Whitman; Kiran Shekar; Dominik Wiedemann; Roberto Lorusso; Post-Cardiotomy Extracorporeal Life Support (PELS-1) Investigators

doi:10.1016/j.athoracsur.2023.05.045

On-Support and Postweaning Mortality in Postcardiotomy Extracorporeal Membrane Oxygenation

Silvia Mariani^*, Anne-Kristin Schaefer, Bas C T van Bussel, Michele Di Mauro, Luca Conci, Philipp Szalkiewicz, Maria Elena De Piero, Samuel Heuts, Justine Ravaux, Iwan C C van der Horst, Diyar Saeed, Matteo Pozzi, Antonio Loforte, Udo Boeken, Robertas Samalavicius, Karl Bounader, Xiaotong Hou, Jeroen J H Bunge, Hergen Buscher, Leonardo SalazarBart Meyns, Daniel Herr, Sacha Matteucci, Sandro Sponga, Graeme MacLaren, Claudio Russo, Francesco Formica, Pranya Sakiyalak, Antonio Fiore, Daniele Camboni, Giuseppe Maria Raffa, Rodrigo Diaz, I-Wen Wang, Jae-Seung Jung, Jan Belohlavek, Vin Pellegrino, Giacomo Bianchi, Matteo Pettinari, Alessandro Barbone, José P Garcia, Glenn Whitman, Kiran Shekar, Dominik Wiedemann, Roberto Lorusso, Post-Cardiotomy Extracorporeal Life Support (PELS-1) Investigators

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Postcardiotomy venoarterial extracorporeal membrane oxygenation (VA ECMO) is characterized by discrepancies between weaning and survival-to-discharge rates. This study analyzes the differences between postcardiotomy VA ECMO patients who survived, died on ECMO, or died after ECMO weaning. Causes of death and variables associated with mortality at different time points are investigated. METHODS: The retrospective, multicenter, observational Postcardiotomy Extracorporeal Life Support Study (PELS) includes adults requiring postcardiotomy VA ECMO between 2000 and 2020. Variables associated with on-ECMO mortality and postweaning mortality were modeled using mixed Cox proportional hazards, including random effects for center and year. RESULTS: In 2058 patients (men, 59%; median age, 65 years; interquartile range [IQR], 55-72 years), weaning rate was 62.7%, and survival to discharge was 39.6%. Patients who died (n = 1244) included 754 on-ECMO deaths (36.6%; median support time, 79 hours; IQR, 24-192 hours), and 476 postweaning deaths (23.1%; median support time, 146 hours; IQR, 96-235.5 hours). Multiorgan (n = 431 of 1158 [37.2%]) and persistent heart failure (n = 423 of 1158 [36.5%]) were the main causes of death, followed by bleeding (n = 56 of 754 [7.4%]) for on-ECMO mortality and sepsis (n = 61 of 401 [15.4%]) for postweaning mortality. On-ECMO death was associated with emergency surgery, preoperative cardiac arrest, cardiogenic shock, right ventricular failure, cardiopulmonary bypass time, and ECMO implantation timing. Diabetes, postoperative bleeding, cardiac arrest, bowel ischemia, acute kidney injury, and septic shock were associated with postweaning mortality. CONCLUSIONS: A discrepancy exists between weaning and discharge rate in postcardiotomy ECMO. Deaths occurred during ECMO support in 36.6% of patients, mostly associated with unstable preoperative hemodynamics. Another 23.1% of patients died after weaning in association with severe complications. This underscores the importance of postweaning care for postcardiotomy VA ECMO patients.

Original language	English
Pages (from-to)	1079-1089
Number of pages	11
Journal	The Annals of thoracic surgery
Volume	116
Issue number	5
Early online date	5 Jul 2023
DOIs	https://doi.org/10.1016/j.athoracsur.2023.05.045
Publication status	Published - Nov 2023

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10.1016/j.athoracsur.2023.05.045

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Mariani, S., Schaefer, A.-K., van Bussel, B. C. T., Di Mauro, M., Conci, L., Szalkiewicz, P., De Piero, M. E., Heuts, S., Ravaux, J., van der Horst, I. C. C., Saeed, D., Pozzi, M., Loforte, A., Boeken, U., Samalavicius, R., Bounader, K., Hou, X., Bunge, J. J. H., Buscher, H., ... Post-Cardiotomy Extracorporeal Life Support (PELS-1) Investigators (2023). On-Support and Postweaning Mortality in Postcardiotomy Extracorporeal Membrane Oxygenation. The Annals of thoracic surgery, 116(5), 1079-1089. https://doi.org/10.1016/j.athoracsur.2023.05.045

@article{fc6f1bad9e684941883fee89f37219b6,

title = "On-Support and Postweaning Mortality in Postcardiotomy Extracorporeal Membrane Oxygenation",

abstract = "BACKGROUND: Postcardiotomy venoarterial extracorporeal membrane oxygenation (VA ECMO) is characterized by discrepancies between weaning and survival-to-discharge rates. This study analyzes the differences between postcardiotomy VA ECMO patients who survived, died on ECMO, or died after ECMO weaning. Causes of death and variables associated with mortality at different time points are investigated. METHODS: The retrospective, multicenter, observational Postcardiotomy Extracorporeal Life Support Study (PELS) includes adults requiring postcardiotomy VA ECMO between 2000 and 2020. Variables associated with on-ECMO mortality and postweaning mortality were modeled using mixed Cox proportional hazards, including random effects for center and year. RESULTS: In 2058 patients (men, 59%; median age, 65 years; interquartile range [IQR], 55-72 years), weaning rate was 62.7%, and survival to discharge was 39.6%. Patients who died (n = 1244) included 754 on-ECMO deaths (36.6%; median support time, 79 hours; IQR, 24-192 hours), and 476 postweaning deaths (23.1%; median support time, 146 hours; IQR, 96-235.5 hours). Multiorgan (n = 431 of 1158 [37.2%]) and persistent heart failure (n = 423 of 1158 [36.5%]) were the main causes of death, followed by bleeding (n = 56 of 754 [7.4%]) for on-ECMO mortality and sepsis (n = 61 of 401 [15.4%]) for postweaning mortality. On-ECMO death was associated with emergency surgery, preoperative cardiac arrest, cardiogenic shock, right ventricular failure, cardiopulmonary bypass time, and ECMO implantation timing. Diabetes, postoperative bleeding, cardiac arrest, bowel ischemia, acute kidney injury, and septic shock were associated with postweaning mortality. CONCLUSIONS: A discrepancy exists between weaning and discharge rate in postcardiotomy ECMO. Deaths occurred during ECMO support in 36.6% of patients, mostly associated with unstable preoperative hemodynamics. Another 23.1% of patients died after weaning in association with severe complications. This underscores the importance of postweaning care for postcardiotomy VA ECMO patients.",

author = "Silvia Mariani and Anne-Kristin Schaefer and {van Bussel}, {Bas C T} and {Di Mauro}, Michele and Luca Conci and Philipp Szalkiewicz and {De Piero}, {Maria Elena} and Samuel Heuts and Justine Ravaux and {van der Horst}, {Iwan C C} and Diyar Saeed and Matteo Pozzi and Antonio Loforte and Udo Boeken and Robertas Samalavicius and Karl Bounader and Xiaotong Hou and Bunge, {Jeroen J H} and Hergen Buscher and Leonardo Salazar and Bart Meyns and Daniel Herr and Sacha Matteucci and Sandro Sponga and Graeme MacLaren and Claudio Russo and Francesco Formica and Pranya Sakiyalak and Antonio Fiore and Daniele Camboni and Raffa, {Giuseppe Maria} and Rodrigo Diaz and I-Wen Wang and Jae-Seung Jung and Jan Belohlavek and Vin Pellegrino and Giacomo Bianchi and Matteo Pettinari and Alessandro Barbone and Garcia, {Jos{\'e} P} and Glenn Whitman and Kiran Shekar and Dominik Wiedemann and Roberto Lorusso and {Post-Cardiotomy Extracorporeal Life Support (PELS-1) Investigators}",

year = "2023",

month = nov,

doi = "10.1016/j.athoracsur.2023.05.045",

language = "English",

volume = "116",

pages = "1079--1089",

journal = "The Annals of thoracic surgery",

issn = "1552-6259",

number = "5",

}

Mariani, S, Schaefer, A-K, van Bussel, BCT, Di Mauro, M, Conci, L, Szalkiewicz, P, De Piero, ME, Heuts, S , Ravaux, J , van der Horst, ICC, Saeed, D, Pozzi, M, Loforte, A, Boeken, U, Samalavicius, R, Bounader, K, Hou, X, Bunge, JJH, Buscher, H, Salazar, L, Meyns, B, Herr, D, Matteucci, S, Sponga, S, MacLaren, G, Russo, C, Formica, F, Sakiyalak, P, Fiore, A, Camboni, D, Raffa, GM, Diaz, R, Wang, I-W, Jung, J-S, Belohlavek, J, Pellegrino, V, Bianchi, G, Pettinari, M, Barbone, A, Garcia, JP, Whitman, G, Shekar, K, Wiedemann, D, Lorusso, R & Post-Cardiotomy Extracorporeal Life Support (PELS-1) Investigators 2023, 'On-Support and Postweaning Mortality in Postcardiotomy Extracorporeal Membrane Oxygenation', The Annals of thoracic surgery, vol. 116, no. 5, pp. 1079-1089. https://doi.org/10.1016/j.athoracsur.2023.05.045

TY - JOUR

T1 - On-Support and Postweaning Mortality in Postcardiotomy Extracorporeal Membrane Oxygenation

AU - Mariani, Silvia

AU - Schaefer, Anne-Kristin

AU - van Bussel, Bas C T

AU - Di Mauro, Michele

AU - Conci, Luca

AU - Szalkiewicz, Philipp

AU - De Piero, Maria Elena

AU - Heuts, Samuel

AU - Ravaux, Justine

AU - van der Horst, Iwan C C

AU - Saeed, Diyar

AU - Pozzi, Matteo

AU - Loforte, Antonio

AU - Boeken, Udo

AU - Samalavicius, Robertas

AU - Bounader, Karl

AU - Hou, Xiaotong

AU - Bunge, Jeroen J H

AU - Buscher, Hergen

AU - Salazar, Leonardo

AU - Meyns, Bart

AU - Herr, Daniel

AU - Matteucci, Sacha

AU - Sponga, Sandro

AU - MacLaren, Graeme

AU - Russo, Claudio

AU - Formica, Francesco

AU - Sakiyalak, Pranya

AU - Fiore, Antonio

AU - Camboni, Daniele

AU - Raffa, Giuseppe Maria

AU - Diaz, Rodrigo

AU - Wang, I-Wen

AU - Jung, Jae-Seung

AU - Belohlavek, Jan

AU - Pellegrino, Vin

AU - Bianchi, Giacomo

AU - Pettinari, Matteo

AU - Barbone, Alessandro

AU - Garcia, José P

AU - Whitman, Glenn

AU - Shekar, Kiran

AU - Wiedemann, Dominik

AU - Lorusso, Roberto

AU - Post-Cardiotomy Extracorporeal Life Support (PELS-1) Investigators

PY - 2023/11

Y1 - 2023/11

N2 - BACKGROUND: Postcardiotomy venoarterial extracorporeal membrane oxygenation (VA ECMO) is characterized by discrepancies between weaning and survival-to-discharge rates. This study analyzes the differences between postcardiotomy VA ECMO patients who survived, died on ECMO, or died after ECMO weaning. Causes of death and variables associated with mortality at different time points are investigated. METHODS: The retrospective, multicenter, observational Postcardiotomy Extracorporeal Life Support Study (PELS) includes adults requiring postcardiotomy VA ECMO between 2000 and 2020. Variables associated with on-ECMO mortality and postweaning mortality were modeled using mixed Cox proportional hazards, including random effects for center and year. RESULTS: In 2058 patients (men, 59%; median age, 65 years; interquartile range [IQR], 55-72 years), weaning rate was 62.7%, and survival to discharge was 39.6%. Patients who died (n = 1244) included 754 on-ECMO deaths (36.6%; median support time, 79 hours; IQR, 24-192 hours), and 476 postweaning deaths (23.1%; median support time, 146 hours; IQR, 96-235.5 hours). Multiorgan (n = 431 of 1158 [37.2%]) and persistent heart failure (n = 423 of 1158 [36.5%]) were the main causes of death, followed by bleeding (n = 56 of 754 [7.4%]) for on-ECMO mortality and sepsis (n = 61 of 401 [15.4%]) for postweaning mortality. On-ECMO death was associated with emergency surgery, preoperative cardiac arrest, cardiogenic shock, right ventricular failure, cardiopulmonary bypass time, and ECMO implantation timing. Diabetes, postoperative bleeding, cardiac arrest, bowel ischemia, acute kidney injury, and septic shock were associated with postweaning mortality. CONCLUSIONS: A discrepancy exists between weaning and discharge rate in postcardiotomy ECMO. Deaths occurred during ECMO support in 36.6% of patients, mostly associated with unstable preoperative hemodynamics. Another 23.1% of patients died after weaning in association with severe complications. This underscores the importance of postweaning care for postcardiotomy VA ECMO patients.

AB - BACKGROUND: Postcardiotomy venoarterial extracorporeal membrane oxygenation (VA ECMO) is characterized by discrepancies between weaning and survival-to-discharge rates. This study analyzes the differences between postcardiotomy VA ECMO patients who survived, died on ECMO, or died after ECMO weaning. Causes of death and variables associated with mortality at different time points are investigated. METHODS: The retrospective, multicenter, observational Postcardiotomy Extracorporeal Life Support Study (PELS) includes adults requiring postcardiotomy VA ECMO between 2000 and 2020. Variables associated with on-ECMO mortality and postweaning mortality were modeled using mixed Cox proportional hazards, including random effects for center and year. RESULTS: In 2058 patients (men, 59%; median age, 65 years; interquartile range [IQR], 55-72 years), weaning rate was 62.7%, and survival to discharge was 39.6%. Patients who died (n = 1244) included 754 on-ECMO deaths (36.6%; median support time, 79 hours; IQR, 24-192 hours), and 476 postweaning deaths (23.1%; median support time, 146 hours; IQR, 96-235.5 hours). Multiorgan (n = 431 of 1158 [37.2%]) and persistent heart failure (n = 423 of 1158 [36.5%]) were the main causes of death, followed by bleeding (n = 56 of 754 [7.4%]) for on-ECMO mortality and sepsis (n = 61 of 401 [15.4%]) for postweaning mortality. On-ECMO death was associated with emergency surgery, preoperative cardiac arrest, cardiogenic shock, right ventricular failure, cardiopulmonary bypass time, and ECMO implantation timing. Diabetes, postoperative bleeding, cardiac arrest, bowel ischemia, acute kidney injury, and septic shock were associated with postweaning mortality. CONCLUSIONS: A discrepancy exists between weaning and discharge rate in postcardiotomy ECMO. Deaths occurred during ECMO support in 36.6% of patients, mostly associated with unstable preoperative hemodynamics. Another 23.1% of patients died after weaning in association with severe complications. This underscores the importance of postweaning care for postcardiotomy VA ECMO patients.

U2 - 10.1016/j.athoracsur.2023.05.045

DO - 10.1016/j.athoracsur.2023.05.045

M3 - Article

SN - 1552-6259

VL - 116

SP - 1079

EP - 1089

JO - The Annals of thoracic surgery

JF - The Annals of thoracic surgery

IS - 5

ER -

On-Support and Postweaning Mortality in Postcardiotomy Extracorporeal Membrane Oxygenation

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