TY - JOUR
T1 - Postcardiotomy extracorporeal membrane oxygenation after elective, urgent, and emergency cardiac operations
T2 - Insights from the PELS observational study
AU - Mariani, Silvia
AU - Perazzo, Alvaro
AU - De Piero, Maria Elena
AU - van Bussel, Bas C.T.
AU - Di Mauro, Michele
AU - Wiedemann, Dominik
AU - Lehmann, Sven
AU - Pozzi, Matteo
AU - Loforte, Antonio
AU - Boeken, Udo
AU - Samalavicius, Robertas
AU - Bounader, Karl
AU - Hou, Xiaotong
AU - Bunge, Jeroen J.H.
AU - Sriranjan, Kogulan
AU - Salazar, Leonardo
AU - Meyns, Bart
AU - Mazzeffi, Michael A.
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 - Shekar, Kiran
AU - Whitman, Glenn
AU - Lorusso, Roberto
AU - PELS Investigators
N1 - Publisher Copyright:
© 2025 The Author(s)
PY - 2025/1/1
Y1 - 2025/1/1
N2 - Background: Outcomes in cardiac surgery are influenced by surgical priority, with higher mortality in emergency cases. Whether this applies to postcardiotomy venoarterial (VA) extracorporeal membrane oxygenation (ECMO) remains unknown. This study describes characteristics and outcomes of patients undergoing cardiac operations and requiring VA ECMO, stratified by emergency, urgent, or elective operation. Methods: This retrospective multicenter observational study included adults requiring postcardiotomy VA ECMO between 2000 and 2020. Preoperative and procedural characteristics, complications, and survival were compared among the 3 patient groups. The association between emergency surgery and in-hospital survival was investigated through mixed Cox proportional hazard models. Results: The study cohort comprised 1063 patients (52.2%) with elective operations, 445 (21.8%) with urgent operations, and 528 (26%) with emergency operations. Emergency operations included more coronary artery bypass grafting operations (n = 286; 54.2%; P <.001) and aortic procedures (n = 126; 23.9%; P =.001) in patients with more unstable preoperative hemodynamic conditions compared to elective and urgent patients. VA ECMO was initiated more frequently intraoperatively in emergency patients (n = 353; 66.9%; P <.001). Postoperative bleeding (n = 338; 64.3%; P <.001), stroke (n = 79; 15%; P <.001), and right ventricular failure (n = 124; 25.3%) were more frequent after emergency operations. In-hospital mortality was 60.5% in the elective group, 57.8% in the urgent group, 63.4% in the emergency group (P =.191). The crude hazard ratio for in-hospital mortality in emergency surgery was 1.15 (95% confidence interval [CI], 1.01-1.32; P =.039) and dropped to 1.09 (95% CI, 0.93-1.27; P =.295) after adjustment for indicators of preoperative instability. 5-year survival was comparable in 30-day survivors (P =.083). Conclusions: One-quarter of postcardiotomy VA ECMOs are implemented after emergency operations. Despite more complications in emergency cases, in-hospital and 5-year survival are comparable between emergency, urgent, or elective operations.
AB - Background: Outcomes in cardiac surgery are influenced by surgical priority, with higher mortality in emergency cases. Whether this applies to postcardiotomy venoarterial (VA) extracorporeal membrane oxygenation (ECMO) remains unknown. This study describes characteristics and outcomes of patients undergoing cardiac operations and requiring VA ECMO, stratified by emergency, urgent, or elective operation. Methods: This retrospective multicenter observational study included adults requiring postcardiotomy VA ECMO between 2000 and 2020. Preoperative and procedural characteristics, complications, and survival were compared among the 3 patient groups. The association between emergency surgery and in-hospital survival was investigated through mixed Cox proportional hazard models. Results: The study cohort comprised 1063 patients (52.2%) with elective operations, 445 (21.8%) with urgent operations, and 528 (26%) with emergency operations. Emergency operations included more coronary artery bypass grafting operations (n = 286; 54.2%; P <.001) and aortic procedures (n = 126; 23.9%; P =.001) in patients with more unstable preoperative hemodynamic conditions compared to elective and urgent patients. VA ECMO was initiated more frequently intraoperatively in emergency patients (n = 353; 66.9%; P <.001). Postoperative bleeding (n = 338; 64.3%; P <.001), stroke (n = 79; 15%; P <.001), and right ventricular failure (n = 124; 25.3%) were more frequent after emergency operations. In-hospital mortality was 60.5% in the elective group, 57.8% in the urgent group, 63.4% in the emergency group (P =.191). The crude hazard ratio for in-hospital mortality in emergency surgery was 1.15 (95% confidence interval [CI], 1.01-1.32; P =.039) and dropped to 1.09 (95% CI, 0.93-1.27; P =.295) after adjustment for indicators of preoperative instability. 5-year survival was comparable in 30-day survivors (P =.083). Conclusions: One-quarter of postcardiotomy VA ECMOs are implemented after emergency operations. Despite more complications in emergency cases, in-hospital and 5-year survival are comparable between emergency, urgent, or elective operations.
KW - cardiac surgery
KW - cardiogenic shock
KW - complications
KW - emergency
KW - extracorporeal life support
KW - extracorporeal membrane oxygenation
U2 - 10.1016/j.xjon.2025.01.018
DO - 10.1016/j.xjon.2025.01.018
M3 - Article
SN - 2666-2736
VL - 24
SP - 280
EP - 310
JO - JTCVS open
JF - JTCVS open
ER -