TY - JOUR
T1 - Variables associated with in-hospital and postdischarge outcomes after postcardiotomy extracorporeal membrane oxygenation
T2 - Netherlands Heart Registration Cohort
AU - Mariani, Silvia
AU - van Bussel, Bas C T
AU - Ravaux, Justine M
AU - Roefs, Maaike M
AU - De Piero, Maria Elena
AU - Di Mauro, Michele
AU - Willers, Anne
AU - Segers, Patrique
AU - Delnoij, Thijs
AU - van der Horst, Iwan C C
AU - Maessen, Jos
AU - Lorusso, Roberto
AU - Netherlands Heart Registration Cardiothoracic Surgery Registration Committee
N1 - Funding Information:
The authors thank Rashida K. Polk, BSN, PDTN, RN-BC, CCRN, and Marta Cucchi, MSc PH, TND, BSN, for their contribution in the language revision process. The Netherlands Heart Registration Cardiothoracic Surgery Registration Committee members include Jos A. Bekkers, MD, PhD (Department of Cardio-Thoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands); Wim Jan P. Van Boven, MD, PhD (Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands); Thomas J. Van Brakel, MD (Department of Cardio-Thoracic Surgery, Leids University Medical Center, Leiden, The Netherlands); Sander Bramer, MD (Department of Cardio-Thoracic Surgery, Amphia Hospital, Breda, The Netherlands); Edgar J. Daeter, MD (Department of Cardio-Thoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands); Gerard J. F. Hoohenkerk, MD (Department of Cardio-Thoracic Surgery, Haga Hospital, Den Haag, The Netherlands); Niels P. Van der Kaaij, MD, PhD (Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands); Bart M. J. A. Koene, MD (Department of Cardio-Thoracic Surgery, Catarina Hospital, Eindhoven, The Netherlands); Wilson W. L. Li, MD (Department of Cardio-Thoracic Surgery, Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands); Thanasie A. L. P. Markou, MD (Department of Cardio-Thoracic Surgery, Isala Clinic Zwolle, Zwolle, The Netherlands); Yvonne L. Douglas, MD, PhD (Department of Cardio-Thoracic Surgery, University Medical Center Groningen, Groningen, The Netherlands); Fabiano Porta, MD (Department of Cardio-Thoracic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands); Ron G. H. Speekenbrink, MD, PhD (Department of Cardio-Thoracic Surgery, Thoraxcenter Medical Spectrum Twente, Enschede, The Netherlands); Wim Stooker, MD, PhD (Department of Cardio-Thoracic Surgery, OLVG, Amsterdam, The Netherlands); and Alexander B. A. Vonk, MD, PhD (Department of Cardio-Thoracic Surgery, Amsterdam UMC- Location VUmc, Amsterdam, The Netherlands).
Publisher Copyright:
© 2022 The Authors
PY - 2023/3
Y1 - 2023/3
N2 - OBJECTIVES: Extracorporeal membrane oxygenation (ECMO) for postcardiotomy cardiogenic shock has been increasingly used without concomitant mortality reduction. This study aims to investigate determinants of in-hospital and postdischarge mortality in patients requiring postcardiotomy ECMO in the Netherlands.METHODS: The Netherlands Heart Registration collects nationwide prospective data from cardiac surgery units. Adults receiving intraoperative or postoperative ECMO included in the register from January 2013 to December 2019 were studied. Survival status was established through the national Personal Records Database. Multivariable logistic regression analyses were used to investigate determinants of in-hospital (3 models) and 12-month postdischarge mortality (4 models). Each model was developed to target specific time points during a patient's clinical course.RESULTS: Overall, 406 patients (67.2% men, median age, 66.0 years [interquartile range, 55.0-72.0 years]) were included. In-hospital mortality was 51.7%, with death occurring in a median of 5 days (interquartile range, 2-14 days) after surgery. Hospital survivors (n = 196) experienced considerable rates of pulmonary infections, respiratory failure, arrhythmias, and deep sternal wound infections during a hospitalization of median 29 days (interquartile range, 17-51 days). Older age (odds ratio [OR], 1.02; 95% CI, 1.0-1.04) and preoperative higher body mass index (OR, 1.08; 95% CI, 1.02-1.14) were associated with in-hospital death. Within 12 months after discharge, 35.1% of hospital survivors (n = 63) died. Postoperative renal failure (OR, 2.3; 95% CI, 1.6-4.9), respiratory failure (OR, 3.6; 95% CI, 1.3-9.9), and re-thoracotomy (OR, 2.9; 95% CI, 1.3-6.5) were associated with 12-month postdischarge mortality.CONCLUSIONS: In-hospital and postdischarge mortality after postcardiotomy ECMO in adults remains high in the Netherlands. ECMO support in patients with higher age and body mass index, which drive associations with higher in-hospital mortality, should be carefully considered. Further observations suggest that prevention of re-thoracotomies, renal failure, and respiratory failure are targets that may improve postdischarge outcomes.
AB - OBJECTIVES: Extracorporeal membrane oxygenation (ECMO) for postcardiotomy cardiogenic shock has been increasingly used without concomitant mortality reduction. This study aims to investigate determinants of in-hospital and postdischarge mortality in patients requiring postcardiotomy ECMO in the Netherlands.METHODS: The Netherlands Heart Registration collects nationwide prospective data from cardiac surgery units. Adults receiving intraoperative or postoperative ECMO included in the register from January 2013 to December 2019 were studied. Survival status was established through the national Personal Records Database. Multivariable logistic regression analyses were used to investigate determinants of in-hospital (3 models) and 12-month postdischarge mortality (4 models). Each model was developed to target specific time points during a patient's clinical course.RESULTS: Overall, 406 patients (67.2% men, median age, 66.0 years [interquartile range, 55.0-72.0 years]) were included. In-hospital mortality was 51.7%, with death occurring in a median of 5 days (interquartile range, 2-14 days) after surgery. Hospital survivors (n = 196) experienced considerable rates of pulmonary infections, respiratory failure, arrhythmias, and deep sternal wound infections during a hospitalization of median 29 days (interquartile range, 17-51 days). Older age (odds ratio [OR], 1.02; 95% CI, 1.0-1.04) and preoperative higher body mass index (OR, 1.08; 95% CI, 1.02-1.14) were associated with in-hospital death. Within 12 months after discharge, 35.1% of hospital survivors (n = 63) died. Postoperative renal failure (OR, 2.3; 95% CI, 1.6-4.9), respiratory failure (OR, 3.6; 95% CI, 1.3-9.9), and re-thoracotomy (OR, 2.9; 95% CI, 1.3-6.5) were associated with 12-month postdischarge mortality.CONCLUSIONS: In-hospital and postdischarge mortality after postcardiotomy ECMO in adults remains high in the Netherlands. ECMO support in patients with higher age and body mass index, which drive associations with higher in-hospital mortality, should be carefully considered. Further observations suggest that prevention of re-thoracotomies, renal failure, and respiratory failure are targets that may improve postdischarge outcomes.
KW - Acute heart failure
KW - Cardiac surgery
KW - Extracorporeal life support
KW - Extracorporeal membrane oxygenation
KW - Mechanical circulatory support
KW - Postcardiotomy cardiogenic shock
U2 - 10.1016/j.jtcvs.2022.08.024
DO - 10.1016/j.jtcvs.2022.08.024
M3 - Article
C2 - 36229294
SN - 0022-5223
VL - 165
SP - 1127-1137.e14
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 3
ER -