Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock in Elderly Patients: Trends in Application and Outcome From the Extracorporeal Life Support Organization (ELSO) Registry

Roberto Lorusso; Sandro Gelsomino; Orlando Parise; Priya Mendiratta; Parthak Prodhan; Peter Rycus; Graeme MacLaren; Thomas V. Brogan; Yih-Sharng Chen; Jos Maessen; Xiaotong Hou; Ravi R. Thiagarajan

doi:10.1016/j.athoracsur.2016.10.023

Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock in Elderly Patients: Trends in Application and Outcome From the Extracorporeal Life Support Organization (ELSO) Registry

Roberto Lorusso^*, Sandro Gelsomino, Orlando Parise, Priya Mendiratta, Parthak Prodhan, Peter Rycus, Graeme MacLaren, Thomas V. Brogan, Yih-Sharng Chen, Jos Maessen, Xiaotong Hou, Ravi R. Thiagarajan

^*Corresponding author for this work

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

Abstract

Background. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock (RCS) is increasingly used in adult patients, but age represents a controversial factor in this setting.

Methods. Data from the Extracorporeal Life Support Organization registry was analyzed to assess in-hospital survival of elderly patients (>= 70 years of age) undergoing VA-ECMO for RCS from 1992 to 2015. In-hospital survival and complications for elderly patients were compared with data in younger adults (>= 18 to

Results. The mean age of the patient cohort (n [ 5,408) was 53.0 +/- 15.7years (range, 18 to 91 years). The elderly group included 735 patients (13.6%), with a mean age of 75.2 +/- 4.4 years. In the elderly group, pre-ECMO cardiac procedures were performed in 134 cases (18.9%), and 2.2% received VA-ECMOfor postcardiotomy support comparedwith 0.7% in the younger cohort. The mean duration of VA-ECMO in the elderly groupwas 101 +/- 91hcomparedwith 138 +/- 146hin the younger group (p <0.001). Overall, survival to hospital discharge for the entire adult cohort was 41.4% (2,240 of 5,408), with 30.5% (224 of 735) in the elderly patient group and 43.1% (2,016 of 4,673) in the younger patient group (p <0.001). Elderly patients had a higher rate of multiorgan failure. At multivariable analysis age represented an independent negative predictor of in-hospital survival.

Conclusions. Based on the acceptable survival to hospital discharge in our study, older age alone should not represent an absolute contraindication when considering VA-ECMO support for RCS. (C) 2017 by The Society of Thoracic Surgeons

Original language	English
Pages (from-to)	62-69
Number of pages	8
Journal	Annals of Thoracic Surgery
Volume	104
Issue number	1
DOIs	https://doi.org/10.1016/j.athoracsur.2016.10.023
Publication status	Published - Jul 2017

Keywords

MECHANICAL CIRCULATORY SUPPORT
SHORT-TERM
ADULT PATIENTS
SURVIVAL
COMPLICATIONS
METAANALYSIS
POPULATION
EXPERIENCE
FAILURE

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10.1016/j.athoracsur.2016.10.023

Cite this

Lorusso, R., Gelsomino, S., Parise, O., Mendiratta, P., Prodhan, P., Rycus, P., MacLaren, G., Brogan, T. V., Chen, Y.-S., Maessen, J., Hou, X., & Thiagarajan, R. R. (2017). Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock in Elderly Patients: Trends in Application and Outcome From the Extracorporeal Life Support Organization (ELSO) Registry. Annals of Thoracic Surgery, 104(1), 62-69. https://doi.org/10.1016/j.athoracsur.2016.10.023

@article{766c978f9bef4b9d8a4f1fa7050c773a,

title = "Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock in Elderly Patients: Trends in Application and Outcome From the Extracorporeal Life Support Organization (ELSO) Registry",

abstract = "Background. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock (RCS) is increasingly used in adult patients, but age represents a controversial factor in this setting.Methods. Data from the Extracorporeal Life Support Organization registry was analyzed to assess in-hospital survival of elderly patients (>= 70 years of age) undergoing VA-ECMO for RCS from 1992 to 2015. In-hospital survival and complications for elderly patients were compared with data in younger adults (>= 18 toResults. The mean age of the patient cohort (n [ 5,408) was 53.0 +/- 15.7years (range, 18 to 91 years). The elderly group included 735 patients (13.6%), with a mean age of 75.2 +/- 4.4 years. In the elderly group, pre-ECMO cardiac procedures were performed in 134 cases (18.9%), and 2.2% received VA-ECMOfor postcardiotomy support comparedwith 0.7% in the younger cohort. The mean duration of VA-ECMO in the elderly groupwas 101 +/- 91hcomparedwith 138 +/- 146hin the younger group (p <0.001). Overall, survival to hospital discharge for the entire adult cohort was 41.4% (2,240 of 5,408), with 30.5% (224 of 735) in the elderly patient group and 43.1% (2,016 of 4,673) in the younger patient group (p <0.001). Elderly patients had a higher rate of multiorgan failure. At multivariable analysis age represented an independent negative predictor of in-hospital survival.Conclusions. Based on the acceptable survival to hospital discharge in our study, older age alone should not represent an absolute contraindication when considering VA-ECMO support for RCS. (C) 2017 by The Society of Thoracic Surgeons",

keywords = "MECHANICAL CIRCULATORY SUPPORT, SHORT-TERM, ADULT PATIENTS, SURVIVAL, COMPLICATIONS, METAANALYSIS, POPULATION, EXPERIENCE, FAILURE",

author = "Roberto Lorusso and Sandro Gelsomino and Orlando Parise and Priya Mendiratta and Parthak Prodhan and Peter Rycus and Graeme MacLaren and Brogan, {Thomas V.} and Yih-Sharng Chen and Jos Maessen and Xiaotong Hou and Thiagarajan, {Ravi R.}",

year = "2017",

month = jul,

doi = "10.1016/j.athoracsur.2016.10.023",

language = "English",

volume = "104",

pages = "62--69",

journal = "Annals of Thoracic Surgery",

issn = "0003-4975",

publisher = "Elsevier Science",

number = "1",

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Lorusso, R , Gelsomino, S, Parise, O, Mendiratta, P, Prodhan, P, Rycus, P, MacLaren, G, Brogan, TV, Chen, Y-S, Maessen, J, Hou, X & Thiagarajan, RR 2017, 'Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock in Elderly Patients: Trends in Application and Outcome From the Extracorporeal Life Support Organization (ELSO) Registry', Annals of Thoracic Surgery, vol. 104, no. 1, pp. 62-69. https://doi.org/10.1016/j.athoracsur.2016.10.023

Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock in Elderly Patients: Trends in Application and Outcome From the Extracorporeal Life Support Organization (ELSO) Registry. / Lorusso, Roberto ; Gelsomino, Sandro; Parise, Orlando et al.
In: Annals of Thoracic Surgery, Vol. 104, No. 1, 07.2017, p. 62-69.

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

TY - JOUR

T1 - Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock in Elderly Patients

T2 - Trends in Application and Outcome From the Extracorporeal Life Support Organization (ELSO) Registry

AU - Lorusso, Roberto

AU - Gelsomino, Sandro

AU - Parise, Orlando

AU - Mendiratta, Priya

AU - Prodhan, Parthak

AU - Rycus, Peter

AU - MacLaren, Graeme

AU - Brogan, Thomas V.

AU - Chen, Yih-Sharng

AU - Maessen, Jos

AU - Hou, Xiaotong

AU - Thiagarajan, Ravi R.

PY - 2017/7

Y1 - 2017/7

N2 - Background. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock (RCS) is increasingly used in adult patients, but age represents a controversial factor in this setting.Methods. Data from the Extracorporeal Life Support Organization registry was analyzed to assess in-hospital survival of elderly patients (>= 70 years of age) undergoing VA-ECMO for RCS from 1992 to 2015. In-hospital survival and complications for elderly patients were compared with data in younger adults (>= 18 toResults. The mean age of the patient cohort (n [ 5,408) was 53.0 +/- 15.7years (range, 18 to 91 years). The elderly group included 735 patients (13.6%), with a mean age of 75.2 +/- 4.4 years. In the elderly group, pre-ECMO cardiac procedures were performed in 134 cases (18.9%), and 2.2% received VA-ECMOfor postcardiotomy support comparedwith 0.7% in the younger cohort. The mean duration of VA-ECMO in the elderly groupwas 101 +/- 91hcomparedwith 138 +/- 146hin the younger group (p <0.001). Overall, survival to hospital discharge for the entire adult cohort was 41.4% (2,240 of 5,408), with 30.5% (224 of 735) in the elderly patient group and 43.1% (2,016 of 4,673) in the younger patient group (p <0.001). Elderly patients had a higher rate of multiorgan failure. At multivariable analysis age represented an independent negative predictor of in-hospital survival.Conclusions. Based on the acceptable survival to hospital discharge in our study, older age alone should not represent an absolute contraindication when considering VA-ECMO support for RCS. (C) 2017 by The Society of Thoracic Surgeons

AB - Background. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock (RCS) is increasingly used in adult patients, but age represents a controversial factor in this setting.Methods. Data from the Extracorporeal Life Support Organization registry was analyzed to assess in-hospital survival of elderly patients (>= 70 years of age) undergoing VA-ECMO for RCS from 1992 to 2015. In-hospital survival and complications for elderly patients were compared with data in younger adults (>= 18 toResults. The mean age of the patient cohort (n [ 5,408) was 53.0 +/- 15.7years (range, 18 to 91 years). The elderly group included 735 patients (13.6%), with a mean age of 75.2 +/- 4.4 years. In the elderly group, pre-ECMO cardiac procedures were performed in 134 cases (18.9%), and 2.2% received VA-ECMOfor postcardiotomy support comparedwith 0.7% in the younger cohort. The mean duration of VA-ECMO in the elderly groupwas 101 +/- 91hcomparedwith 138 +/- 146hin the younger group (p <0.001). Overall, survival to hospital discharge for the entire adult cohort was 41.4% (2,240 of 5,408), with 30.5% (224 of 735) in the elderly patient group and 43.1% (2,016 of 4,673) in the younger patient group (p <0.001). Elderly patients had a higher rate of multiorgan failure. At multivariable analysis age represented an independent negative predictor of in-hospital survival.Conclusions. Based on the acceptable survival to hospital discharge in our study, older age alone should not represent an absolute contraindication when considering VA-ECMO support for RCS. (C) 2017 by The Society of Thoracic Surgeons

KW - MECHANICAL CIRCULATORY SUPPORT

KW - SHORT-TERM

KW - ADULT PATIENTS

KW - SURVIVAL

KW - COMPLICATIONS

KW - METAANALYSIS

KW - POPULATION

KW - EXPERIENCE

KW - FAILURE

U2 - 10.1016/j.athoracsur.2016.10.023

DO - 10.1016/j.athoracsur.2016.10.023

M3 - Article

SN - 0003-4975

VL - 104

SP - 62

EP - 69

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

IS - 1

ER -