Central versus Peripheral Postcardiotomy Veno-Arterial Extracorporeal Membrane Oxygenation: Systematic Review and Individual Patient Data Meta-Analysis

Fausto Biancari^{1

2}, Alexander Kaserer³, Andrea Perrotti⁴, Vito G Ruggieri⁵, Sung-Min Cho⁶, Jin Kook Kang⁶, Magnus Dalén⁷, Henryk Welp⁸, Kristján Jónsson⁹, Sigurdur Ragnarsson¹⁰, Francisco J Hernández Pérez¹¹, Giuseppe Gatti¹², Khalid Alkhamees¹³, Antonio Loforte¹⁴, Andrea Lechiancole¹⁵, Stefano Rosato¹⁶, Cristiano Spadaccio¹⁷, Matteo Pettinari¹⁸, Antonio Fiore¹⁹, Timo Mäkikallio², Sebastian D Sahli³, Camilla L'Acqua^{20

21}, Amr A Arafat^{22

23}, Monirah A Albabtain²⁴, Mohammed M AlBarak²⁵, Mohamed Laimoud^{26

27}, Ilija Djordjevic²⁸, Ihor Krasivskyi²⁸, Robertas Samalavicius^{29

30}, Lina Puodziukaite²⁹, Marta Alonso-Fernandez-Gatta^{31

32}, Markus J Wilhelm³³, Giovanni Mariscalco³⁴

Affiliations

¹ Heart and Lung Center, Helsinki University Hospital, Haartmaninkatu 4, P.O. Box 340, 00029 Helsinki, Finland.
² Department of Medicine, South-Karelia Central Hospital, University of Helsinki, 53130 Lappeenranta, Finland.
³ Institute of Anesthesiology, University and University Hospital Zurich, 8091 Zurich, Switzerland.
⁴ Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, 25030 Besançon, France.
⁵ Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, 51100 Reims, France.
⁶ Divisions of Neurosciences, Critical Care and Cardiac Surgery, Departments of Neurology, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21201, USA.
⁷ Department of Molecular Medicine and Surgery, Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden.
⁸ Department of Cardiothoracic Surgery, Münster University Hospital, 48149 Münster, Germany.
⁹ Department of Cardiac Surgery, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden.
¹⁰ Department of Cardiothoracic Surgery, University of Lund, 10392 Lund, Sweden.
¹¹ Puerta de Hierro University Hospital, 29222 Madrid, Spain.
¹² Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, University Hospital of Trieste, 34128 Trieste, Italy.
¹³ Prince Sultan Cardiac Center, Al Hassa 36441, Saudi Arabia.
¹⁴ Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy.
¹⁵ Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy.
¹⁶ Center for Global Health, Italian National Institute, 00161 Rome, Italy.
¹⁷ Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 13400, USA.
¹⁸ Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium.
¹⁹ Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Creteil, France.
²⁰ Anesthesia and Intensive Care Unit, Centro Cardiologico Monzino, 20138 Milan, Italy.
²¹ Anesthesia and Intensive Care Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy.
²² Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh 12611, Saudi Arabia.
²³ Cardiothoracic Surgery Department, Tanta University, Tanta 31527, Egypt.
²⁴ Cardiology Clinical Pharmacy, Prince Sultan Cardiac Center, Riyadh 12611, Saudi Arabia.
²⁵ Intensive Care Department, Prince Sultan Cardiac Center, Riyadh 12611, Saudi Arabia.
²⁶ Cardiac Surgical Intensive Care Department, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia.
²⁷ Critical Care Medicine Department, Cairo University, Cairo 12613, Egypt.
²⁸ Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany.
²⁹ 2nd Department of Anesthesia, Vilnius University Hospital Santaros Klinikos, 08410 Vilnius, Lithuania.
³⁰ Clinic of Emergency Medicine, Medical Faculty, Vilnius University, 03101 Vilnius, Lithuania.
³¹ Cardiology Department, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain.
³² CIBER-CV Instituto de Salud Carlos III, 28029 Madrid, Spain.
³³ Clinic for Cardiac Surgery, University Heart Center, University and University Hospital Zurich, 8091 Zurich, Switzerland.
³⁴ Department of Intensive Care Medicine and Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester LE2 9QP, UK.

PMID: 36556021
PMCID: PMC9785985
DOI: 10.3390/jcm11247406

Review

Central versus Peripheral Postcardiotomy Veno-Arterial Extracorporeal Membrane Oxygenation: Systematic Review and Individual Patient Data Meta-Analysis

Fausto Biancari et al. J Clin Med. 2022.

. 2022 Dec 14;11(24):7406.

doi: 10.3390/jcm11247406.

Authors

Affiliations

¹ Heart and Lung Center, Helsinki University Hospital, Haartmaninkatu 4, P.O. Box 340, 00029 Helsinki, Finland.
² Department of Medicine, South-Karelia Central Hospital, University of Helsinki, 53130 Lappeenranta, Finland.
³ Institute of Anesthesiology, University and University Hospital Zurich, 8091 Zurich, Switzerland.
⁴ Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, 25030 Besançon, France.
⁵ Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, 51100 Reims, France.
⁶ Divisions of Neurosciences, Critical Care and Cardiac Surgery, Departments of Neurology, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21201, USA.
⁷ Department of Molecular Medicine and Surgery, Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden.
⁸ Department of Cardiothoracic Surgery, Münster University Hospital, 48149 Münster, Germany.
⁹ Department of Cardiac Surgery, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden.
¹⁰ Department of Cardiothoracic Surgery, University of Lund, 10392 Lund, Sweden.
¹¹ Puerta de Hierro University Hospital, 29222 Madrid, Spain.
¹² Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, University Hospital of Trieste, 34128 Trieste, Italy.
¹³ Prince Sultan Cardiac Center, Al Hassa 36441, Saudi Arabia.
¹⁴ Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy.
¹⁵ Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy.
¹⁶ Center for Global Health, Italian National Institute, 00161 Rome, Italy.
¹⁷ Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 13400, USA.
¹⁸ Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium.
¹⁹ Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Creteil, France.
²⁰ Anesthesia and Intensive Care Unit, Centro Cardiologico Monzino, 20138 Milan, Italy.
²¹ Anesthesia and Intensive Care Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy.
²² Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh 12611, Saudi Arabia.
²³ Cardiothoracic Surgery Department, Tanta University, Tanta 31527, Egypt.
²⁴ Cardiology Clinical Pharmacy, Prince Sultan Cardiac Center, Riyadh 12611, Saudi Arabia.
²⁵ Intensive Care Department, Prince Sultan Cardiac Center, Riyadh 12611, Saudi Arabia.
²⁶ Cardiac Surgical Intensive Care Department, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia.
²⁷ Critical Care Medicine Department, Cairo University, Cairo 12613, Egypt.
²⁸ Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany.
²⁹ 2nd Department of Anesthesia, Vilnius University Hospital Santaros Klinikos, 08410 Vilnius, Lithuania.
³⁰ Clinic of Emergency Medicine, Medical Faculty, Vilnius University, 03101 Vilnius, Lithuania.
³¹ Cardiology Department, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain.
³² CIBER-CV Instituto de Salud Carlos III, 28029 Madrid, Spain.
³³ Clinic for Cardiac Surgery, University Heart Center, University and University Hospital Zurich, 8091 Zurich, Switzerland.
³⁴ Department of Intensive Care Medicine and Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester LE2 9QP, UK.

PMID: 36556021
PMCID: PMC9785985
DOI: 10.3390/jcm11247406

Abstract

Background: It is unclear whether peripheral arterial cannulation is superior to central arterial cannulation for postcardiotomy veno-arterial extracorporeal membrane oxygenation (VA-ECMO).

Methods: A systematic review was conducted using PubMed, Scopus, and Google Scholar to identify studies on postcardiotomy VA-ECMO for the present individual patient data (IPD) meta-analysis. Analysis was performed according to the intention-to-treat principle.

Results: The investigators of 10 studies agreed to participate in the present IPD meta-analysis. Overall, 1269 patients were included in the analysis. Crude rates of in-hospital mortality after central versus peripheral arterial cannulation for VA-ECMO were 70.7% vs. 63.7%, respectively (adjusted OR 1.38, 95% CI 1.08-1.75). Propensity score matching yielded 538 pairs of patients with balanced baseline characteristics and operative variables. Among these matched cohorts, central arterial cannulation VA-ECMO was associated with significantly higher in-hospital mortality compared to peripheral arterial cannulation VA-ECMO (64.5% vs. 70.8%, p = 0.027). These findings were confirmed by aggregate data meta-analysis, which showed that central arterial cannulation was associated with an increased risk of in-hospital mortality compared to peripheral arterial cannulation (OR 1.35, 95% CI 1.04-1.76, I² 21%).

Conclusions: Among patients requiring postcardiotomy VA-ECMO, central arterial cannulation was associated with an increased risk of in-hospital mortality compared to peripheral arterial cannulation. This increased risk is of limited magnitude, and further studies are needed to confirm the present findings and to identify the mechanisms underlying the potential beneficial effects of peripheral VA-ECMO.

Keywords: ECMO; cardiac surgery; central; extracorporeal membrane oxygenation; peripheral; postcardiotomy.

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Conflict of interest statement

Alexander Kaserer received honoraria for lecturing from Bayer AG Switzerland and CSL Behring GmbH. Sung-Min Cho is supported by a grant from NIH NHLBI K23HL157610 and Hyperfine, Inc. for the SAFE MRI ECMO study. The other authors declare no conflict of interest.

Figures

**Figure 2**
Forest plot and funnel plot from aggregate data meta-analysis [2,12,13,14,15,16,17,18,19,20].

See this image and copyright information in PMC

References

1. Kowalewski M., Zieliński K., Brodie D., MacLaren G., Whitman G., Raffa G.M., Boeken U., Shekar K., Chen Y.S., Bermudez C., et al. Venoarterial extracorporeal membrane oxygenation for postcardiotomy shock-analysis of the extracorporeal life support organization registry. Crit. Care Med. 2021;49:1107–1117. doi: 10.1097/CCM.0000000000004695. - DOI - PMC - PubMed
1. Biancari F., Dalén M., Fiore A., Ruggieri V.G., Saeed D., Jónsson K., Gatti G., Zipfel S., Perrotti A., Bounader K., et al. Multicenter study on postcardiotomy venoarterial extracorporeal membrane oxygenation. J. Thorac. Cardiovasc. Surg. 2020;159:1844–1854. doi: 10.1016/j.jtcvs.2019.06.039. - DOI - PubMed
1. Biancari F., Perrotti A., Dalén M., Guerrieri M., Fiore A., Reichart D., Dell’Aquila A.M., Gatti G., Ala-Kokko T., Kinnunen E.M., et al. Meta-analysis of the outcome after postcardiotomy venoarterial extracorporeal membrane oxygenation in adult patients. J. Cardiothorac. Vasc. Anesth. 2018;32:1175–1182. doi: 10.1053/j.jvca.2017.08.048. - DOI - PubMed
1. Bowles C., Hiesinger W. Postcardiotomy shock extracorporeal membrane oxygenation: Peripheral or central? JTCVS Open. 2021;8:66–69. doi: 10.1016/j.xjon.2021.10.020. - DOI - PMC - PubMed
1. Mariscalco G., Salsano A., Fiore A., Dalén M., Ruggieri V.G., Saeed D., Jónsson K., Gatti G., Zipfel S., Dell’Aquila A.M., et al. Peripheral versus central extracorporeal membrane oxygenation for postcardiotomy shock: Multicenter registry, systematic review, and meta-analysis. J. Thorac. Cardiovasc. Surg. 2020;160:1207–1216.e44. doi: 10.1016/j.jtcvs.2019.10.078. - DOI - PubMed

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Central versus Peripheral Postcardiotomy Veno-Arterial Extracorporeal Membrane Oxygenation: Systematic Review and Individual Patient Data Meta-Analysis

Affiliations

Central versus Peripheral Postcardiotomy Veno-Arterial Extracorporeal Membrane Oxygenation: Systematic Review and Individual Patient Data Meta-Analysis

Authors

Affiliations

Abstract

Conflict of interest statement

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