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Multicenter Study
. 2023 Jul 18;12(14):e029609.
doi: 10.1161/JAHA.123.029609. Epub 2023 Jul 8.

Patient and Management Variables Associated With Survival After Postcardiotomy Extracorporeal Membrane Oxygenation in Adults: The PELS-1 Multicenter Cohort Study

Silvia Mariani  1 , Samuel Heuts  1 , Bas C T van Bussel  2 , Michele Di Mauro  1 , Dominik Wiedemann  3 , Diyar Saeed  4 , Matteo Pozzi  5 , Antonio Loforte  6   7 , Udo Boeken  8 , Robertas Samalavicius  9 , Karl Bounader  10 , Xiaotong Hou  11 , Jeroen J H Bunge  12 , Hergen Buscher  13   14 , Leonardo Salazar  15 , Bart Meyns  16 , Daniel Herr  17 , Marco L Sacha Matteucci  18 , Sandro Sponga  19 , Graeme MacLaren  20 , Claudio Russo  21 , Francesco Formica  22   23 , Pranya Sakiyalak  24 , Antonio Fiore  25 , Daniele Camboni  26 , Giuseppe Maria Raffa  27 , Rodrigo Diaz  28 , I-Wen Wang  29 , Jae-Seung Jung  30 , Jan Belohlavek  31 , Vin Pellegrino  32 , Giacomo Bianchi  33 , Matteo Pettinari  34 , Alessandro Barbone  35 , José P Garcia  36 , Kiran Shekar  37 , Glenn J R Whitman  38 , Roberto Lorusso  1 ; PELS‐1 Investigators *
Collaborators, Affiliations
Multicenter Study

Patient and Management Variables Associated With Survival After Postcardiotomy Extracorporeal Membrane Oxygenation in Adults: The PELS-1 Multicenter Cohort Study

Silvia Mariani et al. J Am Heart Assoc. .

Abstract

Background Extracorporeal membrane oxygenation (ECMO) has been increasingly used for postcardiotomy cardiogenic shock, but without a concomitant reduction in observed in-hospital mortality. Long-term outcomes are unknown. This study describes patients' characteristics, in-hospital outcome, and 10-year survival after postcardiotomy ECMO. Variables associated with in-hospital and postdischarge mortality are investigated and reported. Methods and Results The retrospective international multicenter observational PELS-1 (Postcardiotomy Extracorporeal Life Support) study includes data on adults requiring ECMO for postcardiotomy cardiogenic shock between 2000 and 2020 from 34 centers. Variables associated with mortality were estimated preoperatively, intraoperatively, during ECMO, and after the occurrence of any complications, and then analyzed at different time points during a patient's clinical course, through mixed Cox proportional hazards models containing fixed and random effects. Follow-up was established by institutional chart review or contacting patients. This analysis included 2058 patients (59% were men; median [interquartile range] age, 65.0 [55.0-72.0] years). In-hospital mortality was 60.5%. Independent variables associated with in-hospital mortality were age (hazard ratio [HR], 1.02 [95% CI, 1.01-1.02]) and preoperative cardiac arrest (HR, 1.41 [95% CI, 1.15-1.73]). In the subgroup of hospital survivors, the overall 1-, 2-, 5-, and 10-year survival rates were 89.5% (95% CI, 87.0%-92.0%), 85.4% (95% CI, 82.5%-88.3%), 76.4% (95% CI, 72.5%-80.5%), and 65.9% (95% CI, 60.3%-72.0%), respectively. Variables associated with postdischarge mortality included older age, atrial fibrillation, emergency surgery, type of surgery, postoperative acute kidney injury, and postoperative septic shock. Conclusions In adults, in-hospital mortality after postcardiotomy ECMO remains high; however, two-thirds of those who are discharged from hospital survive up to 10 years. Patient selection, intraoperative decisions, and ECMO management remain key variables associated with survival in this cohort. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03857217.

Keywords: acute heart failure; cardiac surgery; extracorporeal membrane oxygenation; mechanical circulatory support; postcardiotomy cardiogenic shock.

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Figures

Figure 1
Figure 1. Kaplan‐Meier survival curves with 95% CIs.
See this image and copyright information in PMC

References

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