Meta-Analysis

. 2025 Jan 17;25(1):29.

doi: 10.1186/s12871-025-02898-2.

Outcome and complications in postcardiotomy cardiogenic shock treated with extracorporeal life support - a systematic review and meta-analysis

Romana Maria Kienlein^#¹, Ralf Felix Trauzeddel^#¹, Nilufar Akbari², Leonello Avalli³, Fausto Biancari⁴, Carlotta Sorini Dini^{5

6}, Sabina Guenther^{7

8}, Christian Hagl^{7

8}, Matthias Heringlake⁹, Jochen Kruppa¹⁰, Timo Mäkikallio¹¹, Raphael Martins¹², Marc Pineton de Chambrun^{13

14}, Ardawan Julian Rastan¹⁵, Antonio Rubino¹⁶, Floris van den Brink¹⁷, Michael Nordine¹⁸, Sascha Treskatsch¹⁹

Affiliations

¹ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Hindenburgdamm 30, Berlin, 12203, Germany.
² Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, Berlin, 10117, Germany.
³ Department of Cardiovascular Surgery, Centro Cardiologico Monzino, Milan, Italy.
⁴ Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy.
⁵ Intensive Cardiac Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
⁶ Intensive Cardiac Care Unit, Azienda Ospedaliera-Universitaria Senese, Siena, Italy.
⁷ Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany.
⁸ DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
⁹ Department of Anesthesiology and Intensive Care Medicine, Heart- and Diabetes Center Mecklenburg - Western Pomerania, Karlsburg Hospital, Karlsburg, Germany.
¹⁰ Hochschule Osnabrück, University of Applied Sciences, Osnabrück, Germany.
¹¹ Department of Medicine, South Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland.
¹² 1CHU Rennes, Service de Cardiologie Et Maladies Vasculaires, Rennes, France.
¹³ Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France.
¹⁴ Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme Et Nutrition (ICAN), Paris, France.
¹⁵ Department of Cardiac and Thoracic Vascular Surgery, Marburg University Hospital, Marburg, Germany.
¹⁶ Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK.
¹⁷ Department of Intensive Care, Leids Universitair Medisch Centrum, Albinusdreef 2, Leiden, 2333ZA, The Netherlands.
¹⁸ Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
¹⁹ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Hindenburgdamm 30, Berlin, 12203, Germany. sascha.treskatsch@charite.de.

^# Contributed equally.

PMID: 39825250
PMCID: PMC11740342
DOI: 10.1186/s12871-025-02898-2

Meta-Analysis

Outcome and complications in postcardiotomy cardiogenic shock treated with extracorporeal life support - a systematic review and meta-analysis

Romana Maria Kienlein et al. BMC Anesthesiol. 2025.

. 2025 Jan 17;25(1):29.

doi: 10.1186/s12871-025-02898-2.

Authors

Affiliations

¹ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Hindenburgdamm 30, Berlin, 12203, Germany.
² Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, Berlin, 10117, Germany.
³ Department of Cardiovascular Surgery, Centro Cardiologico Monzino, Milan, Italy.
⁴ Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy.
⁵ Intensive Cardiac Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
⁶ Intensive Cardiac Care Unit, Azienda Ospedaliera-Universitaria Senese, Siena, Italy.
⁷ Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany.
⁸ DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
⁹ Department of Anesthesiology and Intensive Care Medicine, Heart- and Diabetes Center Mecklenburg - Western Pomerania, Karlsburg Hospital, Karlsburg, Germany.
¹⁰ Hochschule Osnabrück, University of Applied Sciences, Osnabrück, Germany.
¹¹ Department of Medicine, South Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland.
¹² 1CHU Rennes, Service de Cardiologie Et Maladies Vasculaires, Rennes, France.
¹³ Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive Réanimation, Paris, France.
¹⁴ Sorbonne Université, Inserm, UMRS_1166-ICAN, Institut de Cardiométabolisme Et Nutrition (ICAN), Paris, France.
¹⁵ Department of Cardiac and Thoracic Vascular Surgery, Marburg University Hospital, Marburg, Germany.
¹⁶ Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK.
¹⁷ Department of Intensive Care, Leids Universitair Medisch Centrum, Albinusdreef 2, Leiden, 2333ZA, The Netherlands.
¹⁸ Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
¹⁹ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Hindenburgdamm 30, Berlin, 12203, Germany. sascha.treskatsch@charite.de.

^# Contributed equally.

PMID: 39825250
PMCID: PMC11740342
DOI: 10.1186/s12871-025-02898-2

Abstract

Background: Postcardiotomy cardiogenic shock (PCCS) in cardiac surgery is associated with a high rate of morbidity and mortality. Beside other therapeutic measures (e.g. intraaortic balloon pump (IABP)), extracorporeal life support is being increasingly used in this particular form of shock. Objectives of this meta-analysis were to determine mortality and complications of extracorporeal life support treatment (ECLS) in cardiac surgery patients, and if outcomes were influenced by a preexisting cardiovascular risk profile.

Methods: MEDLINE and EMBASE were searched for studies in English, published between January 1^st 2000 and January 16^th 2023, reporting mortality and morbidity in patients aged ≥ 18 treated with ECLS for PCCS. Supplementary data were requested from the respective corresponding authors. Outcomes were weaning from extracorporeal life support, hospital survival and complications.

Results: Two thousand, seven hundred seventy-four papers were screened, of which 132 full text articles were assessed for suitability. 70 remaining studies were included for further evaluation and data analysis. Five studies could be included in the final analysis since the corresponding authors provided additional necessary information. Successful weaning from extracorporeal life support was accomplished in 52.8% (30.8%-57.4%) and 31.1% were discharged alive (mortality of 25.0 - 56.2% after weaning). 95.1% of all treated patients suffered from at least one complication. Diabetes mellitus and obesity seem to be independent risk factors for poor outcome.

Conclusions: Extracorporeal life support for PCCS is associated with a substantial mortality and complication rate. Diabetes mellitus and obesity seem to be independent risk factors. Therefore, until future work has elucidated which patients benefit at all, the risks of ECLS-treatment must be critically weighed up against a possible benefit.

Keywords: Extracorporeal life support; Meta-analysis; Outcome; Postcardiotomy cardiogenic shock; Veno-arterial extracorporeal membrane oxygenation.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: This meta-analysis was approved by the local ethics committee at Charité – Universitätsmedizin Berlin (EA4/239/19) as well as the local data protection authority. Consent to participate was not applicable. Consent for publication: Not applicable. Competing interests: RFT, RMK, LA, CSD, RM, NA, JK, JAR, MN, MPdC, FB, TM, AR, FvdB have nothing to declare. SPWG received funding for the ECLS-SHOCK Trial (NCT02544594, Registration Date 02.09.2015) from the Sorin Group, Italy. MH reports honoraria for lectures and scientific advice by Orion Pharma, Amomed Pharma, Edwards Lifesciences, and CSL Behring. ST received funding for experimental research as well as honoraria for lectures from Edwards, OrionPharma, Amomed and Smith & Nephews outside this work.

Figures

**Fig. 1**
Flowchart of the literature research process and supplementary data request

**Fig. 2**
Complications averaged over all included studies

**Fig. 3**
Weaning from ECMO. a displays the Forest plot showing odds ratios regarding weaning from ECMO related to risk factors. b displays the chart showing the interaction between age, smoking status and weaning from ECLS

**Fig. 4**
Hospital survival after ECMO therapy. a displays the Forest plot showing odds ratios regarding hospital survival related to risk factors. b displays the chard showing the interaction between age, smoking status and hospital survival

See this image and copyright information in PMC

References

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1. Hirose H, Gupta S, Pitcher H, Miessau J, Yang Q, Yang J, et al. Feasibility of diagnosis of postcardiotomy tamponade by miniaturized transesophageal echocardiography. J Surg Res. 2014;190(1):276–9. - PubMed
1. Iversen S, Mayer E, Hake U, Schmiedt W, Jakob H, Oelert H. Efficacy of phosphodiesterase inhibitor enoximone in management of postcardiotomy cardiogenic shock. Scand J Thorac Cardiovasc Surg. 1992;26(2):143–9. - PubMed
1. Geller BJ, Sinha SS, Kapur NK, Bakitas M, Balsam LB, Chikwe J, et al. Escalating and de-escalating temporary mechanical circulatory support in cardiogenic shock: a scientific statement from the American Heart Association. Circulation. 2022;146(6):e50–68. - PubMed
1. Corujo Rodriguez A, Richter E, Ibekwe SO, Shah T, Faloye AO. Postcardiotomy shock syndrome: a narrative review of perioperative diagnosis and management. J Cardiothorac Vasc Anesth. 2023;37(12):2621–33. - PubMed

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Outcome and complications in postcardiotomy cardiogenic shock treated with extracorporeal life support - a systematic review and meta-analysis

Affiliations

Outcome and complications in postcardiotomy cardiogenic shock treated with extracorporeal life support - a systematic review and meta-analysis

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical