TABLE 4.
Outcome and predictors of in-hospital mortality of adult patients undergoing post-cardiotomy ECMO
| Authorreference – Year of Publication | Weaning, % | In-Hospital Survival, % | Bridge to LVAD/HTx, n/total patients % | In-Hospital Survival LVAD/HTx after ECMO, n/total patients % | 1-Year Survival, % | Predictors of In-Hospital Mortality |
|---|---|---|---|---|---|---|
| Magovern14 - 1994 | 76 | 52 | None | - | 47.6 | Mitral valve surgery Non-convertible ventricular fibrillation |
| Kodera15 - 1996 | 70.6 | 47.1 | None | - | na (30.9 at 5 years) |
ECMO duration > 60 hours |
| Fiser16 - 2001 | 31 | 16 | na | na | na | Age >65 yrs., LVEF <30% after 48 hours on ECMO Prolonged CPR (> 5 minutes) prior to ECMO implant |
| Smedira17 - 2001 | 39.2 | 33,3 | HTx: 0 (0%) LVAD:18/107 (16.8%) |
HTx: - LVAD: 13/18 (72%) at 1-year follow-up |
na | na |
| Ko18 - 2002 | 60.5 | 26.3 | HTx: 2/76 (2.6%) LVAD: 2/76 (2.6%) |
HTx: 0/2 (0%) LVAD: 1/2 (50%) |
45.4 | ARF requiring dialysis on ECMO Peak CPK (U/L)a |
| Zhang19 - 2006 | 43.7 | 25 | na | na | na | Blood lactate level 48 hours after ECMO initiation MB--isoenzyme 48 hours after ECMO initiation CK-MB relative index (CK-MB/total CK) 48 hours after ECMO initiation |
| Bakhtiary20 - 2007 | 55.5 | 29 | HTx: 2/45 (4%) LVAD: 5/45 (11%) |
HTx: 1/2 (50%) LVAD: 3/5 (60%) at 30-day follow-up |
29 | PA hypertension Diabetes Lack of IABP |
| Hsu21 - 2010 | 53 | 24.8 | HTx: 4/51 (8%) LVAD: - |
HTx: 3/4 (75%) at 30-day follow-up; 1/4 (25%) at 1-year follow-up. LVAD:- |
16.5 | Low peri-op serum albumin level Platelet count Oxygen pressure of the venous tube of the ECMO Poor cardiac systolic function |
| Rastan22 - 2010 | 63.3 | 30,4 | HTx: 5/517 (1%) LVAD: 15/517 (3%) |
HTx: 2/5 (40%) LVAD: 3/15 (20%) |
na | Age >70, Diabetes, Obesity, Preoperative CRF, Operative lactate >4 mmol/l, Logistic Euroscore >20 |
| Elsharkawy23 – 2010 | na | 16 | na | na | na | Older age Higher preoperative albumin Diabetes CABG surgery Longer CPB time Cardiogenic shock at time of VA-ECMO implant |
| Pokersnik24 - 2012 | 54.9 (63.6b/ 45.5c/ 55.6d) | 36 | HTx: - LVAD: 2/33 (6%) |
HTx: - LVAD: 0/2 (0%) |
na | Older age |
| Mikus25 - 2013 | 50 | 42.8 | None | - | na | High transfusion rate |
| Slottosch26 - 2013 | 62 | 32.6 | HTx: 2/77 (2.6%) VAD: -- |
HTx: 0/2 (0%) VAD:-- |
na | Older age Greater lactate after 24hours of ECMO Longer ECMO duration ECMO related or gastrointestinal complications |
| Unosawa27 - 2013 | 61.7 | 40.3 | na | - | 24.5 | Older age Incomplete sternal closure ECMO support >48 hours Dialysis for ARF MOF Brain injury Peak Cr (mg/dl) during ECMO |
| Ariyaratnam28 - 2014 | 50 | 31.2 | na | - | na | Increase requirements for vasoconstrictors |
| Li29 - 2015 | 56 | 34.1 | na | - | na | Age Gender (Female) Mean lactate concentration (at 6 and 12 hours from ECMO initiation) Lactate clearance (at 6 and 12 hours from ECMO initiation) |
| Saxena30 – 2015e | 53.4 | 24.4 | None | - | na | Preoperative atrial fibrillation CVVH Lactic acidosis on ECMO Persistent coagulopathy on ECMO Delayed ECMO implant MOF in patients 50–69 High postop AST |
| Khorsandi31 - 2016 | na | 51 | na | - | 29.8 | Older age Emergent nature of surgery Pre-existing preoperative severe LV impairment |
| Distelmaier32 – 2016f | na | 32 | na | - | na | na |
| Mazzeffi33 - 2016 f | na | 30.1 | HTx: - LVAD: 2/23 (8.7%) |
HTx: - LVAD: na |
na | Age >50 years, Cause of cardiac arrest except tamponade |
| Chen34 - 2017 | na | 38.3 | na | na | 24.1 | ARF Massive blood transfusion |
| Guihaire35 - 2017 | 48 | 42 | HTx: 2/92 (2.17%) LVAD: 2/92 (2.17%) |
HTx: 2/2 (100%) LVAD: 1/2 (50%) | 39 | Age Valvular surgery Peak lactate level at 24 hrs |
| Raffa36 - 2017 | 49.4 | 37 | None | - | na | Age >65 years Postoperative Arrhythmias |
| Fux37 – 2018 | 51 | 56 | HTx: 1/105 (0.9%) LVAD: 1/105 (0.9%) |
na | na | Arterial lactate Ischemic heart disease |
AST: aspartate transaminase; ARF: acute renal failure; AVR: aortic valve replacement; CABG: coronary artery bypass grafting; CPB: cardio-pulmonary bypass; CPK: creatine-phosphokinase; CPR: cardiopulmonary resuscitation; CRF: chronic renal failure; CVVH: continuous veno-venous hemofiltration; ECMO: extracorporeal membrane oxygenation; HTx: heart transplant; IABP: intra-aortic balloon pump; LV; left ventricle; LVAD; left ventricular assist device; LVEF: left ventricular ejection fraction; MOF: multiorgan failure; na: not available; PA: pulmonary artery; VA: veno-arterial; VAD: ventricular assist device
Values in the first 3 days of ECMO initiation
Group of patients receiving Biomedicus (Medtronic Inc, Minneapolis, Minn) pump and Affinity oxygenator (Medtronic Inc. Minneapolis, Minn)
Group of patients receiving Biomedicus (Medtronic Inc, Minneapolis, Minn) and Quadrox D (Getinge, Hirrlingen, Germany) oxygenator
Group of patients receiving Rotaflow (Getinge, Hirrlingen, Germany) pump and Quadrox D (Getinge, Hirrlingen, Germany) oxygenator
Study included only patients over 70 years of age
Study included only extracorporeal cardiopulmonary resuscitation (ECPR) after cardiac surgery