Understanding the “extracorporeal membrane oxygenation gap” in veno‐arterial configuration for adult patients: Timing and causes of death

Maged Makhoul; Samuel Heuts; Abdulrahman Mansouri; Fabio Silvio Taccone; Amir Obeid; Belliato Mirko; Lars Mikael Broman; Maximilian Valentin Malfertheiner; Paolo Meani; Giuseppe Maria Raffa; Thijs Delnoij; Jos Maessen; Gil Bolotin; Roberto Lorusso

doi:10.1111/aor.14006

. 2021 Jul 6;45(10):1155–1167. doi: 10.1111/aor.14006

Understanding the “extracorporeal membrane oxygenation gap” in veno‐arterial configuration for adult patients: Timing and causes of death

Maged Makhoul ^1,², Samuel Heuts ¹, Abdulrahman Mansouri ¹, Fabio Silvio Taccone ³, Amir Obeid ², Belliato Mirko ⁴, Lars Mikael Broman ⁵, Maximilian Valentin Malfertheiner ⁶, Paolo Meani ⁷, Giuseppe Maria Raffa ^1,⁸, Thijs Delnoij ^8,⁹, Jos Maessen ^1,¹⁰, Gil Bolotin ², Roberto Lorusso ^1,^10,^✉

PMCID: PMC8518076 PMID: 34101843

Abstract

Timing and causes of hospital mortality in adult patients undergoing veno‐arterial extracorporeal membrane oxygenation (V‐A ECMO) have been poorly described. Aim of the current review was to investigate the timing and causes of death of adult patients supported with V‐A ECMO and subsequently define the “V‐A ECMO gap,” which represents the patients who are successfully weaned of ECMO but eventually die during hospital stay. A systematic search was performed using electronic MEDLINE and EMBASE databases through PubMed. Studies reporting on adult V‐A ECMO patients from January 1993 to December 2020 were screened. The studies included in this review were studies that reported more than 10 adult, human patients, and no mechanical circulatory support other than V‐A ECMO. Information extracted from each study included mainly mortality and causes of death on ECMO and after weaning. Complications and discharge rates were also extracted. Sixty studies with 9181 patients were included for analysis in this systematic review. Overall mortality was 38.0% (95% confidence intervals [CIs] 34.2%‐41.9%) during V‐A ECMO support (reported by 60 studies) and 15.3% (95% CI 11.1%‐19.5%, reported by 57 studies) after weaning. Finally, 44.0% of patients (95% CI 39.8‐52.2) were discharged from hospital (reported by 60 studies). Most common causes of death on ECMO were multiple organ failure, followed by cardiac failure and neurological causes. More than one‐third of V‐A ECMO patients die during ECMO support. Additionally, many of successfully weaned patients still decease during hospital stay, defining the “V‐A ECMO gap.” Underreporting and lack of uniformity in reporting of important parameters remains problematic in ECMO research. Future studies should uniformly define timing and causes of death in V‐A ECMO patients to better understand the effectiveness and complications of this support.

Keywords: cause of death, complications, extracorporeal life support, extracorporeal membrane oxygenation, mortality, temporary mechanical circulatory support

1. INTRODUCTION

For several decades, extracorporeal membrane oxygenation (ECMO) has been used to support patients in the presence of acute refractory heart and/or lung dysfunction. ¹ In case of cardiogenic shock or cardiac arrest, the veno‐arterial (V‐A) configuration is used to support the cardio‐circulatory system. The use of ECMO has been gaining popularity over the last years. According to the Extracorporeal Life Support Organization (ELSO), there have been more than 61.000 ECMO cases in adult patients in more than 450 centers worldwide. ² Recent reports have shown an exponential trend of ECMO use for adult respiratory compromise (veno‐venous, [V‐V] ECMO), increasing from 100 cases a year between 1996 and 2007 to more than 800 cases a year in the 2009‐2012 period. This was mainly due to the H1N1 influenza pandemic in 2009 ³ and the COVID‐19 pandemic in 2020. However, use of adult V‐A ECMO has also increased over the past years, particularly in the postcardiotomy setting. ⁴ , ⁵

In‐hospital mortality among V‐A ECMO patients remains high. Previous reviews reported up to 50%‐70% in‐hospital mortality among adult patients. ⁶ , ⁷ Despite the knowledge and skills that ECMO teams have gained during the last years regarding this technology, mortality rates have not declined, ⁸ which might reflect the severity of illness, complexity of patient profile, or the older age of ECMO patients when compared with previous experiences. ⁹ Moreover, in‐hospital ECMO mortality has not been comprehensively described until now. In particular, data are limited on the timing of death (ie, during or after ECMO support) as well as on the main causes of death in this setting. Causes of death and complications on‐ECMO are described relatively well, but in‐hospital mortality rate and cause of death in‐hospital, but after weaning, are poorly reported and not well understood. We defined this observation and patient group as the “V‐A ECMO gap,” which describes the quote of patients with unfavorable in‐hospital outcome despite successful ECMO weaning.

Still, it remains difficult to compare different studies to each other and to conduct systematic reviews and meta‐analyses of separate trials as terminology, indications, and outcomes are reported without uniformity. Therefore, the present systematic review aims to investigate the timing and causes of death during the hospital stay in adult patients supported with V‐A ECMO. Furthermore, it will make an attempt to give insight into reporting, underreporting, uniformity of reporting, and quality of reporting of indications and outcomes in adult V‐A ECMO studies.

2. METHODS AND MATERIALS

2.1. Protocol

A predefined protocol was registered in PROSPERO (CRD42019130815). ¹⁰ This systematic review was written in accordance with the Preferred Reporting in Systematic Reviews and Meta‐analyses (PRISMA) statement. ¹¹

2.2. Search strategy

Potentially eligible studies were identified by searching the electronic MEDLINE and EMBASE databases through PubMed and Ovid, respectively. (The following search criteria were used: Adult, Veno‐arterial, Extracorporeal Life Support, Extra‐Corporeal Membrane Oxygenation, ECMO, ECLS, V‐A ECMO.) All studies that reported on ECMO as a form of Mechanical Circulatory Support (MCS) in V‐A configuration in adult patients were identified in the study selection. Additionally, reference lists of the prescreened studies were manually checked for additional eligible studies. Original studies from January 1993 to December 2020 were reviewed in order to include more modern ECMO technology.

2.3. Study criteria

Due to the emergent nature of the condition and the lack of randomized data, all observational studies and case series comprising >10 patients were considered for inclusion. Non‐English studies and studies conducted in animal models or in pediatric cohorts were excluded. Studies with circulatory support other than V‐A ECMO (V‐V ECMO, combined ECMO modes, combination of ECMO, and ventricular assist devices) were excluded as well. In case several MCS devices (ie, left‐ventricular or biventricular assist devices) were included in one study, results were included only if the V‐A ECMO group was analysed separately. When multiple publications of the same research group were identified, the publication reporting on the largest cohort was used, if eligible. Studies including less than 10 patients, duplicates, editorials, commentaries, letters to editor, opinion articles, reviews, or meeting abstracts were also excluded. Sample‐size cutoffs were chosen pre‐hoc in an attempt to limit the risks of imprecision and publication bias. Finally, studies that did not report on at least on‐ECMO mortality and discharge rate were excluded from analysis as they could not provide valuable information regarding the ECMO‐gap.

2.4. Data extraction

The following key information was extracted from each publication: year of publication, mortality on ECMO, weaning rate, in‐hospital mortality, number of discharged patients, cause of death on ECMO, cause of death after weaning, and in‐hospital complications.

2.5. End‐point definition

The primary outcome is the reported mortality rate on‐ECMO and mortality rate after weaning during the ECMO‐related hospitalization. These findings are then used to define the V‐A ECMO gap as follows: the difference between the rate of patients who were successfully weaned from ECMO and the rate of patients who were finally discharged at the end of the ECMO‐related hospital admittance (ie, the in‐hospital mortality rate after successful weaning). Secondary outcomes are, if available, causes of death either on‐ECMO or after weaning, rate of hospital discharge, and complications of ECMO. Studies that included causes of death on‐ECMO and after weaning were analyzed separately.

2.6. Data synthesis

Data synthesis was performed by two researchers with extensive expertise in statistics and epidemiology. Given the large number of patients expected to be included, the potentially low quality of the studies, and an expected number of missing patient data, heterogeneity of results was expected, and these should be interpreted with caution. Still, to illustrate the mortality rates on‐ and after ECMO, these rates were reported per study with corresponding 95% confidence intervals (95% CIs). All studies were assigned a certain weight, based on their sample size and distribution of data. Eventually, these rates were also pooled and presented in the same fashion. The results of I ² test for heterogeneity were also reported in which a result of >50%, in conjunction with a P value <.10 was considered significant. Complications and causes of death were reported as ranges. A freely available software package (OpenMetaAnalyst, http://www.cebm.brown.edu/openmeta) was used for data synthesis.

3. RESULTS

3.1. Included studies

The predefined literature search generated 12 436 studies (Figure 1). Sixty duplicates were removed after which 11 871 studies were excluded based on title, abstract, and keywords. Then, after careful full‐text review, 415 studies were excluded for reasons specified in Figure 1 (PRISMA flowchart). Eventually, 91 articles were included in our analysis. The selected articles provided a total number of 12 569 adult patients. The number of patients per article varied from 10 to 5263. However, only 60/91 studies reported on at least on‐ECMO mortality and discharge rate. These 31 studies were excluded from analysis as they do not provide any valuable information on the ECMO‐gap (Table S1). The 60 analyzed studies comprised 9181 patients (Table 1).

Study selection procedure shown in a PRISMA flow diagram. V‐A ECMO, veno‐arterial extracorporeal membrane oxygenation

TABLE 1.

Study characteristics and ECMO outcomes, including on‐ECMO mortality, weaning rate, and after weaning mortality rate and discharge rate

Author	Year	Total number of patients	On‐ECMO mortality (n)	%	95% CI	Weaning rate (n)	%	95% CI	Mortality after weaning (n)	%	95% CI	Discharge rate (n)	%	95% CI
Acker ³⁵	2001	37	10	27.0	12.7‐41.3	27	73.0	58.7‐87.3	1	2.7	0‐7.9	26	70.3	55.5‐85.0
Ariyaratnam ³⁶	2014	14	7	50.0	23.8‐76.2	7	50.0	23.8‐76.2	3	21.4	0‐42.9	2	14.3	0‐32.6
Aso ³⁷	2016	5263	1823	34.6	33.4‐35.9	3389	64.4	63.1‐65.7	1994	37.9	36.6‐39.2	1395	26.5	25.3‐27.7
Aziz ^a , ¹²	2010	10	4	40.0	9.6‐70.4	6	60.0	29.6‐90.4	0	0	0‐16.9	6	60.0	29.6‐90.4
Bednarczyk ³⁸	2014	32	7	21.9	7.6‐36.2	18	56.2	39.1‐73.4	3	9.4	0‐19.5	15	46.9	29.6‐64.2
Beurtheret ³⁹	2013	87	48	55.2	44.7‐65.6	39	44.8	34.4‐55.3	7	8.0	2.3‐13.8	32	36.8	26.6‐46.9
Borges Lima ⁴⁰	2015	11	2	18.2	0‐41.0	9	81.8	59.0‐100.0	2	18.2	0‐41.0	7	63.6	35.2‐92.1
Bouabdallaoui ^a , ¹³	2017	10	5	50.0	19.0‐81.0	5	50.0	19.0‐81.0	0	0	0‐16.9	5	50.0	19.0‐81.0
Chen ^a , ¹⁴	2005	15	1	6.7	0‐19.3	14	93.3	80.7‐100.0	3	20.0	0‐40.2	11	73.3	51.0‐95.7
Chou ⁴¹	2010	40	11	27.5	13.7‐41.3	29	72.5	58.7‐86.3	8	20.0	7.6‐32.4	21	52.5	37.0‐68.0
Chung ⁴²	2012	134	66	49.3	40.8‐57.7	68	50.7	42.3‐59.2	11	8.2	3.6‐12.9	57	42.5	34.2‐50.9
Demondion ^a , ¹⁵	2013	77	40	51.9	40.8‐63.1	19	24.7	15.0‐34.3	4	5.2	0.2‐10.2	30	39.0	28.1‐49.9
Den Uil ^a , ¹⁶	2017	132	46	34.8	26.7‐43.0	86	65.2	57.0‐73.3	19	14.4	8.4‐20.4	67	50.8	42.2‐59.3
Dini ^a , ¹⁷	2015	14	6	42.9	16.9‐68.8	8	57.1	31.2‐83.1	0	0	0‐12.3	8	57.1	31.2‐83.1
Esper ⁴³	2015	18	3	16.7	0‐33.9	15	83.3	66.1‐100.0	3	16.7	0‐33.9	12	66.7	44.9‐88.4
Fiser ⁴⁴	2001	51	35	68.6	55.9‐81.4	16	31.4	18.6‐44.1	8	15.7	5.7‐25.7	8	15.7	5.7‐25.7
George ⁴⁵	2018	32	11	34.4	17.9‐50.8	21	65.6	49.2‐82.1	4	12.5	1.0‐24.0	17	53.1	35.8‐70.4
Guenther ^a , ¹⁸	2013	41	15	36.6	21.8‐51.3	26	63.4	48.7‐78.2	6	14.6	3.8‐25.5	20	48.8	33.5‐64.1
Hei ⁴⁶	2010	68	16	23.5	13.4‐33.6	52	76.5	66.4‐86.6	9	13.2	5.2‐21.3	43	63.2	51.8‐74.7
Hsu ^a , ¹⁹	2010	51	24	47.1	33.4‐60.8	27	52.9	39.2‐66.6	10	19.6	8.7‐30.5	17	33.3	20.4‐46.3
Kagawa ⁴⁷	2010	77	40	51.9	40.8‐63.1	37	48.1	36.9‐59.2	19	24.6	15.0‐34.3	18	23.4	13.9‐23.8
Kara ⁴⁸	2016	24	9	37.5	18.1‐56.9	15	62.5	43.1‐81.9	0	0	0‐7.5	15	62.5	43.1‐81.9
Kim GS ⁴⁹	2017	61	34	55.7	43.3‐68.2	27	44.3	31.8‐56.7	8	13.1	4.6‐21.6	16	26.2	15.2‐37.3
Kim DW ⁵⁰	2018	38	17	44.7	28.9‐60.5	21	55.3	39.5‐71.1	1	2.6	0‐7.7	20	52.6	36.8‐68.5
Kim H ^a , ²⁰	2012	27	5	18.5	3.9‐33.2	22	81.5	66.8‐96.1	6	22.2	6.5‐37.9	16	59.3	40.7‐77.8
Ko ^a , ²¹	2002	76	30	39.4	28.5‐50.5	46	60.5	49.5‐71.5	22	28.9	18.8‐39.1	20	26.3	16.4‐36.2
Kosinski ^a , ²²	2018	29	11	37.9	20.3‐55.6	18	62.1	44.4‐79.7	2	6.9	0‐16.1	16	55.2	37.1‐73.3
Lazzara ⁵¹	1993	11	3	27.3	1.0‐53.6	8	72.7	46.4‐99.0	2	18.2	0‐41.0	6	54.5	25.1‐84.0
Lee SN ⁵²	2017	95	40	42.1	32.2‐52.0	55	57.9	48.0‐67.8	25	26.3	17.5‐35.2	30	31.6	22.2‐40.9
Loforte ⁵³	2014	228	84	36.8	30.6‐43.1	107	46.9	40.5‐53.4	22	9.6	5.8‐13.5	122	53.5	47.0‐60.0
Luyt ⁵⁴	2012	41	14	34.1	19.6‐48.7	23	56.1	40.9‐71.3	5	12.2	2.2‐22.2	18	43.9	28.7‐59.1
Mikus ⁵⁵	2013	14	7	50.0	23.8‐76.2	6	42.9	16.9‐68.8	1	7.1	0‐20.6	6	42.9	16.9‐68.8
Mirabel ⁵⁶	2011	35	13	37.1	21.1‐53.2	22	62.9	46.8‐78.9	1	2.9	0‐8.4	21	60.0	53.8‐76.2
Muehrcke ⁵⁷	1996	23	10	43.5	23.2‐63.7	9	39.1	19.2‐59.1	2	8.7	0‐20.2	7	30.4	11.6‐49.2
Pasrija ³⁰	2018	56	1	1.8	0‐5.3	14	25.0	13.7‐36.3	5	8.9	1.5‐16.4	50	89.3	81.2‐97.4
Pokersnik ⁵⁸	2012	49	22	44.9	31.0‐58.8	27	55.1	41.2‐69.0	11	22.4	10.8‐34.1	16	32.7	19.5‐45.8
Rastan ⁵⁹	2010	517	190	36.8	32.6‐40.9	327	63.2	59.1‐67.4	199	38.5	34.3‐42.7	128	24.8	21.0‐28.5
Rubino ⁶⁰	2017	101	43	42.6	32.9‐52.2	58	57.4	47.8‐67.1	24	23.8	15.5‐32.1	34	33.7	24.4‐42.9
Saito ⁶¹	2007	91	34	37.4	27.4‐47.3	56	61.5	51.5‐71.5	17	18.7	10.7‐26.7	40	44.0	33.8‐54.2
Sakamoto ⁶²	2012	98	44	44.9	35.1‐54.7	54	55.1	45.3‐64.9	22	22.4	14.2‐30.7	32	32.7	19.5‐45.8
Sangalli ⁶³	2016	10	1	10.0	0‐28.6	9	90.0	71.4‐100.0	1	10.0	0‐28.6	8	80.0	55.2‐100.0
Saxena ⁶⁴	2015	45	21	46.7	32.1‐61.2	24	53.3	38.8‐67.9	13	28.9	15.6‐42.1	11	24.4	11.9‐37.0
Shinn ⁶⁵	2009	92	33	35.9	26.1‐45.7	59	64.1	54.3‐73.9	20	21.7	13.3‐30.2	39	42.4	32.3‐52.5
Slottosch ⁶⁶	2013	77	29	37.7	26.8‐48.5	48	62.3	51.5‐73.2	11	14.3	6.5‐22.1	37	48.1	36.9‐59.2
Smedira ⁶⁷	2001	202	83	41.1	34.3‐47.9	71	35.1	28.6‐41.7	NR	–	–	76	37.6	30.9‐44.3
Smith ^a , ²³	2001	17	6	35.3	12.6‐58.0	11	64.7	42.0‐84.5	4	23.5	3.4‐43.7	7	41.2	17.8‐64.6
Stub ^a , ²⁴	2015	24	11	45.8	25.9‐65.8	13	54.2	34.2‐74.1	1	4.1	0‐12.2	12	50.0	30.0‐70.0
Takayama ⁶⁸	2015	101	40	39.6	30.1‐49.1	24	23.8	15.5‐32.1	NR	–	–	58	57.4	47.8‐67.1
Tanaka ⁷	2016	84	34	40.5	30.0‐51.0	50	59.5	49.0‐70.0	14	16.7	8.7‐24.6	36	42.9	32.3‐53.4
Tarzia ⁶⁹	2015	64	9	14.1	5.5‐22.6	NR	–	–	NR	–	–	37	57.8	45.7‐69.9
Tsai ⁷⁰	2017	105	31	29.5	20.8‐38.2	74	70.5	61.8‐79.2	19	18.1	10.7‐25.5	55	52.4	42.8‐61.9
Unosawa ^a , ²⁵	2013	47	18	38.3	24.4‐52.2	29	61.7	47.8‐75.6	15	31.9	18.6‐45.2	14	27.7	14.9‐40.4
van den Brink ⁷¹	2017	12	4	33.3	6.7‐60.0	8	66.7	40.0‐93.3	0	0	0‐12.2	8	66.7	40.0‐93.3
Wang S ^a , ²⁶	1996	18	9	50.0	26.9‐73.1	9	50.0	26.9‐73.1	3	16.7	0‐33.9	6	33.3	11.6‐55.1
Wang J ^a , ²⁷	2013	87	36	41.4	31.0‐51.7	51	58.6	48.3‐69.0	8	9.2	3.1‐15.3	43	49.4	38.9‐59.9
Wong ⁷²	2017	103	49	47.6	37.9‐57.2	54	52.4	42.8‐62.1	11	10.7	4.7‐16.6	43	41.7	32.2‐51.3
Wu ⁷³	2010	110	43	39.1	30.0‐48.2	67	60.9	51.8‐70.0	21	19.1	11.7‐26.4	46	41.8	32.6‐51.0
Yeh ⁷⁴	2018	99	71	71.7	62.8‐80.6	28	28.3	19.4‐37.2	15	15.2	8.1‐22.2	13	13.1	6.5‐19.8
Zhang ⁷⁵	2006	32	18	56.2	39.1‐73.4	14	43.7	26.6‐60.9	6	18.8	5.2‐32.3	8	25.0	10.0‐40.0
Zhao ⁷⁶	2015	24	8	33.3	14.5‐52.2	16	66.7	47.8‐85.5	8	33.3	14.5‐52.2	8	33.3	14.5‐52.2
n = 60	Total	9181	3385	38.0	34.2‐41.9	5492	57.0	53.3‐60.7	2659	15.3	11.1‐19.5	2994	44.0	39.8‐52.2

Open in a new tab

Abbreviations: CI, confidence interval; ECMO, extracorporeal membrane oxygenation; NR, not reported.

^{^a}

Studies that report on causes of death.

3.2. Mortality rates, weaning, and discharge

On‐ECMO mortality was reported by all 60 studies (n = 9181 patients). Overall, on‐ECMO mortality rate was 38.0% (95% CI 34.2%‐41.9%) (Table 1) ranging from 6.6% to 68.0%. After weaning, mortality rate was reported by 57 studies (n = 8814 patients). In‐hospital mortality rate after weaning was 15.3% (95% CI 11.1%‐19.5%), which represents the ECMO Gap. For both mortality rates, significant heterogeneity was noted (I ² > 95%, P < .001). A minority of patients could not be weaned and received another form of MCS or transplantation. Weaning rate was reported by 59 studies (n = 9117 patients) and was reported to be 57.0% (95% CI 53.3%‐60.7%). Eventually, 44.0% (95% CI 39.8%‐52.2%) of patients were discharged home. Again, similar heterogeneity was noted (P < .001).

3.3. Causes of death

Of the 60 articles, only 16 specifically reported in detail on cause of death on‐ECMO and after ECMO weaning. ¹² , ¹³ , ¹⁴ , ¹⁵ , ¹⁶ , ¹⁷ , ¹⁸ , ¹⁹ , ²⁰ , ²¹ , ²² , ²³ , ²⁴ , ²⁵ , ²⁶ , ²⁷ In these studies, 675 adult patients were included, of which 37.5% (95% CI 31.2%‐43.9%) died on‐ECMO (Table 1) and 60.3% (95% CI 51.2‐69.4) were weaned successfully. A small percentage was not weaned but received a form of permanent MCS or transplant, of which some patients were discharged.

After analyzing the 16 papers, we found that the most common causes of death on ECMO (Table 2) were multiple organ failure (MOF, ranging from 27% to 100%), followed by cardiac failure (ranging from 15% to 80%), neurological causes (ranging from 3% to 50%), and bleeding (ranging from 8% to 20%). Although MOF was the most common cause of death in most papers, some authors, like Smith et al ²³ and Unosawa et al, ²⁵ show that conditions such as persistent heart failure can also be a common cause of death in these patients (Table 2). The most common causes of in‐hospital death after ECMO weaning were MOF (ranging from 33% to 100%) followed by neurological causes, cardiac failure, and pneumonia (Table 2).

TABLE 2.

Causes of death on‐ECMO and after weaning

Author	Year	Cause of death on‐ECMO (n, %)	Cause of death after weaning (n, %)
Aziz ¹²	2010	MOF (2, 50%)	–
Aziz ¹²	2010	Neurological (2, 50%)	–
Bouabdallaoui ¹³	2017	MOF (4, 80%)	–
Bouabdallaoui ¹³	2017	Sepsis (1, 20%)	–
Chen ¹⁴	2005	MOF (1, 100%)	MOF (2, 67%)
Chen ¹⁴	2005	MOF (1, 100%)	Neurological (1, 33%)
Demondion ¹⁵	2013	MOF (26, 65%)	MOF (2, 50%)
		Cardiac failure (6, 15%)	Neurological (2, 50%)
		Bleeding (3, 8%)
		Sepsis (3, 8%)
		Aortic dissection (1, 3%)
		LV thrombosis (1, 3%)
Den Uil ¹⁶	2017	MOF (17, 40%)	MOF (12, 63%)
		Neurological (18, 39%)	Neurological (4, 21%)
		Cardiac failure (10, 22%)	Cardiac failure (3, 16%)
		ECMO dysfunction (1, 2%)	Cardiac failure (3, 16%)
Dini ¹⁷	2015	MOF (4, 67%)	–
Dini ¹⁷	2015	Cerebral hemorrhage (2, 33%)	–
Guenther ¹⁸	2013	MOF (9, 60%)	MOF (5, 83%)
Guenther ¹⁸	2013	Neurological (6, 40%)	Neurological (1, 17%)
Hsu ¹⁹	2010	MOF (20, 83%)	Cardiac failure (4, 40%)
		Neurological (2, 8%)	Pneumonia (6, 60%)
		Bleeding (2, 8%)	Pneumonia (6, 60%)
Kim H ²⁰	2012	Cardiac failure (4, 80%)	Cardiac failure (1, 17%)
		Bleeding (1, 20%)	Sepsis (2, 33%)
		Bleeding (1, 20%)	Arrhythmia (3, 50%)
Ko ²¹	2002	MOF (16, 53%)	MOF (17, 81%)
		Neurological (3, 10%)	Neurological (1, 45%)
		Circulatory shock (2, 7%)	Sudden death (4, 9%)
		Bleeding (5, 17%)
		Arrhythmia (2, 7%)
		Graft rejection (1, 3%)
		Family request (1, 3%)
Kosinski ²²	2018	MOF (11, 100%)	MOF (2, 100%)
Smith ²³	2001	Neurological (2, 33%)	Neurological (2, 50%)
Smith ²³	2001	Cardiac failure (4, 67%)	Sepsis (2, 50%)
Stub ²⁴	2015	MOF (3, 27%)	Cardiac failure (1, 100%)
		Neurological (4, 36%)
		Cerebral hemorrhage (2, 18%)
		Bleeding (2, 18%)
Unosawa ²⁵	2013	MOF (5, 28%)	MOF (8, 53%)
		Neurological (4, 22%)	Neurological (2, 13%)
		Cardiac failure (7, 39%)	Cardiac failure (2, 13%)
		Bleeding (2, 11%)	Cardiac rupture (2, 13%)
		Bleeding (2, 11%)	Pneumonia (1, 7%)
Wang S ²⁶	1996	MOF (5, 56%)	MOF (1, 33%)
		Sepsis (2, 22%)	Sepsis (1, 33%)
		Tube rupture (1, 11%)	Cerebral hemorrhage (1, 33%)
		ECMO dysfunction (1, 11%)	Cerebral hemorrhage (1, 33%)
Wang J ²⁷	2013	MOF (10, 28%)	MOF (8, 100%)
		Neurological (1, 3%)
		Cardiac failure (22, 61%)
		DIC (3, 8%)

Open in a new tab

Abbreviations: DIC, disseminated intravascular coagulation; ECMO, extracorporeal membrane oxygenation; LV, left ventricle; MOF, multiorgan failure.

3.4. Complications in V‐A ECMO

The cost‐benefit ratio is a highly debated issue in ECMO research, especially in regard to complications and hospital stay. ²⁸ , ²⁹ In the current study, complications were analyzed in 13 articles reporting on complications ¹² , ¹³ , ¹⁴ , ¹⁵ , ¹⁶ , ¹⁷ , ¹⁸ , ¹⁹ , ²¹ , ²³ , ²⁴ , ²⁵ , ³⁰ and presented in Table 3.

TABLE 3.

Complication rates

	Year	Complication	n	%
Aziz ¹²	2010	Bleeding	1	10
		Hemolysis	1	10
		Renal failure	1	10
		Pneumonia	1	10
		Sepsis	1	10
Bouabdallaoui ¹³	2017	Pulmonary edema	2	40
		Sepsis	1	20
		Bleeding	1	20
		Limb ischemia	1	20
Chen ¹⁴	2005	Renal	4	26.6
		Neurological	3	20
		Respiratory	1	6.6
		Bleeding	3	20
Demondion ¹⁵	2013	Pneumonia	40	51.3
		ARF	36	46.1
		Pulmonary edema	24	31.6
		Major bleeding	16	21.3
		Lower limb ischemia	7	9.2
		Wound infection	6	8
		Stroke	2	2.6
Den Uil ¹⁶	2017	Bleeding	40	43.4
		Stroke	8	8.6
		Sepsis	11	11.9
		Limb ischemia	13	14.1
		Cannula change	20	21.7
Dini ¹⁷	2015	Renal failure	7	100
Guenther ¹⁸	2013	Cannula related	4	9.7
		Cannula site bleeding	2	4.8
		Cannula‐ wound healing	2	4.8
		Lower limb ischemia	5	12.1
		Pump thrombosis	1	2.4
Hsu ¹⁹	2010	ARF	38	75
		Femoral bleeding	20	39
		Hematuria	17	33
		GI bleeding	13	25
		Pulmonary infection	11	22
		Compartment syndrome	5	9.8
		ARDS	5	9.8
		Limb ischemia	3	5.9
		Leg amputation	2	3.9
		Neurologic complication	3	5.9
		Catheter‐related infection	3	5.9
		Pancreatitis	1	2
Ko ²⁰	2002	Neurological	9	11.8
		Lower limb reperfusion	20	26.3
		Toe cyanosis	10	13.1
		Fasciotomy	3	3.9
		Bleeding related	35	46
Pasrija ³⁰	2018	Sepsis	1	20
		Dysrhythmia	1	20
		Tracheostomy	3	60
Smith ²³	2001	Major bleeding	6	35
Smith ²³	2001	Lower limb ischemia	4	23
Stub ²⁴	2015	Bleeding	16	69
Stub ²⁴	2015	Cannula‐related reintervention	10	38
Unosawa ²⁵	2012	Incomplete sternal closure	14	100

Open in a new tab

Abbreviations: ARDS, acute respiratory distress syndrome; ARF, acute renal failure; GI, gastrointestinal.

4. DISCUSSION

In‐hospital mortality among V‐A ECMO patients remains high. Despite the knowledge and skills that ECMO teams have gained during the last years regarding this technology, mortality rates have not declined. Furthermore, in‐hospital ECMO mortality has not been comprehensively described until now. In particular, there are scarce data on the timing of death (ie, during or after ECMO support) as well as on the main causes of death in this setting. In our own experience, we observed a lot of patients to still decease after weaning of ECMO, in hospital. We defined this discrepancy as the “V‐A ECMO‐gap.” From our view, an underreporting, either in terms of uniformity or quality about ECMO‐related fatal events, came clearly out. Indeed, only two thirds of selected papers provided information about timing of deaths and related causes.

It is still challenging to explain this ECMO‐gap. Many factors can be considered, such as a weaning process that was initiated in a too early phase, and ethical factors should be recognized. Deaths also occur after weaning of support due to recognition of futility by health workers in order to facilitate a more humanized healthcare or by family members.

Overall, on‐ECMO mortality was 38.0%, and weaning rate was 60.3%. Still, it remains difficult to interpret the discharge rate in respect to the weaning rate for the patients that could not be weaned. In some cases, they underwent some modality of other MCS (or transplant) and are in several studies included in the overall patients discharged from hospital, as other papers only report nontransplanted (or non‐MCS) discharged patients. ¹⁴ , ¹⁵

Many authors report on‐ECMO and after weaning mortality rates, but most of them only provide partial details or do not provide causes of death. For example, Cheng et al report survival to discharge as a cumulative rate, although, they did not specify whether death occurred on‐ECMO or after weaning. ³¹ This provides another example of underreporting in V‐A ECMO research.

Only 16/60 studies reported on causes of death. Most common causes of death on‐ECMO were MOF, cardiac failure, neurological causes, and bleeding, whereas most common causes after weaning were MOF, cardiac failure, neurological causes, and respiratory causes. A marked difference in cause of death between on‐ECMO and after weaning mortality rate is bleeding. Bleeding can be a result of systemic effects of cardiopulmonary bypass, causing platelet dysfunction and hemodilution of clotting factors. Combined with the administration of anticoagulation while on ECMO, reducing the risk of circuit clotting, intracranial bleeding is a highly feared and lethal on‐ECMO complication. ³²

On‐ECMO acute renal failure is an independent predictor for MOF after weaning. ²¹ Renal function on‐ECMO is often assessed by serum creatinine levels rather than by urine volume. Urine volume is a more sensitive marker for acute renal failure than serum creatinine. ³³ Subsequently, impaired renal function on‐ECMO could be masked by use of diuretics, which are regularly used during the weaning process for correction of fluid overload. Finally, the increased rate of pneumonia as cause of death in the weaned group can be related to the increased length of hospitalization and intubation time, which are obvious independent predictors for development hospital acquired pneumonias. ³⁴

The lack of reporting causes of death together (as illustrated by the merely 16 studies describing these findings) with the lack of reporting mortality rates of ECMO patients (as illustrated by the 30 initially excluded studies) makes comprehensive understanding of the “ECMO Gap” even more challenging.

4.1. Limitations

A number of limitations should be recognized when considering this review. During the course of composing this review, a large number of papers dealing mainly with adult V‐A ECMO have been assessed. The reports included, however, were quite heterogeneous, meaning that not all outcomes were reported in all papers, making it difficult to interpret the results of a true meta‐analysis. Therefore, as illustrated by the levels of heterogeneity, pooled rates should be interpreted with caution. Moreover, 30 of the studies, which were included in the systematic review, had to be excluded from analysis as they did not report on the most essential outcomes, further defining the ECMO‐gap in reporting on ECMO outcomes.

It remains challenging to relate mortality to indication as there is no uniformity in reporting of indications and outcomes in ECMO research. Providing the certain causes of death is not always possible because autopsies are not routinely performed, for example, neurological complications and causes of death. However, it is believed that despite these potential issues, the main ideas and results of the review are preserved as the ECMO‐gap is defined and a light is shed on the difference in reporting and underreporting of existing studies.

5. CONCLUSION

In‐hospital mortality rate of adult V‐A ECMO patients is still high. The detailed information about timing and causes of death are, however, not adequately reported in the literature. Identifying the extent and causes of death on‐ECMO and after weaning revealed many of ECMO patients to still die after weaning, in hospital. Timing of death is related to different causes of death, of which bleeding on‐ECMO is the most predominant one compared with after weaning mortality rate, while MOF remains the most important cause of death in both groups.

Underreporting and lack of uniformity in reporting of important parameters remains problematic in ECMO research. Future studies should fully and uniformly define timing and causes of death in V‐A ECMO patients to better understand the effectiveness and complications of this support.

CONFLICT OF INTEREST

The authors have no financial disclosure and conflicts of interest to declare.

AUTHOR CONTRIBUTIONS

Study design: Makhoul, Heuts, Taccone, Obeid, Mirko, Broman, Malfertheiner, Meani, Raffa, Delnoij, Maessen, Bolotin, Lorusso

Data acquisition: Makhoul, Heuts, Mansouri, Lorusso

Data analysis: Makhoul, Heuts, Mansouri, Lorusso

Data interpretation: Makhoul, Heuts, Mansouri, Lorusso

Draft manuscript: Makhoul, Heuts, Lorusso

Revision of the work: Taccone, Obeid, Mirko, Broman, Malfertheiner, Meani, Raffa, Delnoij, Maessen, Bolotin, Lorusso

Supervision: Lorusso

Supporting information

Table S1

Click here for additional data file.^{(22.3KB, docx)}

Makhoul M, Heuts S, Mansouri A, Taccone FS, Obeid A, Mirko B, et al. Understanding the “extracorporeal membrane oxygenation gap” in veno‐arterial configuration for adult patients: Timing and causes of death. Artif. Organs. 2021;45:1155–1167. 10.1111/aor.14006

Maged Makhoul and Samuel Heuts contributed equally to this work.

REFERENCES

1. Abrams D, Combes A, Brodie D. Extracorporeal membrane oxygenation in cardiopulmonary disease in adults. J Am Coll Cardiol. 2014;63:2769–78. [DOI] [PubMed] [Google Scholar]
2. International summary. Extracorporeal Lfe Support Organization; 2017. [cited 2020 Aug 15]. Available from: https://www.elso.org/Registry/Statistics/InternationalSummary.aspx [Google Scholar]
3. Peek GJ, Clemens F, Elbourne D, Firmin R, Hardy P, Hibbert C, et al. CESAR: conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure. BMC Health Serv Res. 2006;6:163. [DOI] [PMC free article] [PubMed] [Google Scholar]
4. Paden ML, Rycus PT, Thiagarajan RR. Update and outcomes in extracorporeal life support. Semin Perinatol. 2014;38:65–70. [DOI] [PubMed] [Google Scholar]
5. Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374:1351–63. [DOI] [PubMed] [Google Scholar]
6. Flecher E, Anselmi A, Corbineau H, Langanay T, Verhoye J‐P, Felix C, et al. Current aspects of extracorporeal membrane oxygenation in a tertiary referral centre: determinants of survival at follow‐up. Eur J Cardiothorac Surg. 2014;46:665–71; discussion 71. [DOI] [PubMed] [Google Scholar]
7. Tanaka D, Hirose H, Cavarocchi N, Entwistle JWC. The impact of vascular complications on survival of patients on venoarterial extracorporeal membrane oxygenation. Ann Thorac Surg. 2016;101:1729–34. [DOI] [PubMed] [Google Scholar]
8. McCarthy FH, McDermott KM, Kini V, Gutsche JT, Wald JW, Xie D, et al. Trends in U.S. Extracorporeal Membrane Oxygenation Use and Outcomes: 2002‐2012. Semin Thorac Cardiovasc Surg. 2015;27:81–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
9. Gray BW, Haft JW, Hirsch JC, Annich GM, Hirschl RB, Bartlett RH. Extracorporeal life support: experience with 2,000 patients. ASAIO J. 2015;61:2–7. [DOI] [PMC free article] [PubMed] [Google Scholar]
10. Booth A, Clarke M, Dooley G, Ghersi D, Moher D, Petticrew M, et al. The nuts and bolts of PROSPERO: an international prospective register of systematic reviews. Syst Rev. 2012;1:2. [DOI] [PMC free article] [PubMed] [Google Scholar]
11. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta‐analyses: the PRISMA statement. BMJ. 2009;339:b2535. [DOI] [PMC free article] [PubMed] [Google Scholar]
12. Aziz TA, Singh G, Popjes E, Stephenson E, Mulvey S, Pae W, et al. Initial experience with CentriMag extracorporal membrane oxygenation for support of critically ill patients with refractory cardiogenic shock. J Heart Lung Transplant. 2010;29:66–71. [DOI] [PubMed] [Google Scholar]
13. Bouabdallaoui N, Demondion P, Leprince P, Lebreton G. Short‐term mechanical circulatory support for cardiogenic shock in severe peripartum cardiomyopathy: La Pitie‐Salpetriere experience. Interact Cardiovasc Thorac Surg. 2017;25:52–6. [DOI] [PubMed] [Google Scholar]
14. Chen Y‐S, Yu H‐Y, Huang S‐C, Chiu K‐M, Lin T‐Y, Lai L‐P, et al. Experience and result of extracorporeal membrane oxygenation in treating fulminant myocarditis with shock: what mechanical support should be considered first? J Heart Lung Transplant. 2005;24:81–7. [DOI] [PubMed] [Google Scholar]
15. Demondion P, Fournel L, Golmard J‐L, Niculescu M, Pavie A, Leprince P. Predictors of 30‐day mortality and outcome in cases of myocardial infarction with cardiogenic shock treated by extracorporeal life support. Eur J Cardiothorac Surg. 2014;45:47–54. [DOI] [PubMed] [Google Scholar]
16. den Uil CA , Jewbali LS, Heeren MJ, Constantinescu AA, Van Mieghem NM, Reis Miranda DD. Isolated left ventricular failure is a predictor of poor outcome in patients receiving veno‐arterial extracorporeal membrane oxygenation. Eur J Heart Fail. 2017;19 Suppl 2:104–9. [DOI] [PubMed] [Google Scholar]
17. Dini CS, Lazzeri C, Chiostri M, Gensini GF, Valente S. A local network for extracorporeal membrane oxygenation in refractory cardiogenic shock. Acute Card Care. 2015;17:49–54. [DOI] [PubMed] [Google Scholar]
18. Guenther S, Theiss HD, Fischer M, Sattler S, Peterss S, Born F, et al. Percutaneous extracorporeal life support for patients in therapy refractory cardiogenic shock: initial results of an interdisciplinary team. Interact Cardiovasc Thorac Surg. 2014;18:283–91. [DOI] [PMC free article] [PubMed] [Google Scholar]
19. Hsu PS, Chen JL, Hong GJ, Tsai YT, Lin CY, Lee CY, et al. Extracorporeal membrane oxygenation for refractory cardiogenic shock after cardiac surgery: predictors of early mortality and outcome from 51 adult patients. Eur J Cardiothorac Surg. 2010;37:328–33. [DOI] [PubMed] [Google Scholar]
20. Kim H, Lim S‐H, Hong J, Hong Y‐S, Lee CJ, Jung J‐H, et al. Efficacy of veno‐arterial extracorporeal membrane oxygenation in acute myocardial infarction with cardiogenic shock. Resuscitation. 2012;83:971–5. [DOI] [PubMed] [Google Scholar]
21. Ko W‐J, Lin C‐Y, Chen RJ, Wang S‐S, Lin F‐Y, Chen Y‐S. Extracorporeal membrane oxygenation support for adult postcardiotomy cardiogenic shock. Ann Thorac Surg. 2002;73:538–45. [DOI] [PubMed] [Google Scholar]
22. Kosiński S, Darocha T, Czerw A, Paal P, Pasquier M, Krawczyk P, et al. Cost‐utility of extracorporeal membrane oxygenation rewarming in accidentally hypothermic patients—a single‐centre retrospective study. Acta Anaesthesiol Scand. 2018;62:1105–11. [DOI] [PubMed] [Google Scholar]
23. Smith C, Bellomo R, Raman JS, Matalanis G, Rosalion A, Buckmaster J, et al. An extracorporeal membrane oxygenation‐based approach to cardiogenic shock in an older population. Ann Thorac Surg. 2001;71:1421–7. [DOI] [PubMed] [Google Scholar]
24. Stub D, Bernard S, Pellegrino V, Smith K, Walker T, Sheldrake J, et al. Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial). Resuscitation. 2015;86:88–94. [DOI] [PubMed] [Google Scholar]
25. Unosawa S, Sezai A, Hata M, Nakata K, Yoshitake I, Wakui S, et al. Long‐term outcomes of patients undergoing extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. Surg Today. 2013;43:264–70. [DOI] [PubMed] [Google Scholar]
26. Wang S‐S, Chen Y‐S, Ko W‐J, Chu S‐H. Extracorporeal membrane oxygenation support for postcardiotomy cardiogenic shock. Artif Organs. 1996;20:1287–91. [DOI] [PubMed] [Google Scholar]
27. Wang J‐G, Han J, Jia Y‐X, Zeng W, Hou X‐T, Meng XU. Outcome of veno‐arterial extracorporeal membrane oxygenation for patients undergoing valvular surgery. PLoS ONE. 2013;8:e63924. [DOI] [PMC free article] [PubMed] [Google Scholar]
28. Lan C, Tsai P‐R, Chen Y‐S, Ko W‐J. Prognostic factors for adult patients receiving extracorporeal membrane oxygenation as mechanical circulatory support—a 14‐year experience at a medical center. Artif Organs. 2010;34:E59–64. [DOI] [PubMed] [Google Scholar]
29. Cheng R, Hachamovitch R, Kittleson M, Patel J, Arabia F, Moriguchi J, et al. Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta‐analysis of 1,866 adult patients. Ann Thorac Surg. 2014;97:610–6. [DOI] [PubMed] [Google Scholar]
30. Pasrija C, Shah A, George P, Kronfli A, Raithel M, Boulos F, et al. Triage and optimization: a new paradigm in the treatment of massive pulmonary embolism. J Thorac Cardiovasc Surg. 2018;156:672–81. [DOI] [PubMed] [Google Scholar]
31. Cheng R, Hachamovitch R, Kittleson M, Patel J, Arabia F, Moriguchi J, et al. Clinical outcomes in fulminant myocarditis requiring extracorporeal membrane oxygenation: a weighted meta‐analysis of 170 patients. J Card Fail. 2014;20:400–6. [DOI] [PubMed] [Google Scholar]
32. Fletcher Sandersjöö A, Bartek J, Thelin EP, Eriksson A, Elmi‐Terander A, Broman M, et al. Predictors of intracranial hemorrhage in adult patients on extracorporeal membrane oxygenation: an observational cohort study. J Intensive Care. 2017;5:27. [DOI] [PMC free article] [PubMed] [Google Scholar]
33. Chang W‐W, Tsai F‐C, Tsai T‐Y, Chang C‐H, Jenq C‐C, Chang M‐Y, et al. Predictors of mortality in patients successfully weaned from extracorporeal membrane oxygenation. PLoS ONE. 2012;7:e42687. [DOI] [PMC free article] [PubMed] [Google Scholar]
34. Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator‐associated pneumonia: a systematic review. Crit Care Med. 2005;33:2184–93. [DOI] [PubMed] [Google Scholar]
35. Acker MA. Mechanical circulatory support for patients with acute‐fulminant myocarditis. Ann Thorac Surg. 2001;71:S73–6; discussion S82–5. [DOI] [PubMed] [Google Scholar]
36. Ariyaratnam P, McLean LA, Cale ARJ, Loubani M. Extra‐corporeal membrane oxygenation for the post‐cardiotomy patient. Heart Fail Rev. 2014;19:717–25. [DOI] [PubMed] [Google Scholar]
37. Aso S, Matsui H, Fushimi K, Yasunaga H. In‐hospital mortality and successful weaning from venoarterial extracorporeal membrane oxygenation: analysis of 5,263 patients using a national inpatient database in Japan. Crit Care. 2016;20:80. [DOI] [PMC free article] [PubMed] [Google Scholar]
38. Bednarczyk JM, White CW, Ducas RA, Golian M, Nepomuceno R, Hiebert B, et al. Resuscitative extracorporeal membrane oxygenation for in hospital cardiac arrest: a Canadian observational experience. Resuscitation. 2014;85:1713–9. [DOI] [PubMed] [Google Scholar]
39. Beurtheret S, Mordant P, Paoletti X, Marijon E, Celermajer DS, Leger P. Emergency circulatory support in refractory cardiogenic shock patients in remote institutions: a pilot study (the cardiac‐RESCUE program). Eur Heart J. 2013;34:112–20. [DOI] [PubMed] [Google Scholar]
40. Lima EB, Cunha CRD, Barzilai VS, Ulhoa MB, Barros MRD, Moraes CS, et al. Experience of ECMO in primary graft dysfunction after orthotopic heart transplantation. Arq Bras Cardiol. 2015;105:285–91. [DOI] [PMC free article] [PubMed] [Google Scholar]
41. Chou NK, Chi NH, Wu IW, Huang SC, Chen YS, Yu HY, et al. Extracoporeal membrane oxygenation to rescue cardiopulmonary failure after heart transplantation: a single‐center experience. Transplant Proc. 2010;42:943–5. [DOI] [PubMed] [Google Scholar]
42. Chung S‐Y, Sheu J‐J, Lin Y‐J, Sun C‐K, Chang L‐T, Chen Y‐L, et al. Outcome of patients with profound cardiogenic shock after cardiopulmonary resuscitation and prompt extracorporeal membrane oxygenation support. A single‐center observational study. Circ J. 2012;76:1385–92. [DOI] [PubMed] [Google Scholar]
43. Esper SA, Bermudez C, Dueweke EJ, Kormos R, Subramaniam K, Mulukutla S, et al. Extracorporeal membrane oxygenation support in acute coronary syndromes complicated by cardiogenic shock. Catheter Cardiovasc Interv. 2015;86 Suppl 1:S45–50. [DOI] [PubMed] [Google Scholar]
44. Fiser SM, Tribble CG, Kaza AK, Long SM, Zacour RK, Kern JA, et al. When to discontinue extracorporeal membrane oxygenation for postcardiotomy support. Ann Thorac Surg. 2001;71:210–4. [DOI] [PubMed] [Google Scholar]
45. George B, Parazino M, Omar HR, Davis G, Guglin M, Gurley J, et al. A retrospective comparison of survivors and non‐survivors of massive pulmonary embolism receiving veno‐arterial extracorporeal membrane oxygenation support. Resuscitation. 2018;122:1–5. [DOI] [PubMed] [Google Scholar]
46. Hei F, Lou S, Li J, Yu K, Liu J, Feng Z, et al. Five‐year results of 121 consecutive patients treated with extracorporeal membrane oxygenation at Fu Wai Hospital. Artif Organs. 2011;35:572–8. [DOI] [PubMed] [Google Scholar]
47. Kagawa E, Inoue I, Kawagoe T, Ishihara M, Shimatani Y, Kurisu S, et al. Assessment of outcomes and differences between in‐ and out‐of‐hospital cardiac arrest patients treated with cardiopulmonary resuscitation using extracorporeal life support. Resuscitation. 2010;81:968–73. [DOI] [PubMed] [Google Scholar]
48. Kara A, Akin S, dos Reis Miranda D , Struijs A, Caliskan K, van Thiel RJ , et al. Microcirculatory assessment of patients under VA‐ECMO. Crit Care. 2016;20:344. [DOI] [PMC free article] [PubMed] [Google Scholar]
49. Kim GS, Lee KS, Park CK, Kang SK, Kim DW, Oh SG, et al. Nosocomial infection in adult patients undergoing veno‐arterial extracorporeal membrane oxygenation. J Korean Med Sci. 2017;32:593–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
50. Kim DW, Cho HJ, Kim GS, Song SY, Na KJ, Oh SG, et al. Predictive value of procalcitonin for infection and survival in adult cardiogenic shock patients treated with extracorporeal membrane oxygenation. Chonnam Med J. 2018;54:48–54. [DOI] [PMC free article] [PubMed] [Google Scholar]
51. Lazzara RR, Magovern JA, Benckart DH, Maher TD, Sakert T, Magovern GJ, et al. Extracorporeal membrane oxygenation for adult post cardiotomy cardiogenic shock using a heparin bonded system. ASAIO J. 1993;39:M444–7. [DOI] [PubMed] [Google Scholar]
52. Lee SN, Jo MS, Yoo KD. Impact of age on extracorporeal membrane oxygenation survival of patients with cardiac failure. Clin Interv Aging. 2017;12:1347–53. [DOI] [PMC free article] [PubMed] [Google Scholar]
53. Loforte A, Marinelli G, Musumeci F, Folesani G, Pilato E, Martin Suarez S, et al. Extracorporeal membrane oxygenation support in refractory cardiogenic shock: treatment strategies and analysis of risk factors. Artif Organs. 2014;38:E129–E141. [DOI] [PubMed] [Google Scholar]
54. Luyt C‐E, Landivier A, Leprince P, Bernard M, Pavie A, Chastre J, et al. Usefulness of cardiac biomarkers to predict cardiac recovery in patients on extracorporeal membrane oxygenation support for refractory cardiogenic shock. J Crit Care. 2012;27:524.e7–14. [DOI] [PubMed] [Google Scholar]
55. Mikus E, Tripodi A, Calvi S, Giglio MD, Cavallucci A, Lamarra M. CentriMag venoarterial extracorporeal membrane oxygenation support as treatment for patients with refractory postcardiotomy cardiogenic shock. ASAIO J. 2013;59:18–23. [DOI] [PubMed] [Google Scholar]
56. Mirabel M, Luyt C‐E, Leprince P, Trouillet J‐L, Léger P, Pavie A, et al. Outcomes, long‐term quality of life, and psychologic assessment of fulminant myocarditis patients rescued by mechanical circulatory support. Crit Care Med. 2011;39:1029–35. [DOI] [PubMed] [Google Scholar]
57. Muehrcke DD, McCarthy PM, Stewart RW, Foster RC, Ogella DA, Borsh JA, et al. Extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock. Ann Thorac Surg. 1996;61:684–91. [DOI] [PubMed] [Google Scholar]
58. Pokersnik JA, Buda T, Bashour CA, Gonzalez‐Stawinski GV. Have changes in ECMO technology impacted outcomes in adult patients developing postcardiotomy cardiogenic shock? J Card Surg. 2012;27:246–52. [DOI] [PubMed] [Google Scholar]
59. Rastan AJ, Dege A, Mohr M, Doll N, Falk V, Walther T, et al. Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. J Thorac Cardiovasc Surg. 2010;139:302–11.e1. [DOI] [PubMed] [Google Scholar]
60. Rubino A, Costanzo D, Stanszus D, Valchanov K, Jenkins D, Sertic F, et al. Central veno‐arterial extracorporeal membrane oxygenation (C‐VA‐ECMO) after cardiothoracic surgery: a single‐center experience. J Cardiothorac Vasc Anesth. 2018;32:1169–74. [DOI] [PubMed] [Google Scholar]
61. Saito S, Nakatani T, Kobayashi J, Tagusari O, Bando KO, Niwaya K, et al. Is extracorporeal life support contraindicated in elderly patients? Ann Thorac Surg. 2007;83:140–5. [DOI] [PubMed] [Google Scholar]
62. Sakamoto S, Taniguchi N, Nakajima S, Takahashi A. Extracorporeal life support for cardiogenic shock or cardiac arrest due to acute coronary syndrome. Ann Thorac Surg. 2012;94:1–7. [DOI] [PubMed] [Google Scholar]
63. Sangalli F, Avalli L, Laratta M, Formica F, Maggioni E, Caruso R, et al. Effects of levosimendan on endothelial function and hemodynamics during weaning from veno‐arterial extracorporeal life support. J Cardiothorac Vasc Anesth. 2016;30:1449–53. [DOI] [PubMed] [Google Scholar]
64. Saxena P, Neal J, Joyce LD, Greason KL, Schaff HV, Guru P, et al. Extracorporeal membrane oxygenation support in postcardiotomy elderly patients: the Mayo Clinic experience. Ann Thorac Surg. 2015;99:2053–60. [DOI] [PubMed] [Google Scholar]
65. Shinn SH, Lee YT, Sung K, Min S, Kim WS, Park PW, et al. Efficacy of emergent percutaneous cardiopulmonary support in cardiac or respiratory failure: fight or flight? Interact Cardiovasc Thorac Surg. 2009;9:269–73. [DOI] [PubMed] [Google Scholar]
66. Slottosch I, Liakopoulos O, Kuhn E, Deppe A‐C, Scherner M, Madershahian N, et al. Outcomes after peripheral extracorporeal membrane oxygenation therapy for postcardiotomy cardiogenic shock: a single‐center experience. J Surg Res. 2013;181:e47–e55. [DOI] [PubMed] [Google Scholar]
67. Smedira NG, Moazami N, Golding CM, McCarthy PM, Apperson‐Hansen C, Blackstone EH, et al. Clinical experience with 202 adults receiving extracorporeal membrane oxygenation for cardiac failure: survival at five years. J Thorac Cardiovasc Surg. 2001;122:92–102. [DOI] [PubMed] [Google Scholar]
68. Takayama H, Landes E, Truby L, Fujita K, Kirtane AJ, Mongero L, et al. Feasibility of smaller arterial cannulas in venoarterial extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg. 2015;149:1428–33. [DOI] [PubMed] [Google Scholar]
69. Tarzia V, Bortolussi G, Bianco R, Buratto E, Bejko J, Carrozzini M, et al. Extracorporeal life support in cardiogenic shock: impact of acute versus chronic etiology on outcome. J Thorac Cardiovasc Surg. 2015;150:333–40. [DOI] [PubMed] [Google Scholar]
70. Tsai T‐Y, Tsai F‐C, Fan P‐C, Chang C‐H, Lin C‐Y, Chang W‐W, et al. Application of the age, creatinine, and left ventricular ejection fraction score for patients on extracorporeal membrane oxygenation. Artif Organs. 2017;41:146–52. [DOI] [PubMed] [Google Scholar]
71. van den Brink FS , Magan AD, Noordzij PG, Zivelonghi C, Agostoni P, Eefting FD, et al. Veno‐arterial extracorporeal membrane oxygenation in addition to primary PCI in patients presenting with ST‐elevation myocardial infarction. Neth Heart J. 2018;26:76–84. [DOI] [PMC free article] [PubMed] [Google Scholar]
72. Wong JK, Melvin AL, Joshi DJ, Lee CY, Archibald WJ, Angona RE, et al. Cannulation‐related complications on veno‐arterial extracorporeal membrane oxygenation: prevalence and effect on mortality. Artif Organs. 2017;41:827–34. [DOI] [PubMed] [Google Scholar]
73. Wu M‐Y, Lin P‐J, Lee M‐Y, Tsai F‐C, Chu J‐J, Chang Y‐S, et al. Using extracorporeal life support to resuscitate adult postcardiotomy cardiogenic shock: treatment strategies and predictors of short‐term and midterm survival. Resuscitation. 2010;81:1111–6. [DOI] [PubMed] [Google Scholar]
74. Yeh T‐C, Chang H‐H, Ger L‐P, Wang J‐O, Kao S, Ho S‐T. Clinical risk factors of extracorporeal membrane oxygenation support in older adults. PLoS ONE. 2018;13:e0195445. [DOI] [PMC free article] [PubMed] [Google Scholar]
75. Zhang R, Kofidis T, Kamiya H, Shrestha M, Tessmann R, Haverich A, et al. Creatine kinase isoenzyme MB relative index as predictor of mortality on extracorporeal membrane oxygenation support for postcardiotomy cardiogenic shock in adult patients. Eur J Cardiothorac Surg. 2006;30:617–20. [DOI] [PubMed] [Google Scholar]
76. Zhao Y, Xing J, Du Z, Liu F, Jia M, Hou X. Extracorporeal cardiopulmonary resuscitation for adult patients who underwent post‐cardiac surgery. Eur J Med Res. 2015;20:83. [DOI] [PMC free article] [PubMed] [Google Scholar]
77. Akin S, dos Reis Miranda D , Caliskan K, Soliman OI, Guven G, Struijs A, et al. Functional evaluation of sublingual microcirculation indicates successful weaning from VA‐ECMO in cardiogenic shock. Crit Care. 2017;21:265. [DOI] [PMC free article] [PubMed] [Google Scholar]
78. Arlt M, Philipp A, Voelkel S, Schopka S, Husser O, Hengstenberg C, et al. Early experiences with miniaturized extracorporeal life‐support in the catheterization laboratory. Eur J Cardiothorac Surg. 2012;42:858–63. [DOI] [PubMed] [Google Scholar]
79. Asaumi Y, Yasuda S, Morii I, Kakuchi H, Otsuka Y, Kawamura A, et al. Favourable clinical outcome in patients with cardiogenic shock due to fulminant myocarditis supported by percutaneous extracorporeal membrane oxygenation. Eur Heart J. 2005;26:2185–92. [DOI] [PubMed] [Google Scholar]
80. Bermudez CA, Rocha RV, Toyoda Y, Zaldonis D, Sappington PL, Mulukutla S, et al. Extracorporeal membrane oxygenation for advanced refractory shock in acute and chronic cardiomyopathy. Ann Thorac Surg. 2011;92:2125–31. [DOI] [PubMed] [Google Scholar]
81. Bougouin W, Aissaoui N, Combes A, Deye N, Lamhaut L, Jost D, et al. Post‐cardiac arrest shock treated with veno‐arterial extracorporeal membrane oxygenation: an observational study and propensity‐score analysis. Resuscitation. 2017;110:126–32. [DOI] [PubMed] [Google Scholar]
82. Carroll BJ, Shah RV, Murthy V, McCullough SA, Reza N, Thomas SS, et al. Clinical features and outcomes in adults with cardiogenic shock supported by extracorporeal membrane oxygenation. Am J Cardiol. 2015;116:1624–30. [DOI] [PubMed] [Google Scholar]
83. Chamogeorgakis T, Rafael A, Shafii AE, Nagpal D, Pokersnik JA, Gonzalez‐Stawinski GV. Which is better: a miniaturized percutaneous ventricular assist device or extracorporeal membrane oxygenation for patients with cardiogenic shock? ASAIO J. 2013;59:607–11. [DOI] [PubMed] [Google Scholar]
84. Chiu R, Pillado E, Sareh S, De La Cruz K, Shemin RJ, Benharash P. Financial and clinical outcomes of extracorporeal mechanical support. J Card Surg. 2017;32:215–21. [DOI] [PubMed] [Google Scholar]
85. Distelmaier K, Schrutka L, Binder C, Steinlechner B, Heinz G, Lang IM, et al. Cardiac arrest does not affect survival in post‐operative cardiovascular surgery patients undergoing extracorporeal membrane oxygenation. Resuscitation. 2016;104:24–7. [DOI] [PubMed] [Google Scholar]
86. Elsharkawy HA, Li L, Esa WAS, Sessler DI, Bashour CA. Outcome in patients who require venoarterial extracorporeal membrane oxygenation support after cardiac surgery. J Cardiothorac Vasc Anesth. 2010;24:946–51. [DOI] [PubMed] [Google Scholar]
87. Giani M, Scaravilli V, Colombo SM, Confalonieri A, Leo R, Maggioni E, et al. Apnea test during brain death assessment in mechanically ventilated and ECMO patients. Intensive Care Med. 2016;42:72–81. [DOI] [PubMed] [Google Scholar]
88. Hoefer J, Ulmer H, Kilo J, Margreiter R, Grimm M, Mair P, et al. Antithrombin III is associated with acute liver failure in patients with end‐stage heart failure undergoing mechanical circulatory support. J Thorac Cardiovasc Surg. 2017;153:1374–82. [DOI] [PubMed] [Google Scholar]
89. Iwashita Y, Yukimitsu M, Matsuduki M, Yamamoto A, Ishikura K, Imai H. Use of a fixed, body weight‐unadjusted loading dose of unfractionated heparin for extracorporeal cardiopulmonary resuscitation. J Intensive Care. 2015;3:33. [DOI] [PMC free article] [PubMed] [Google Scholar]
90. Kimmoun A, Oulehri W, Sonneville R, Grisot P‐H, Zogheib E, Amour J, et al. Prevalence and outcome of heparin‐induced thrombocytopenia diagnosed under veno‐arterial extracorporeal membrane oxygenation: a retrospective nationwide study. Intensive Care Med. 2018;44:1460–9. [DOI] [PubMed] [Google Scholar]
91. Kuroki N, Abe D, Iwama T, Sugiyama K, Akashi A, Hamabe Y, et al. Prognostic effect of estimated glomerular filtration rate in patients with cardiogenic shock or cardiac arrest undergoing percutaneous veno‐arterial extracorporeal membrane oxygenation. J Cardiol. 2016;68:439–46. [DOI] [PubMed] [Google Scholar]
92. Lee SH, Shin D‐S, Kim JR, Kim H. Factors associated with mortality risk in critical care patients treated with veno‐arterial extracorporeal membrane oxygenation. Heart Lung. 2017;46:137–42. [DOI] [PubMed] [Google Scholar]
93. Li C‐L, Wang H, Jia M, Ma N, Meng XU, Hou X‐T. The early dynamic behavior of lactate is linked to mortality in postcardiotomy patients with extracorporeal membrane oxygenation support: a retrospective observational study. J Thorac Cardiovasc Surg. 2015;149:1445–50. [DOI] [PubMed] [Google Scholar]
94. Lyu L, Yao J, Gao G, Long C, Hei F, Ji B, et al. Incidence, risk factors, and outcomes of hyperbilirubinemia in adult cardiac patients supported by veno‐arterial ECMO. Artif Organs. 2018;42:148–54. [DOI] [PubMed] [Google Scholar]
95. Mazzeffi MA, Sanchez PG, Herr D, Krause E, Evans CF, Rector R, et al. Outcomes of extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest in adult cardiac surgery patients. J Thorac Cardiovasc Surg. 2016;152:1133–9. [DOI] [PubMed] [Google Scholar]
96. Mohan B, Singh B, Gupta V, Ralhan S, Gupta D, Puri S, et al. Outcome of patients supported by extracorporeal membrane oxygenation for aluminum phosphide poisoning: an observational study. Indian Heart J. 2016;68:295–301. [DOI] [PMC free article] [PubMed] [Google Scholar]
97. Musiał R, Moncznik P, Śmiałek P, Stoliński J, Sadowski J, Drwiła R. Veno‐arterial extracorporeal membrane oxygenation for short‐term mechanical circulation support in adults with cardiogenic shock: a single centre experience. Kardiol Pol. 2016;74:1477–84. [DOI] [PubMed] [Google Scholar]
98. Narotsky DL, Mosca MS, Mochari‐Greenberger H, Beck J, Liao M, Mongero L, et al. Short‐term and longer‐term survival after veno‐arterial extracorporeal membrane oxygenation in an adult patient population: does older age matter? Perfusion. 2016;31:366–75. [DOI] [PubMed] [Google Scholar]
99. Pozzebon S, Blandino Ortiz A, Franchi F, Cristallini S, Belliato M, Lheureux O, et al. Cerebral near‐infrared spectroscopy in adult patients undergoing veno‐arterial extracorporeal membrane oxygenation. Neurocrit Care. 2018;29:94–104. [DOI] [PubMed] [Google Scholar]
100. Ranney DN, Benrashid E, Meza JM, Keenan JE, Bonadonna DK, Bartz R, et al. Central cannulation as a viable alternative to peripheral cannulation in extracorporeal membrane oxygenation. Semin Thorac Cardiovasc Surg. 2017;29:188–95. [DOI] [PubMed] [Google Scholar]
101. Roth C, Schrutka L, Binder C, Kriechbaumer L, Heinz G, Lang IM, et al. Liver function predicts survival in patients undergoing extracorporeal membrane oxygenation following cardiovascular surgery. Crit Care. 2016;20:57. [DOI] [PMC free article] [PubMed] [Google Scholar]
102. Saeed D, Stosik H, Islamovic M, Albert A, Kamiya H, Maxhera B, et al. Femoro‐femoral versus atrio‐aortic extracorporeal membrane oxygenation: selecting the ideal cannulation technique. Artif Organs. 2014;38:549–55. [DOI] [PubMed] [Google Scholar]
103. Schmidt M, Burrell A, Roberts L, Bailey M, Sheldrake J, Rycus PT, et al. Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno‐arterial‐ECMO (SAVE)‐score. Eur Heart J. 2015;36:2246–56. [DOI] [PubMed] [Google Scholar]
104. Shin TG, Jo IJ, Sim MS, Song Y‐B, Yang J‐H, Hahn J‐Y, et al. Two‐year survival and neurological outcome of in‐hospital cardiac arrest patients rescued by extracorporeal cardiopulmonary resuscitation. Int J Cardiol. 2013;168:3424–30. [DOI] [PubMed] [Google Scholar]
105. Trenkwalder T, Pellegrini C, Holzamer A, Rheude T, Riester J, Reinhard W, et al. Prophylactic ECMO during TAVI in patients with depressed left ventricular ejection fraction. Clin Res Cardiol. 2019;108:366–74. [DOI] [PubMed] [Google Scholar]
106. Yeo HJ, Kim HJ, Jang JH, Kang LH, Cho WH, Kim D. Vascular complications arising from hemostasis with manual compression following extracorporeal membrane oxygenation decannulation. J Card Surg. 2016;31:123–6. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Table S1

Click here for additional data file.^{(22.3KB, docx)}

[aor14006-bib-0001] 1. Abrams D, Combes A, Brodie D. Extracorporeal membrane oxygenation in cardiopulmonary disease in adults. J Am Coll Cardiol. 2014;63:2769–78. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0002] 2. International summary. Extracorporeal Lfe Support Organization; 2017. [cited 2020 Aug 15]. Available from: https://www.elso.org/Registry/Statistics/InternationalSummary.aspx [Google Scholar]

[aor14006-bib-0003] 3. Peek GJ, Clemens F, Elbourne D, Firmin R, Hardy P, Hibbert C, et al. CESAR: conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure. BMC Health Serv Res. 2006;6:163. [DOI] [PMC free article] [PubMed] [Google Scholar]

[aor14006-bib-0004] 4. Paden ML, Rycus PT, Thiagarajan RR. Update and outcomes in extracorporeal life support. Semin Perinatol. 2014;38:65–70. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0005] 5. Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374:1351–63. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0006] 6. Flecher E, Anselmi A, Corbineau H, Langanay T, Verhoye J‐P, Felix C, et al. Current aspects of extracorporeal membrane oxygenation in a tertiary referral centre: determinants of survival at follow‐up. Eur J Cardiothorac Surg. 2014;46:665–71; discussion 71. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0007] 7. Tanaka D, Hirose H, Cavarocchi N, Entwistle JWC. The impact of vascular complications on survival of patients on venoarterial extracorporeal membrane oxygenation. Ann Thorac Surg. 2016;101:1729–34. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0008] 8. McCarthy FH, McDermott KM, Kini V, Gutsche JT, Wald JW, Xie D, et al. Trends in U.S. Extracorporeal Membrane Oxygenation Use and Outcomes: 2002‐2012. Semin Thorac Cardiovasc Surg. 2015;27:81–8. [DOI] [PMC free article] [PubMed] [Google Scholar]

[aor14006-bib-0009] 9. Gray BW, Haft JW, Hirsch JC, Annich GM, Hirschl RB, Bartlett RH. Extracorporeal life support: experience with 2,000 patients. ASAIO J. 2015;61:2–7. [DOI] [PMC free article] [PubMed] [Google Scholar]

[aor14006-bib-0010] 10. Booth A, Clarke M, Dooley G, Ghersi D, Moher D, Petticrew M, et al. The nuts and bolts of PROSPERO: an international prospective register of systematic reviews. Syst Rev. 2012;1:2. [DOI] [PMC free article] [PubMed] [Google Scholar]

[aor14006-bib-0011] 11. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta‐analyses: the PRISMA statement. BMJ. 2009;339:b2535. [DOI] [PMC free article] [PubMed] [Google Scholar]

[aor14006-bib-0012] 12. Aziz TA, Singh G, Popjes E, Stephenson E, Mulvey S, Pae W, et al. Initial experience with CentriMag extracorporal membrane oxygenation for support of critically ill patients with refractory cardiogenic shock. J Heart Lung Transplant. 2010;29:66–71. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0013] 13. Bouabdallaoui N, Demondion P, Leprince P, Lebreton G. Short‐term mechanical circulatory support for cardiogenic shock in severe peripartum cardiomyopathy: La Pitie‐Salpetriere experience. Interact Cardiovasc Thorac Surg. 2017;25:52–6. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0014] 14. Chen Y‐S, Yu H‐Y, Huang S‐C, Chiu K‐M, Lin T‐Y, Lai L‐P, et al. Experience and result of extracorporeal membrane oxygenation in treating fulminant myocarditis with shock: what mechanical support should be considered first? J Heart Lung Transplant. 2005;24:81–7. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0015] 15. Demondion P, Fournel L, Golmard J‐L, Niculescu M, Pavie A, Leprince P. Predictors of 30‐day mortality and outcome in cases of myocardial infarction with cardiogenic shock treated by extracorporeal life support. Eur J Cardiothorac Surg. 2014;45:47–54. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0016] 16. den Uil CA , Jewbali LS, Heeren MJ, Constantinescu AA, Van Mieghem NM, Reis Miranda DD. Isolated left ventricular failure is a predictor of poor outcome in patients receiving veno‐arterial extracorporeal membrane oxygenation. Eur J Heart Fail. 2017;19 Suppl 2:104–9. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0017] 17. Dini CS, Lazzeri C, Chiostri M, Gensini GF, Valente S. A local network for extracorporeal membrane oxygenation in refractory cardiogenic shock. Acute Card Care. 2015;17:49–54. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0018] 18. Guenther S, Theiss HD, Fischer M, Sattler S, Peterss S, Born F, et al. Percutaneous extracorporeal life support for patients in therapy refractory cardiogenic shock: initial results of an interdisciplinary team. Interact Cardiovasc Thorac Surg. 2014;18:283–91. [DOI] [PMC free article] [PubMed] [Google Scholar]

[aor14006-bib-0019] 19. Hsu PS, Chen JL, Hong GJ, Tsai YT, Lin CY, Lee CY, et al. Extracorporeal membrane oxygenation for refractory cardiogenic shock after cardiac surgery: predictors of early mortality and outcome from 51 adult patients. Eur J Cardiothorac Surg. 2010;37:328–33. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0020] 20. Kim H, Lim S‐H, Hong J, Hong Y‐S, Lee CJ, Jung J‐H, et al. Efficacy of veno‐arterial extracorporeal membrane oxygenation in acute myocardial infarction with cardiogenic shock. Resuscitation. 2012;83:971–5. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0021] 21. Ko W‐J, Lin C‐Y, Chen RJ, Wang S‐S, Lin F‐Y, Chen Y‐S. Extracorporeal membrane oxygenation support for adult postcardiotomy cardiogenic shock. Ann Thorac Surg. 2002;73:538–45. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0022] 22. Kosiński S, Darocha T, Czerw A, Paal P, Pasquier M, Krawczyk P, et al. Cost‐utility of extracorporeal membrane oxygenation rewarming in accidentally hypothermic patients—a single‐centre retrospective study. Acta Anaesthesiol Scand. 2018;62:1105–11. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0023] 23. Smith C, Bellomo R, Raman JS, Matalanis G, Rosalion A, Buckmaster J, et al. An extracorporeal membrane oxygenation‐based approach to cardiogenic shock in an older population. Ann Thorac Surg. 2001;71:1421–7. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0024] 24. Stub D, Bernard S, Pellegrino V, Smith K, Walker T, Sheldrake J, et al. Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial). Resuscitation. 2015;86:88–94. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0025] 25. Unosawa S, Sezai A, Hata M, Nakata K, Yoshitake I, Wakui S, et al. Long‐term outcomes of patients undergoing extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. Surg Today. 2013;43:264–70. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0026] 26. Wang S‐S, Chen Y‐S, Ko W‐J, Chu S‐H. Extracorporeal membrane oxygenation support for postcardiotomy cardiogenic shock. Artif Organs. 1996;20:1287–91. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0027] 27. Wang J‐G, Han J, Jia Y‐X, Zeng W, Hou X‐T, Meng XU. Outcome of veno‐arterial extracorporeal membrane oxygenation for patients undergoing valvular surgery. PLoS ONE. 2013;8:e63924. [DOI] [PMC free article] [PubMed] [Google Scholar]

[aor14006-bib-0028] 28. Lan C, Tsai P‐R, Chen Y‐S, Ko W‐J. Prognostic factors for adult patients receiving extracorporeal membrane oxygenation as mechanical circulatory support—a 14‐year experience at a medical center. Artif Organs. 2010;34:E59–64. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0029] 29. Cheng R, Hachamovitch R, Kittleson M, Patel J, Arabia F, Moriguchi J, et al. Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta‐analysis of 1,866 adult patients. Ann Thorac Surg. 2014;97:610–6. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0030] 30. Pasrija C, Shah A, George P, Kronfli A, Raithel M, Boulos F, et al. Triage and optimization: a new paradigm in the treatment of massive pulmonary embolism. J Thorac Cardiovasc Surg. 2018;156:672–81. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0031] 31. Cheng R, Hachamovitch R, Kittleson M, Patel J, Arabia F, Moriguchi J, et al. Clinical outcomes in fulminant myocarditis requiring extracorporeal membrane oxygenation: a weighted meta‐analysis of 170 patients. J Card Fail. 2014;20:400–6. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0032] 32. Fletcher Sandersjöö A, Bartek J, Thelin EP, Eriksson A, Elmi‐Terander A, Broman M, et al. Predictors of intracranial hemorrhage in adult patients on extracorporeal membrane oxygenation: an observational cohort study. J Intensive Care. 2017;5:27. [DOI] [PMC free article] [PubMed] [Google Scholar]

[aor14006-bib-0033] 33. Chang W‐W, Tsai F‐C, Tsai T‐Y, Chang C‐H, Jenq C‐C, Chang M‐Y, et al. Predictors of mortality in patients successfully weaned from extracorporeal membrane oxygenation. PLoS ONE. 2012;7:e42687. [DOI] [PMC free article] [PubMed] [Google Scholar]

[aor14006-bib-0034] 34. Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator‐associated pneumonia: a systematic review. Crit Care Med. 2005;33:2184–93. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0035] 35. Acker MA. Mechanical circulatory support for patients with acute‐fulminant myocarditis. Ann Thorac Surg. 2001;71:S73–6; discussion S82–5. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0036] 36. Ariyaratnam P, McLean LA, Cale ARJ, Loubani M. Extra‐corporeal membrane oxygenation for the post‐cardiotomy patient. Heart Fail Rev. 2014;19:717–25. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0037] 37. Aso S, Matsui H, Fushimi K, Yasunaga H. In‐hospital mortality and successful weaning from venoarterial extracorporeal membrane oxygenation: analysis of 5,263 patients using a national inpatient database in Japan. Crit Care. 2016;20:80. [DOI] [PMC free article] [PubMed] [Google Scholar]

[aor14006-bib-0038] 38. Bednarczyk JM, White CW, Ducas RA, Golian M, Nepomuceno R, Hiebert B, et al. Resuscitative extracorporeal membrane oxygenation for in hospital cardiac arrest: a Canadian observational experience. Resuscitation. 2014;85:1713–9. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0039] 39. Beurtheret S, Mordant P, Paoletti X, Marijon E, Celermajer DS, Leger P. Emergency circulatory support in refractory cardiogenic shock patients in remote institutions: a pilot study (the cardiac‐RESCUE program). Eur Heart J. 2013;34:112–20. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0040] 40. Lima EB, Cunha CRD, Barzilai VS, Ulhoa MB, Barros MRD, Moraes CS, et al. Experience of ECMO in primary graft dysfunction after orthotopic heart transplantation. Arq Bras Cardiol. 2015;105:285–91. [DOI] [PMC free article] [PubMed] [Google Scholar]

[aor14006-bib-0041] 41. Chou NK, Chi NH, Wu IW, Huang SC, Chen YS, Yu HY, et al. Extracoporeal membrane oxygenation to rescue cardiopulmonary failure after heart transplantation: a single‐center experience. Transplant Proc. 2010;42:943–5. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0042] 42. Chung S‐Y, Sheu J‐J, Lin Y‐J, Sun C‐K, Chang L‐T, Chen Y‐L, et al. Outcome of patients with profound cardiogenic shock after cardiopulmonary resuscitation and prompt extracorporeal membrane oxygenation support. A single‐center observational study. Circ J. 2012;76:1385–92. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0043] 43. Esper SA, Bermudez C, Dueweke EJ, Kormos R, Subramaniam K, Mulukutla S, et al. Extracorporeal membrane oxygenation support in acute coronary syndromes complicated by cardiogenic shock. Catheter Cardiovasc Interv. 2015;86 Suppl 1:S45–50. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0044] 44. Fiser SM, Tribble CG, Kaza AK, Long SM, Zacour RK, Kern JA, et al. When to discontinue extracorporeal membrane oxygenation for postcardiotomy support. Ann Thorac Surg. 2001;71:210–4. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0045] 45. George B, Parazino M, Omar HR, Davis G, Guglin M, Gurley J, et al. A retrospective comparison of survivors and non‐survivors of massive pulmonary embolism receiving veno‐arterial extracorporeal membrane oxygenation support. Resuscitation. 2018;122:1–5. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0046] 46. Hei F, Lou S, Li J, Yu K, Liu J, Feng Z, et al. Five‐year results of 121 consecutive patients treated with extracorporeal membrane oxygenation at Fu Wai Hospital. Artif Organs. 2011;35:572–8. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0047] 47. Kagawa E, Inoue I, Kawagoe T, Ishihara M, Shimatani Y, Kurisu S, et al. Assessment of outcomes and differences between in‐ and out‐of‐hospital cardiac arrest patients treated with cardiopulmonary resuscitation using extracorporeal life support. Resuscitation. 2010;81:968–73. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0048] 48. Kara A, Akin S, dos Reis Miranda D , Struijs A, Caliskan K, van Thiel RJ , et al. Microcirculatory assessment of patients under VA‐ECMO. Crit Care. 2016;20:344. [DOI] [PMC free article] [PubMed] [Google Scholar]

[aor14006-bib-0049] 49. Kim GS, Lee KS, Park CK, Kang SK, Kim DW, Oh SG, et al. Nosocomial infection in adult patients undergoing veno‐arterial extracorporeal membrane oxygenation. J Korean Med Sci. 2017;32:593–8. [DOI] [PMC free article] [PubMed] [Google Scholar]

[aor14006-bib-0050] 50. Kim DW, Cho HJ, Kim GS, Song SY, Na KJ, Oh SG, et al. Predictive value of procalcitonin for infection and survival in adult cardiogenic shock patients treated with extracorporeal membrane oxygenation. Chonnam Med J. 2018;54:48–54. [DOI] [PMC free article] [PubMed] [Google Scholar]

[aor14006-bib-0051] 51. Lazzara RR, Magovern JA, Benckart DH, Maher TD, Sakert T, Magovern GJ, et al. Extracorporeal membrane oxygenation for adult post cardiotomy cardiogenic shock using a heparin bonded system. ASAIO J. 1993;39:M444–7. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0052] 52. Lee SN, Jo MS, Yoo KD. Impact of age on extracorporeal membrane oxygenation survival of patients with cardiac failure. Clin Interv Aging. 2017;12:1347–53. [DOI] [PMC free article] [PubMed] [Google Scholar]

[aor14006-bib-0053] 53. Loforte A, Marinelli G, Musumeci F, Folesani G, Pilato E, Martin Suarez S, et al. Extracorporeal membrane oxygenation support in refractory cardiogenic shock: treatment strategies and analysis of risk factors. Artif Organs. 2014;38:E129–E141. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0054] 54. Luyt C‐E, Landivier A, Leprince P, Bernard M, Pavie A, Chastre J, et al. Usefulness of cardiac biomarkers to predict cardiac recovery in patients on extracorporeal membrane oxygenation support for refractory cardiogenic shock. J Crit Care. 2012;27:524.e7–14. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0055] 55. Mikus E, Tripodi A, Calvi S, Giglio MD, Cavallucci A, Lamarra M. CentriMag venoarterial extracorporeal membrane oxygenation support as treatment for patients with refractory postcardiotomy cardiogenic shock. ASAIO J. 2013;59:18–23. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0056] 56. Mirabel M, Luyt C‐E, Leprince P, Trouillet J‐L, Léger P, Pavie A, et al. Outcomes, long‐term quality of life, and psychologic assessment of fulminant myocarditis patients rescued by mechanical circulatory support. Crit Care Med. 2011;39:1029–35. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0057] 57. Muehrcke DD, McCarthy PM, Stewart RW, Foster RC, Ogella DA, Borsh JA, et al. Extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock. Ann Thorac Surg. 1996;61:684–91. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0058] 58. Pokersnik JA, Buda T, Bashour CA, Gonzalez‐Stawinski GV. Have changes in ECMO technology impacted outcomes in adult patients developing postcardiotomy cardiogenic shock? J Card Surg. 2012;27:246–52. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0059] 59. Rastan AJ, Dege A, Mohr M, Doll N, Falk V, Walther T, et al. Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. J Thorac Cardiovasc Surg. 2010;139:302–11.e1. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0060] 60. Rubino A, Costanzo D, Stanszus D, Valchanov K, Jenkins D, Sertic F, et al. Central veno‐arterial extracorporeal membrane oxygenation (C‐VA‐ECMO) after cardiothoracic surgery: a single‐center experience. J Cardiothorac Vasc Anesth. 2018;32:1169–74. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0061] 61. Saito S, Nakatani T, Kobayashi J, Tagusari O, Bando KO, Niwaya K, et al. Is extracorporeal life support contraindicated in elderly patients? Ann Thorac Surg. 2007;83:140–5. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0062] 62. Sakamoto S, Taniguchi N, Nakajima S, Takahashi A. Extracorporeal life support for cardiogenic shock or cardiac arrest due to acute coronary syndrome. Ann Thorac Surg. 2012;94:1–7. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0063] 63. Sangalli F, Avalli L, Laratta M, Formica F, Maggioni E, Caruso R, et al. Effects of levosimendan on endothelial function and hemodynamics during weaning from veno‐arterial extracorporeal life support. J Cardiothorac Vasc Anesth. 2016;30:1449–53. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0064] 64. Saxena P, Neal J, Joyce LD, Greason KL, Schaff HV, Guru P, et al. Extracorporeal membrane oxygenation support in postcardiotomy elderly patients: the Mayo Clinic experience. Ann Thorac Surg. 2015;99:2053–60. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0065] 65. Shinn SH, Lee YT, Sung K, Min S, Kim WS, Park PW, et al. Efficacy of emergent percutaneous cardiopulmonary support in cardiac or respiratory failure: fight or flight? Interact Cardiovasc Thorac Surg. 2009;9:269–73. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0066] 66. Slottosch I, Liakopoulos O, Kuhn E, Deppe A‐C, Scherner M, Madershahian N, et al. Outcomes after peripheral extracorporeal membrane oxygenation therapy for postcardiotomy cardiogenic shock: a single‐center experience. J Surg Res. 2013;181:e47–e55. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0067] 67. Smedira NG, Moazami N, Golding CM, McCarthy PM, Apperson‐Hansen C, Blackstone EH, et al. Clinical experience with 202 adults receiving extracorporeal membrane oxygenation for cardiac failure: survival at five years. J Thorac Cardiovasc Surg. 2001;122:92–102. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0068] 68. Takayama H, Landes E, Truby L, Fujita K, Kirtane AJ, Mongero L, et al. Feasibility of smaller arterial cannulas in venoarterial extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg. 2015;149:1428–33. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0069] 69. Tarzia V, Bortolussi G, Bianco R, Buratto E, Bejko J, Carrozzini M, et al. Extracorporeal life support in cardiogenic shock: impact of acute versus chronic etiology on outcome. J Thorac Cardiovasc Surg. 2015;150:333–40. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0070] 70. Tsai T‐Y, Tsai F‐C, Fan P‐C, Chang C‐H, Lin C‐Y, Chang W‐W, et al. Application of the age, creatinine, and left ventricular ejection fraction score for patients on extracorporeal membrane oxygenation. Artif Organs. 2017;41:146–52. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0071] 71. van den Brink FS , Magan AD, Noordzij PG, Zivelonghi C, Agostoni P, Eefting FD, et al. Veno‐arterial extracorporeal membrane oxygenation in addition to primary PCI in patients presenting with ST‐elevation myocardial infarction. Neth Heart J. 2018;26:76–84. [DOI] [PMC free article] [PubMed] [Google Scholar]

[aor14006-bib-0072] 72. Wong JK, Melvin AL, Joshi DJ, Lee CY, Archibald WJ, Angona RE, et al. Cannulation‐related complications on veno‐arterial extracorporeal membrane oxygenation: prevalence and effect on mortality. Artif Organs. 2017;41:827–34. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0073] 73. Wu M‐Y, Lin P‐J, Lee M‐Y, Tsai F‐C, Chu J‐J, Chang Y‐S, et al. Using extracorporeal life support to resuscitate adult postcardiotomy cardiogenic shock: treatment strategies and predictors of short‐term and midterm survival. Resuscitation. 2010;81:1111–6. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0074] 74. Yeh T‐C, Chang H‐H, Ger L‐P, Wang J‐O, Kao S, Ho S‐T. Clinical risk factors of extracorporeal membrane oxygenation support in older adults. PLoS ONE. 2018;13:e0195445. [DOI] [PMC free article] [PubMed] [Google Scholar]

[aor14006-bib-0075] 75. Zhang R, Kofidis T, Kamiya H, Shrestha M, Tessmann R, Haverich A, et al. Creatine kinase isoenzyme MB relative index as predictor of mortality on extracorporeal membrane oxygenation support for postcardiotomy cardiogenic shock in adult patients. Eur J Cardiothorac Surg. 2006;30:617–20. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0076] 76. Zhao Y, Xing J, Du Z, Liu F, Jia M, Hou X. Extracorporeal cardiopulmonary resuscitation for adult patients who underwent post‐cardiac surgery. Eur J Med Res. 2015;20:83. [DOI] [PMC free article] [PubMed] [Google Scholar]

[aor14006-bib-0077] 77. Akin S, dos Reis Miranda D , Caliskan K, Soliman OI, Guven G, Struijs A, et al. Functional evaluation of sublingual microcirculation indicates successful weaning from VA‐ECMO in cardiogenic shock. Crit Care. 2017;21:265. [DOI] [PMC free article] [PubMed] [Google Scholar]

[aor14006-bib-0078] 78. Arlt M, Philipp A, Voelkel S, Schopka S, Husser O, Hengstenberg C, et al. Early experiences with miniaturized extracorporeal life‐support in the catheterization laboratory. Eur J Cardiothorac Surg. 2012;42:858–63. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0079] 79. Asaumi Y, Yasuda S, Morii I, Kakuchi H, Otsuka Y, Kawamura A, et al. Favourable clinical outcome in patients with cardiogenic shock due to fulminant myocarditis supported by percutaneous extracorporeal membrane oxygenation. Eur Heart J. 2005;26:2185–92. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0080] 80. Bermudez CA, Rocha RV, Toyoda Y, Zaldonis D, Sappington PL, Mulukutla S, et al. Extracorporeal membrane oxygenation for advanced refractory shock in acute and chronic cardiomyopathy. Ann Thorac Surg. 2011;92:2125–31. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0081] 81. Bougouin W, Aissaoui N, Combes A, Deye N, Lamhaut L, Jost D, et al. Post‐cardiac arrest shock treated with veno‐arterial extracorporeal membrane oxygenation: an observational study and propensity‐score analysis. Resuscitation. 2017;110:126–32. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0082] 82. Carroll BJ, Shah RV, Murthy V, McCullough SA, Reza N, Thomas SS, et al. Clinical features and outcomes in adults with cardiogenic shock supported by extracorporeal membrane oxygenation. Am J Cardiol. 2015;116:1624–30. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0083] 83. Chamogeorgakis T, Rafael A, Shafii AE, Nagpal D, Pokersnik JA, Gonzalez‐Stawinski GV. Which is better: a miniaturized percutaneous ventricular assist device or extracorporeal membrane oxygenation for patients with cardiogenic shock? ASAIO J. 2013;59:607–11. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0084] 84. Chiu R, Pillado E, Sareh S, De La Cruz K, Shemin RJ, Benharash P. Financial and clinical outcomes of extracorporeal mechanical support. J Card Surg. 2017;32:215–21. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0085] 85. Distelmaier K, Schrutka L, Binder C, Steinlechner B, Heinz G, Lang IM, et al. Cardiac arrest does not affect survival in post‐operative cardiovascular surgery patients undergoing extracorporeal membrane oxygenation. Resuscitation. 2016;104:24–7. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0086] 86. Elsharkawy HA, Li L, Esa WAS, Sessler DI, Bashour CA. Outcome in patients who require venoarterial extracorporeal membrane oxygenation support after cardiac surgery. J Cardiothorac Vasc Anesth. 2010;24:946–51. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0087] 87. Giani M, Scaravilli V, Colombo SM, Confalonieri A, Leo R, Maggioni E, et al. Apnea test during brain death assessment in mechanically ventilated and ECMO patients. Intensive Care Med. 2016;42:72–81. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0088] 88. Hoefer J, Ulmer H, Kilo J, Margreiter R, Grimm M, Mair P, et al. Antithrombin III is associated with acute liver failure in patients with end‐stage heart failure undergoing mechanical circulatory support. J Thorac Cardiovasc Surg. 2017;153:1374–82. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0089] 89. Iwashita Y, Yukimitsu M, Matsuduki M, Yamamoto A, Ishikura K, Imai H. Use of a fixed, body weight‐unadjusted loading dose of unfractionated heparin for extracorporeal cardiopulmonary resuscitation. J Intensive Care. 2015;3:33. [DOI] [PMC free article] [PubMed] [Google Scholar]

[aor14006-bib-0090] 90. Kimmoun A, Oulehri W, Sonneville R, Grisot P‐H, Zogheib E, Amour J, et al. Prevalence and outcome of heparin‐induced thrombocytopenia diagnosed under veno‐arterial extracorporeal membrane oxygenation: a retrospective nationwide study. Intensive Care Med. 2018;44:1460–9. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0091] 91. Kuroki N, Abe D, Iwama T, Sugiyama K, Akashi A, Hamabe Y, et al. Prognostic effect of estimated glomerular filtration rate in patients with cardiogenic shock or cardiac arrest undergoing percutaneous veno‐arterial extracorporeal membrane oxygenation. J Cardiol. 2016;68:439–46. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0092] 92. Lee SH, Shin D‐S, Kim JR, Kim H. Factors associated with mortality risk in critical care patients treated with veno‐arterial extracorporeal membrane oxygenation. Heart Lung. 2017;46:137–42. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0093] 93. Li C‐L, Wang H, Jia M, Ma N, Meng XU, Hou X‐T. The early dynamic behavior of lactate is linked to mortality in postcardiotomy patients with extracorporeal membrane oxygenation support: a retrospective observational study. J Thorac Cardiovasc Surg. 2015;149:1445–50. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0094] 94. Lyu L, Yao J, Gao G, Long C, Hei F, Ji B, et al. Incidence, risk factors, and outcomes of hyperbilirubinemia in adult cardiac patients supported by veno‐arterial ECMO. Artif Organs. 2018;42:148–54. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0095] 95. Mazzeffi MA, Sanchez PG, Herr D, Krause E, Evans CF, Rector R, et al. Outcomes of extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest in adult cardiac surgery patients. J Thorac Cardiovasc Surg. 2016;152:1133–9. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0096] 96. Mohan B, Singh B, Gupta V, Ralhan S, Gupta D, Puri S, et al. Outcome of patients supported by extracorporeal membrane oxygenation for aluminum phosphide poisoning: an observational study. Indian Heart J. 2016;68:295–301. [DOI] [PMC free article] [PubMed] [Google Scholar]

[aor14006-bib-0097] 97. Musiał R, Moncznik P, Śmiałek P, Stoliński J, Sadowski J, Drwiła R. Veno‐arterial extracorporeal membrane oxygenation for short‐term mechanical circulation support in adults with cardiogenic shock: a single centre experience. Kardiol Pol. 2016;74:1477–84. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0098] 98. Narotsky DL, Mosca MS, Mochari‐Greenberger H, Beck J, Liao M, Mongero L, et al. Short‐term and longer‐term survival after veno‐arterial extracorporeal membrane oxygenation in an adult patient population: does older age matter? Perfusion. 2016;31:366–75. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0099] 99. Pozzebon S, Blandino Ortiz A, Franchi F, Cristallini S, Belliato M, Lheureux O, et al. Cerebral near‐infrared spectroscopy in adult patients undergoing veno‐arterial extracorporeal membrane oxygenation. Neurocrit Care. 2018;29:94–104. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0100] 100. Ranney DN, Benrashid E, Meza JM, Keenan JE, Bonadonna DK, Bartz R, et al. Central cannulation as a viable alternative to peripheral cannulation in extracorporeal membrane oxygenation. Semin Thorac Cardiovasc Surg. 2017;29:188–95. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0101] 101. Roth C, Schrutka L, Binder C, Kriechbaumer L, Heinz G, Lang IM, et al. Liver function predicts survival in patients undergoing extracorporeal membrane oxygenation following cardiovascular surgery. Crit Care. 2016;20:57. [DOI] [PMC free article] [PubMed] [Google Scholar]

[aor14006-bib-0102] 102. Saeed D, Stosik H, Islamovic M, Albert A, Kamiya H, Maxhera B, et al. Femoro‐femoral versus atrio‐aortic extracorporeal membrane oxygenation: selecting the ideal cannulation technique. Artif Organs. 2014;38:549–55. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0103] 103. Schmidt M, Burrell A, Roberts L, Bailey M, Sheldrake J, Rycus PT, et al. Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno‐arterial‐ECMO (SAVE)‐score. Eur Heart J. 2015;36:2246–56. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0104] 104. Shin TG, Jo IJ, Sim MS, Song Y‐B, Yang J‐H, Hahn J‐Y, et al. Two‐year survival and neurological outcome of in‐hospital cardiac arrest patients rescued by extracorporeal cardiopulmonary resuscitation. Int J Cardiol. 2013;168:3424–30. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0105] 105. Trenkwalder T, Pellegrini C, Holzamer A, Rheude T, Riester J, Reinhard W, et al. Prophylactic ECMO during TAVI in patients with depressed left ventricular ejection fraction. Clin Res Cardiol. 2019;108:366–74. [DOI] [PubMed] [Google Scholar]

[aor14006-bib-0106] 106. Yeo HJ, Kim HJ, Jang JH, Kang LH, Cho WH, Kim D. Vascular complications arising from hemostasis with manual compression following extracorporeal membrane oxygenation decannulation. J Card Surg. 2016;31:123–6. [DOI] [PubMed] [Google Scholar]

PERMALINK

Understanding the “extracorporeal membrane oxygenation gap” in veno‐arterial configuration for adult patients: Timing and causes of death

Maged Makhoul

Samuel Heuts

Abdulrahman Mansouri

Fabio Silvio Taccone

Amir Obeid

Belliato Mirko

Lars Mikael Broman

Maximilian Valentin Malfertheiner

Paolo Meani

Giuseppe Maria Raffa

Thijs Delnoij

Jos Maessen

Gil Bolotin

Roberto Lorusso

Abstract

1. INTRODUCTION

2. METHODS AND MATERIALS

2.1. Protocol

2.2. Search strategy

2.3. Study criteria

2.4. Data extraction

2.5. End‐point definition

2.6. Data synthesis

3. RESULTS

3.1. Included studies

FIGURE 1.

TABLE 1.

3.2. Mortality rates, weaning, and discharge

3.3. Causes of death

TABLE 2.

3.4. Complications in V‐A ECMO

TABLE 3.

4. DISCUSSION

4.1. Limitations

5. CONCLUSION

CONFLICT OF INTEREST

AUTHOR CONTRIBUTIONS

Supporting information

REFERENCES

Associated Data

Supplementary Materials

ACTIONS

PERMALINK

RESOURCES

Similar articles

Cited by other articles

Links to NCBI Databases