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Venoarterial extracorporeal membrane oxygenation after coronary artery bypass grafting: Results of a multicenter
Fausto Biancari1, Magnus Dalén2, Andrea Perrotti3
1Department of Surgery, Oulu University Hospital, Oulu, Finland.
Insights
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) after coronary artery bypass grafting (CABG) has scarce evidence of benefit. Only one-third of patients requiring VA-ECMO post-CABG survive, necessitating further research for optimal patient selection.
Area of Science:
- Cardiovascular Surgery
- Critical Care Medicine
- Extracorporeal Life Support
Background:
- Evidence supporting venoarterial extracorporeal membrane oxygenation (VA-ECMO) use post-coronary artery bypass grafting (CABG) is limited.
- VA-ECMO is a critical intervention for patients experiencing cardiac or respiratory failure after major cardiac surgery.
Purpose of the Study:
- To analyze the outcomes and survival rates of patients requiring VA-ECMO after isolated CABG.
- To identify predictors of in-hospital mortality in this patient population.
Main Methods:
- A retrospective analysis of 148 patients who received VA-ECMO after isolated CABG across 12 centers (2005-2016).
- Exclusion of patients requiring ECMO preoperatively.
- Logistic regression analysis to determine independent predictors of mortality.
Main Results:
- In-hospital mortality was high at 64.2%, with pooled mortality at 65.9%.
- Independent predictors of mortality included lower creatinine clearance, presence of pulmonary disease, and higher pre-VA-ECMO blood lactate levels.
- One-, two-, and three-year survival rates were 31.0%, 27.9%, and 26.1%, respectively.
Conclusions:
- Approximately one-third of patients requiring VA-ECMO after CABG survive to discharge.
- The significant resource burden and limited survival highlight the need for further studies to identify patients most likely to benefit from VA-ECMO.
Background:
The evidence of the benefits of using venoarterial extracorporeal membrane oxygenation (VA-ECMO) after coronary artery bypass grafting (CABG) is scarce.
Methods:
We analyzed the outcomes of patients who received VA-ECMO therapy due to cardiac or respiratory failure after isolated CABG in 12 centers between 2005 and 2016. Patients treated preoperatively with ECMO were excluded from this study.
Results:
VA-ECMO was employed in 148 patients after CABG for median of 5.0days (mean, 6.4, SD 5.6days). In-hospital mortality was 64.2%. Pooled in-hospital mortality was 65.9% without significant heterogeneity between the centers (I2 8.6%). The proportion of VA-ECMO in each center did not affect in-hospital mortality (p=0.861). No patients underwent heart transplantation and six patients received a left ventricular assist device. Logistic regression showed that creatinine clearance (p=0.004, OR 0.98, 95% CI 0.97-0.99), pulmonary disease (p=0.018, OR 4.42, 95% CI 1.29-15.15) and pre-VA-ECMO blood lactate (p=0.015, OR 1.10, 95% CI 1.02-1.18) were independent baseline predictors of in-hospital mortality. One-, 2-, and 3-year survival was 31.0%, 27.9%, and 26.1%, respectively.
Conclusions:
One third of patients with need for VA-ECMO after CABG survive to discharge. In view of the burden of resources associated with VA-ECMO treatment and the limited number of patients surviving to discharge, further studies are needed to identify patients who may benefit the most from this treatment.