Characteristics and Outcomes of Prolonged Venoarterial Extracorporeal Membrane Oxygenation after Cardiac Surgery: The Post-Cardiotomy Extracorporeal Life Support (PELS-1) Cohort Study

Jeroen J.H. Bunge; Silvia Mariani; Christiaan Meuwese; Bas C.T. Van Bussel; Michele Di Mauro; Dominik Wiedeman; Diyar Saeed; Matteo Pozzi; Antonio Loforte; Udo Boeken; Robertas Samalavicius; Karl Bounader; Xiaotong Hou; Hergen Buscher; Leonardo Salazar; Bart Meyns; Daniel Herr; Sacha Matteucci; Sandro Sponga; Graeme Maclaren; Claudio Russo; Francesco Formica; Pranya Sakiyalak; Antonio Fiore; Daniele Camboni; Giuseppe Maria Raffa; Rodrigo Diaz; I. Wen Wang; Jae Seung Jung; Jan Belohlavek; Vin Pellegrino; Giacomo Bianchi; Matteo Pettinari; Alessandro Barbone; José P. Garcia; Kiran Shekar; Glenn J.R. Whitman; Diederik Gommers; Dinis Dos Reis Miranda; Roberto Lorusso; Samuel Heuts; Justine Ravaux; Anne Kristin Schaefer; Luca Conci; Philipp Szalkiewicz; Jawad Khalil; Sven Lehmann; Jean Francois Obadia; Nikolaos Kalampokas; Agne Jankuviene; Erwan Flecher; Kogulan Sriranjan; Michael A. Mazzeffi; Nazli Vedadi; Marco Di Eusanio; Vitaly Sorokin; Ram Ramanathan; Alessandro Costetti; Chistof Schmid; Roberto Castillo; Vladimir Mikulenka; Tomas Grus; Marco Solinas

doi:10.1097/CCM.0000000000006349

Characteristics and Outcomes of Prolonged Venoarterial Extracorporeal Membrane Oxygenation after Cardiac Surgery: The Post-Cardiotomy Extracorporeal Life Support (PELS-1) Cohort Study

Jeroen J.H. Bunge^*, Silvia Mariani, Christiaan Meuwese, Bas C.T. Van Bussel, Michele Di Mauro, Dominik Wiedeman, Diyar Saeed, Matteo Pozzi, Antonio Loforte, Udo Boeken, Robertas Samalavicius, Karl Bounader, Xiaotong Hou, Hergen Buscher, Leonardo Salazar, Bart Meyns, Daniel Herr, Sacha Matteucci, Sandro Sponga, Graeme MaclarenClaudio Russo, Francesco Formica, Pranya Sakiyalak, Antonio Fiore, Daniele Camboni, Giuseppe Maria Raffa, Rodrigo Diaz, I. Wen Wang, Jae Seung Jung, Jan Belohlavek, Vin Pellegrino, Giacomo Bianchi, Matteo Pettinari, Alessandro Barbone, José P. Garcia, Kiran Shekar, Glenn J.R. Whitman, Diederik Gommers, Dinis Dos Reis Miranda, Roberto Lorusso, Samuel Heuts, Justine Ravaux, Anne Kristin Schaefer, Luca Conci, Philipp Szalkiewicz, Jawad Khalil, Sven Lehmann, Jean Francois Obadia, Nikolaos Kalampokas, Agne Jankuviene, Erwan Flecher, Kogulan Sriranjan, Michael A. Mazzeffi, Nazli Vedadi, Marco Di Eusanio, Vitaly Sorokin, Ram Ramanathan, Alessandro Costetti, Chistof Schmid, Roberto Castillo, Vladimir Mikulenka, Tomas Grus, Marco Solinas

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

1 Citation (Scopus)

Abstract

OBJECTIVES: Most post-cardiotomy (PC) extracorporeal membrane oxygenation (ECMO) runs last less than 7 days. Studies on the outcomes of longer runs have provided conflicting results. This study investigates patient characteristics and short- and long-term outcomes in relation to PC ECMO duration, with a focus on prolonged (> 7 d) ECMO. DESIGN: Retrospective observational cohort study. SETTING: Thirty-four centers from 16 countries between January 2000 and December 2020. PATIENTS: Adults requiring post PC ECMO between 2000 and 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Characteristics, in-hospital, and post-discharge outcomes were compared among patients categorized by ECMO duration. Survivors and nonsurvivors were compared in the subgroup of patients with ECMO duration greater than 7 days. The primary outcome was in-hospital mortality. Two thousand twenty-one patients were included who required PC ECMO for 0-3 days (n = 649 [32.1%]), 4-7 days (n = 776 [38.3%]), 8-10 days (n = 263 [13.0%]), and greater than 10 days (n = 333 [16.5%]). There were no major differences in the investigated preoperative and procedural characteristics among ECMO duration groups. However, the longer ECMO duration category was associated with multiple complications including bleeding, acute kidney injury, arrhythmias, and sepsis. Hospital mortality followed a U-shape curve, with lowest mortality in patients with ECMO duration of 4-7 days (n = 394, 50.8%) and highest in patients with greater than 10 days ECMO support (n = 242, 72.7%). There was no significant difference in post-discharge survival between ECMO duration groups. In patients with ECMO duration greater than 7 days, age, comorbidities, valvular diseases, and complex procedures were associated with nonsurvival. CONCLUSIONS: Nearly 30% of PC ECMO patients were supported for greater than 7 days. In-hospital mortality increased after 7 days of support, especially in patients undergoing valvular and complex surgery, or who had complications, although the long-term post-discharge prognosis was comparable to PC ECMO patients with shorter support duration.

Original language	English
Pages (from-to)	e490-e502
Journal	Critical Care Medicine
Volume	52
Issue number	10
DOIs	https://doi.org/10.1097/CCM.0000000000006349
Publication status	Published - 1 Oct 2024

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© 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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Bunge, J. J. H., Mariani, S., Meuwese, C., Van Bussel, B. C. T., Di Mauro, M., Wiedeman, D., Saeed, D., Pozzi, M., Loforte, A., Boeken, U., Samalavicius, R., Bounader, K., Hou, X., Buscher, H., Salazar, L., Meyns, B., Herr, D., Matteucci, S., Sponga, S., ... Solinas, M. (2024). Characteristics and Outcomes of Prolonged Venoarterial Extracorporeal Membrane Oxygenation after Cardiac Surgery: The Post-Cardiotomy Extracorporeal Life Support (PELS-1) Cohort Study. Critical Care Medicine, 52(10), e490-e502. https://doi.org/10.1097/CCM.0000000000006349

@article{d7941e2aa5474fbb9e41e869c0e04544,

title = "Characteristics and Outcomes of Prolonged Venoarterial Extracorporeal Membrane Oxygenation after Cardiac Surgery: The Post-Cardiotomy Extracorporeal Life Support (PELS-1) Cohort Study",

abstract = "OBJECTIVES: Most post-cardiotomy (PC) extracorporeal membrane oxygenation (ECMO) runs last less than 7 days. Studies on the outcomes of longer runs have provided conflicting results. This study investigates patient characteristics and short- and long-term outcomes in relation to PC ECMO duration, with a focus on prolonged (> 7 d) ECMO. DESIGN: Retrospective observational cohort study. SETTING: Thirty-four centers from 16 countries between January 2000 and December 2020. PATIENTS: Adults requiring post PC ECMO between 2000 and 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Characteristics, in-hospital, and post-discharge outcomes were compared among patients categorized by ECMO duration. Survivors and nonsurvivors were compared in the subgroup of patients with ECMO duration greater than 7 days. The primary outcome was in-hospital mortality. Two thousand twenty-one patients were included who required PC ECMO for 0-3 days (n = 649 [32.1%]), 4-7 days (n = 776 [38.3%]), 8-10 days (n = 263 [13.0%]), and greater than 10 days (n = 333 [16.5%]). There were no major differences in the investigated preoperative and procedural characteristics among ECMO duration groups. However, the longer ECMO duration category was associated with multiple complications including bleeding, acute kidney injury, arrhythmias, and sepsis. Hospital mortality followed a U-shape curve, with lowest mortality in patients with ECMO duration of 4-7 days (n = 394, 50.8%) and highest in patients with greater than 10 days ECMO support (n = 242, 72.7%). There was no significant difference in post-discharge survival between ECMO duration groups. In patients with ECMO duration greater than 7 days, age, comorbidities, valvular diseases, and complex procedures were associated with nonsurvival. CONCLUSIONS: Nearly 30% of PC ECMO patients were supported for greater than 7 days. In-hospital mortality increased after 7 days of support, especially in patients undergoing valvular and complex surgery, or who had complications, although the long-term post-discharge prognosis was comparable to PC ECMO patients with shorter support duration.",

author = "Bunge, {Jeroen J.H.} and Silvia Mariani and Christiaan Meuwese and {Van Bussel}, {Bas C.T.} and {Di Mauro}, Michele and Dominik Wiedeman and Diyar Saeed and Matteo Pozzi and Antonio Loforte and Udo Boeken and Robertas Samalavicius and Karl Bounader and Xiaotong Hou and Hergen Buscher and Leonardo Salazar and Bart Meyns and Daniel Herr and Sacha Matteucci and Sandro Sponga and Graeme Maclaren and Claudio Russo and Francesco Formica and Pranya Sakiyalak and Antonio Fiore and Daniele Camboni and Raffa, {Giuseppe Maria} and Rodrigo Diaz and Wang, {I. Wen} and Jung, {Jae Seung} and Jan Belohlavek and Vin Pellegrino and Giacomo Bianchi and Matteo Pettinari and Alessandro Barbone and Garcia, {Jos{\'e} P.} and Kiran Shekar and Whitman, {Glenn J.R.} and Diederik Gommers and {Dos Reis Miranda}, Dinis and Roberto Lorusso and Samuel Heuts and Justine Ravaux and Schaefer, {Anne Kristin} and Luca Conci and Philipp Szalkiewicz and Jawad Khalil and Sven Lehmann and Obadia, {Jean Francois} and Nikolaos Kalampokas and Agne Jankuviene and Erwan Flecher and Kogulan Sriranjan and Mazzeffi, {Michael A.} and Nazli Vedadi and {Di Eusanio}, Marco and Vitaly Sorokin and Ram Ramanathan and Alessandro Costetti and Chistof Schmid and Roberto Castillo and Vladimir Mikulenka and Tomas Grus and Marco Solinas",

year = "2024",

month = oct,

day = "1",

doi = "10.1097/CCM.0000000000006349",

language = "English",

volume = "52",

pages = "e490--e502",

journal = "Critical Care Medicine",

issn = "0090-3493",

publisher = "Lippincott Williams & Wilkins",

number = "10",

}

Bunge, JJH, Mariani, S, Meuwese, C, Van Bussel, BCT, Di Mauro, M, Wiedeman, D, Saeed, D, Pozzi, M, Loforte, A, Boeken, U, Samalavicius, R, Bounader, K, Hou, X, Buscher, H, Salazar, L, Meyns, B, Herr, D, Matteucci, S, Sponga, S, Maclaren, G, Russo, C, Formica, F, Sakiyalak, P, Fiore, A, Camboni, D, Raffa, GM, Diaz, R, Wang, IW, Jung, JS, Belohlavek, J, Pellegrino, V, Bianchi, G, Pettinari, M, Barbone, A, Garcia, JP, Shekar, K, Whitman, GJR, Gommers, D , Dos Reis Miranda, D, Lorusso, R, Heuts, S, Ravaux, J, Schaefer, AK, Conci, L, Szalkiewicz, P, Khalil, J, Lehmann, S, Obadia, JF, Kalampokas, N, Jankuviene, A, Flecher, E, Sriranjan, K, Mazzeffi, MA, Vedadi, N, Di Eusanio, M, Sorokin, V, Ramanathan, R, Costetti, A, Schmid, C, Castillo, R, Mikulenka, V, Grus, T & Solinas, M 2024, 'Characteristics and Outcomes of Prolonged Venoarterial Extracorporeal Membrane Oxygenation after Cardiac Surgery: The Post-Cardiotomy Extracorporeal Life Support (PELS-1) Cohort Study', Critical Care Medicine, vol. 52, no. 10, pp. e490-e502. https://doi.org/10.1097/CCM.0000000000006349

Characteristics and Outcomes of Prolonged Venoarterial Extracorporeal Membrane Oxygenation after Cardiac Surgery: The Post-Cardiotomy Extracorporeal Life Support (PELS-1) Cohort Study. / Bunge, Jeroen J.H.; Mariani, Silvia; Meuwese, Christiaan et al.
In: Critical Care Medicine, Vol. 52, No. 10, 01.10.2024, p. e490-e502.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Characteristics and Outcomes of Prolonged Venoarterial Extracorporeal Membrane Oxygenation after Cardiac Surgery

T2 - The Post-Cardiotomy Extracorporeal Life Support (PELS-1) Cohort Study

AU - Bunge, Jeroen J.H.

AU - Mariani, Silvia

AU - Meuwese, Christiaan

AU - Van Bussel, Bas C.T.

AU - Di Mauro, Michele

AU - Wiedeman, Dominik

AU - Saeed, Diyar

AU - Pozzi, Matteo

AU - Loforte, Antonio

AU - Boeken, Udo

AU - Samalavicius, Robertas

AU - Bounader, Karl

AU - Hou, Xiaotong

AU - Buscher, Hergen

AU - Salazar, Leonardo

AU - Meyns, Bart

AU - Herr, Daniel

AU - Matteucci, Sacha

AU - Sponga, Sandro

AU - Maclaren, Graeme

AU - Russo, Claudio

AU - Formica, Francesco

AU - Sakiyalak, Pranya

AU - Fiore, Antonio

AU - Camboni, Daniele

AU - Raffa, Giuseppe Maria

AU - Diaz, Rodrigo

AU - Wang, I. Wen

AU - Jung, Jae Seung

AU - Belohlavek, Jan

AU - Pellegrino, Vin

AU - Bianchi, Giacomo

AU - Pettinari, Matteo

AU - Barbone, Alessandro

AU - Garcia, José P.

AU - Shekar, Kiran

AU - Whitman, Glenn J.R.

AU - Gommers, Diederik

AU - Dos Reis Miranda, Dinis

AU - Lorusso, Roberto

AU - Heuts, Samuel

AU - Ravaux, Justine

AU - Schaefer, Anne Kristin

AU - Conci, Luca

AU - Szalkiewicz, Philipp

AU - Khalil, Jawad

AU - Lehmann, Sven

AU - Obadia, Jean Francois

AU - Kalampokas, Nikolaos

AU - Jankuviene, Agne

AU - Flecher, Erwan

AU - Sriranjan, Kogulan

AU - Mazzeffi, Michael A.

AU - Vedadi, Nazli

AU - Di Eusanio, Marco

AU - Sorokin, Vitaly

AU - Ramanathan, Ram

AU - Costetti, Alessandro

AU - Schmid, Chistof

AU - Castillo, Roberto

AU - Mikulenka, Vladimir

AU - Grus, Tomas

AU - Solinas, Marco

PY - 2024/10/1

Y1 - 2024/10/1

N2 - OBJECTIVES: Most post-cardiotomy (PC) extracorporeal membrane oxygenation (ECMO) runs last less than 7 days. Studies on the outcomes of longer runs have provided conflicting results. This study investigates patient characteristics and short- and long-term outcomes in relation to PC ECMO duration, with a focus on prolonged (> 7 d) ECMO. DESIGN: Retrospective observational cohort study. SETTING: Thirty-four centers from 16 countries between January 2000 and December 2020. PATIENTS: Adults requiring post PC ECMO between 2000 and 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Characteristics, in-hospital, and post-discharge outcomes were compared among patients categorized by ECMO duration. Survivors and nonsurvivors were compared in the subgroup of patients with ECMO duration greater than 7 days. The primary outcome was in-hospital mortality. Two thousand twenty-one patients were included who required PC ECMO for 0-3 days (n = 649 [32.1%]), 4-7 days (n = 776 [38.3%]), 8-10 days (n = 263 [13.0%]), and greater than 10 days (n = 333 [16.5%]). There were no major differences in the investigated preoperative and procedural characteristics among ECMO duration groups. However, the longer ECMO duration category was associated with multiple complications including bleeding, acute kidney injury, arrhythmias, and sepsis. Hospital mortality followed a U-shape curve, with lowest mortality in patients with ECMO duration of 4-7 days (n = 394, 50.8%) and highest in patients with greater than 10 days ECMO support (n = 242, 72.7%). There was no significant difference in post-discharge survival between ECMO duration groups. In patients with ECMO duration greater than 7 days, age, comorbidities, valvular diseases, and complex procedures were associated with nonsurvival. CONCLUSIONS: Nearly 30% of PC ECMO patients were supported for greater than 7 days. In-hospital mortality increased after 7 days of support, especially in patients undergoing valvular and complex surgery, or who had complications, although the long-term post-discharge prognosis was comparable to PC ECMO patients with shorter support duration.

AB - OBJECTIVES: Most post-cardiotomy (PC) extracorporeal membrane oxygenation (ECMO) runs last less than 7 days. Studies on the outcomes of longer runs have provided conflicting results. This study investigates patient characteristics and short- and long-term outcomes in relation to PC ECMO duration, with a focus on prolonged (> 7 d) ECMO. DESIGN: Retrospective observational cohort study. SETTING: Thirty-four centers from 16 countries between January 2000 and December 2020. PATIENTS: Adults requiring post PC ECMO between 2000 and 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Characteristics, in-hospital, and post-discharge outcomes were compared among patients categorized by ECMO duration. Survivors and nonsurvivors were compared in the subgroup of patients with ECMO duration greater than 7 days. The primary outcome was in-hospital mortality. Two thousand twenty-one patients were included who required PC ECMO for 0-3 days (n = 649 [32.1%]), 4-7 days (n = 776 [38.3%]), 8-10 days (n = 263 [13.0%]), and greater than 10 days (n = 333 [16.5%]). There were no major differences in the investigated preoperative and procedural characteristics among ECMO duration groups. However, the longer ECMO duration category was associated with multiple complications including bleeding, acute kidney injury, arrhythmias, and sepsis. Hospital mortality followed a U-shape curve, with lowest mortality in patients with ECMO duration of 4-7 days (n = 394, 50.8%) and highest in patients with greater than 10 days ECMO support (n = 242, 72.7%). There was no significant difference in post-discharge survival between ECMO duration groups. In patients with ECMO duration greater than 7 days, age, comorbidities, valvular diseases, and complex procedures were associated with nonsurvival. CONCLUSIONS: Nearly 30% of PC ECMO patients were supported for greater than 7 days. In-hospital mortality increased after 7 days of support, especially in patients undergoing valvular and complex surgery, or who had complications, although the long-term post-discharge prognosis was comparable to PC ECMO patients with shorter support duration.

UR - http://www.scopus.com/inward/record.url?scp=85199753663&partnerID=8YFLogxK

U2 - 10.1097/CCM.0000000000006349

DO - 10.1097/CCM.0000000000006349

M3 - Article

C2 - 38856631

AN - SCOPUS:85199753663

SN - 0090-3493

VL - 52

SP - e490-e502

JO - Critical Care Medicine

JF - Critical Care Medicine

IS - 10

ER -

Characteristics and Outcomes of Prolonged Venoarterial Extracorporeal Membrane Oxygenation after Cardiac Surgery: The Post-Cardiotomy Extracorporeal Life Support (PELS-1) Cohort Study

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