Interventional procedure overview of VA ECMO for postcardiotomy cardiogenic shock in adults
Closed for comments This consultation ended on at Request commenting lead permission
Appendix B: Other relevant studies
Other potentially relevant studies that were not included in the main evidence summary (tables 2 and 3) are listed in table 5 below.
Case studies and observational studies with fewer than 100 people were excluded unless they included outcomes that were not frequently reported.
Study | Number of people and follow up | Direction of conclusions | Reason study was not included in main evidence summary |
|---|---|---|---|
Carroll BJ, Shah RV, Murthy V et al. (2015) Clinical features and outcomes in adults with cardiogenic shock supported by extracorporeal membrane oxygenation. The American Journal of Cardiology 116(10): 1624-30 | Single centre retrospective study, US n=123 (26 postcardiotomy [21%]) Follow-up: In-hospital | Overall, 69 people (56%) were weaned from ECMO, with 48 patients (39%) surviving to discharge. People with postcardiotomy shock had the poorest overall survival after ECMO. | Included in Kowalewski (2020) SLR. |
Distelmaier K, Wiedemann D, Binder C et al. (2018) Duration of extracorporeal membrane oxygenation support and survival in cardiovascular surgery patients. Journal of Thoracic and Cardiovascular Surgery 155(6): 2471-2476 | Single centre retrospective study, Austria n=354 Follow-up: median 45 months (IQR: 20 to 81 months) | Through a median follow-up period of 45 months, 245 people (69%) died. An association between increased duration of ECMO support and mortality was observed in people who survived ECMO support with a crude hazard ratio of 1.96 (95% CI 1.40 to 2.74; p<0.001) for 2 year mortality compared with the third tertile and the second tertile of ECMO duration. | Included in Kowalewski (2020) SLR. |
Djordjevic I, Eghbalzadeh K, Sabashnikov A et al. (2020) Central vs peripheral venoarterial ECMO in postcardiotomy cardiogenic shock. Journal of Cardiac Surgery 35(5): 1037-1042 | Single centre retrospective study, Germany n=156 Follow-up: 30 days | 30‐day mortality was comparable with nearly 70% in both cohorts (cECMO 39 [70%] vs pECMO 69 [69%]; p=0.93). ECMO complications occurred significantly more frequently in people treated with cECMO (cECMO 44 [79%] vs pECMO 54 [54%]; p<0.01). | Outcomes not reported as overall population, but by subgroup: central or peripheral VA ECMO. |
Flecher E, Anselmi A, Corbineau H et al. (2014) Current aspects of extracorporeal membrane oxygenation in a tertiary referral centre: determinants of survival at follow-up. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 46(4): 665-671 | Single centre retrospective study, France n=325 (postcardiotomy 29%) Follow-up: mean 84 days (SD: 86) | Overall in the VA group, weaning rates were 59%, survival after 30 days was 44% and survival at the end of the follow-up was 41%. | More recent studies with outcomes split by aetiologies were included. |
Fux T, Holm M, Corbascio M et al. (2018) Venoarterial extracorporeal membrane oxygenation for postcardiotomy shock: Risk factors for mortality. The Journal of Thoracic and Cardiovascular Surgery 156(5): 1894-1902e3 | Single centre retrospective study, Sweden n=105 Follow-up: 90 days | The 90-day overall mortality was 57%, and in-hospital mortality was 56%. Forty-seven percent of patients died on venoarterial extracorporeal membrane oxygenation, 51% of patients were successfully weaned, 1% of patients were bridged to heart transplantation, and 1%of patients were bridged to left ventricular assist device. | Included in Alba (2021) SLR. |
Khorsandi M, Dougherty S, Bouamra O et al. (2017) Extra-corporeal membrane oxygenation for refractory cardiogenic shock after adult cardiac surgery: a systematic review and meta-analysis. Journal of cardiothoracic surgery 12(1): 55 | Systematic review and meta-analysis n=1,926 24 studies Follow-up: In-hospital | Meta-analysis for overall survival rate to hospital discharge of 31% (95% CI 0.29 to 0.34, p<0.01, I2=60%). | More recent systematic reviews and meta-analyses included. |
Kowalewski M, Raffa G, Zielinski K et al. (2020) Baseline surgical status and short-term mortality after extracorporeal membrane oxygenation for post-cardiotomy shock: a meta-analysis. Perfusion 35(3): 246-254 | Systematic review and meta-analysis n=2,235 22 studies Follow-up: In-hospital, 30 day | Overall in-hospital or 30-day mortality event rate was 67% (95% CI 63 to 70%). There were no differences in in-hospital or 30-day mortality with respect to baseline surgical status in the subgroup analysis (test for subgroup differences; p=0.406). | Studies with more relevant outcomes were included. |
Mariani S, van Bussel BCT, Ravaux JM et al. (2023) Variables associated with in-hospital and postdischarge outcomes after postcardiotomy extracorporeal membrane oxygenation: Netherlands Heart Registration Cohort. Journal of Thoracic and Cardiovascular Surgery 165(3): 1127-1137e14 | Retrospective Netherlands Heart Registry study n=406 Follow-up: In-hospital, 1 year | In-hospital mortality was 52%, with death occurring in a median of 5 days (IQR 2 to 14 days) after surgery. Hospital survivors (n=196) experienced considerable rates of pulmonary infections, respiratory failure, arrhythmias, and deep sternal wound infections during a hospitalisation of median 29 days (IQR 17 to 51 days). | Larger registry studies from broader regions included. |
Melehy A, Ning Y, Kurlansky P et al. (2022) Bleeding and thrombotic events during extracorporeal membrane oxygenation for postcardiotomy shock. The Annals of Thoracic Surgery 113(1): 131-137 | Single centre retrospective study, USA n=141 Follow-up: In-hospital | Of the 152 patients who received ECMO for postcardiotomy shock, 33 (23%) had 40 thrombotic events and 64 (45%) had 86 bleeding events. | Studies with more relevant outcomes were included. |
Mihu MR, El Banayosy AM, Harper MD et al. (2024) Comparing outcomes of post-cardiotomy cardiogenic shock patients: on-site cannulation vs. retrieval for V-A ECMO support. Journal of Clinical Medicine 13(11): 3265 | Single centre retrospective study, USA n=121 Follow-up: In-hospital | The overall mortality rate was 52%. Of the patients who died (n=63), 50 experienced on-ECMO mortalities, and 13 had post-weaning mortalities. The ECLS weaning rate was 55% (n=34) in the retrieved group and 63% (n=37) in the on-site group (p=0.38). | Outcomes not reported as overall population, but by subgroup: cannulation on or off site. |
Papadopoulos N, Marinos S, El-Sayed Ahmad A et al. (2015) Risk factors associated with adverse outcome following extracorporeal life support: Analysis from 360 consecutive patients. Perfusion 30(4): 284-290 | Single centre retrospective study, Germany n=360 Follow-up: In-hospital, 5 years | ECLS weaning was successful in 58% and 30% could be discharged from hospital. The main cause of death was sepsis (69%). Overall, major cerebrovascular events occurred in 12% (bleeding 3%, embolic 9%), limb ischaemia in 13%, GI complications in 16% and RRT in 61%. Kaplan Meier estimates for long-term survival were 26% at one year and 22% at 5 years. | Included in Kowalewski (2020), Biancari (2018), Alba (2021) SLRs. |
Provaznik Z, Philipp A, Zeman F et al. (2021) Extracorporeal life support in postcardiotomy cardiogenic shock: a view on scenario, outcome, and risk factors in 261 patients. The Thoracic and Cardiovascular Surgeon 69(3): 271-278 | Single centre retrospective study, Germany n=261 Follow-up: median 3.2 years | Overall mortality on ECLS was 39%. Overall follow-up survival was 24%. | Larger studies with longer follow-up included. |
Sahli SD, Kaserer A, Braun J et al. (2022) Predictors associated with mortality of extracorporeal life support therapy for acute heart failure: single-center experience with 679 patients. Journal of Thoracic Disease 14(6): 1960-1971 | Single centre retrospective study, Switzerland n=679 (postcardiotomy n=215) Follow-up: In-hospital | In-hospital mortality significantly varied between ECLS indications: 71% (152/215) for postcardiotomy, 68% (108/159) for cardiopulmonary resuscitation, 47% (110/234) for refractory cardiogenic shock, and 10% (7/71) for lung transplantation and expansive thoracic surgery (p<0.001). | Larger studies split by cardiogenic shock aetiology were included. |
Shao C, Wang L, Yang F et al. (2022) Quality of life and mid-term survival in patients receiving extracorporeal membrane oxygenation after cardiac surgery. ASAIO Journal 68(3): 349-355 | Single centre retrospective study, China n=102 Follow-up: 5 years | The SF-36 scores in general health and vitality were significantly lower among the ECMO survivors (p<0.05). After discharge, ECMO versus non-ECMO survival (93% versus 82%; p=0.013). | Studies with more relevant outcomes were included. |
Xie H, Yang F, Hou D et al. (2020) Risk factors of in-hospital mortality in adult postcardiotomy cardiogenic shock patients successfully weaned from venoarterial extracorporeal membrane oxygenation. Perfusion 35(5): 417-426 | Single centre retrospective study, China n=363 Follow-up: In-hospital | In total, 212 (58%) of 363 postcardiotomy cardiogenic shock patients were successfully weaned from venoarterial extracorporeal membrane oxygenation. | Studies with more relevant outcomes and larger studies with longer follow-up were included. |
Zhigalov K, Sa MPBO, Safonov D et al. (2020) Clinical outcomes of venoarterial extracorporeal life support in 462 patients: Single-center experience. Artificial Organs 44(6): 620-627 | Single centre retrospective study, Germany n=462 (postcardiotomy n=357) Follow-up: In-hospital | Overall, the in-hospital survival rate was 26%. There was no statistically significant difference between the groups: 26% for PCS and 25% for non-PCS, respectively. Weaning from VA-ECLS was possible in 44% for PCS and in 30% for non-PCS (p=0.004). | Larger studies split by CS aetiology were included. |
How are you taking part in this consultation?
You will not be able to change how you comment later.
You must be signed in to answer questions