Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock in Elderly Patients: Trends in Application and Outcome From the Extracorporeal Life Support Organization (ELSO) Registry
Journal
Annals of Thoracic Surgery
Journal Volume
104
Journal Issue
1
Pages
62-69
Date Issued
2017
Author(s)
Lorusso R.
Gelsomino S.
Parise O.
Mendiratta P.
Prodhan P.
Rycus P.
MacLaren G.
Brogan T.V.
Maessen J.
Hou X.
Thiagarajan R.R.
Abstract
Background Venoarterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock (RCS) is increasingly used in adult patients, but age represents a controversial factor in this setting. Methods Data from the Extracorporeal Life Support Organization registry was analyzed to assess in-hospital survival of elderly patients (?70 years of age) undergoing VA-ECMO for RCS from 1992 to 2015. In-hospital survival and complications for elderly patients were compared with data in younger adults (?18 to <70 years of age) supported with VA-ECMO during the same time period for similar indications. Results The mean age of the patient cohort (n = 5,408) was 53.0 ± 15.7 years (range, 18 to 91 years). The elderly group included 735 patients (13.6%), with a mean age of 75.2 ± 4.4 years. In the elderly group, pre-ECMO cardiac procedures were performed in 134 cases (18.9%), and 2.2% received VA-ECMO for postcardiotomy support compared with 0.7% in the younger cohort. The mean duration of VA-ECMO in the elderly group was 101 ± 91 h compared with 138 ± 146 h in the younger group (p < 0.001). Overall, survival to hospital discharge for the entire adult cohort was 41.4% (2,240 of 5,408), with 30.5% (224 of 735) in the elderly patient group and 43.1% (2,016 of 4,673) in the younger patient group (p < 0.001). Elderly patients had a higher rate of multiorgan failure. At multivariable analysis age represented an independent negative predictor of in-hospital survival. Conclusions Based on the acceptable survival to hospital discharge in our study, older age alone should not represent an absolute contraindication when considering VA-ECMO support for RCS. ? 2017 The Society of Thoracic Surgeons
SDGs
Other Subjects
aged; Article; bleeding; cardiogenic shock; cohort analysis; controlled study; extracorporeal oxygenation; female; hemolysis; hospital discharge; human; kidney injury; major clinical study; male; multiple organ failure; overall survival; priority journal; respiratory failure; ST segment elevation myocardial infarction; thrombosis; treatment outcome; very elderly; adolescent; adult; age; age distribution; clinical trial; extracorporeal oxygenation; follow up; global health; hospital mortality; middle aged; mortality; multicenter study; procedures; register; retrospective study; risk assessment; Shock, Cardiogenic; trends; young adult; Adolescent; Adult; Age Distribution; Age Factors; Aged; Aged, 80 and over; Extracorporeal Membrane Oxygenation; Follow-Up Studies; Global Health; Hospital Mortality; Humans; Middle Aged; Registries; Retrospective Studies; Risk Assessment; Shock, Cardiogenic; Treatment Outcome; Young Adult
Publisher
Elsevier USA
Type
journal article