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  4. Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock in Elderly Patients: Trends in Application and Outcome From the Extracorporeal Life Support Organization (ELSO) Registry
 
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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.
YIH-SHARNG CHEN  
Maessen J.
Hou X.
Thiagarajan R.R.
DOI
10.1016/j.athoracsur.2016.10.023
URI
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85010369363&doi=10.1016%2fj.athoracsur.2016.10.023&partnerID=40&md5=b0c95ddf1ad59e518cd4d3329c7a3bc2
https://scholars.lib.ntu.edu.tw/handle/123456789/433968
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

[SDGs]SDG3

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

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