دورية أكاديمية
أعرض في EDS

Variables associated with in-hospital and postdischarge outcomes after postcardiotomy extracorporeal membrane oxygenation: Netherlands Heart Registration Cohort.

التفاصيل البيبلوغرافية
العنوان: Variables associated with in-hospital and postdischarge outcomes after postcardiotomy extracorporeal membrane oxygenation: Netherlands Heart Registration Cohort.
المؤلفون: Mariani S; Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands. Electronic address: s.mariani1985@gmail.com., van Bussel BCT; Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands., Ravaux JM; Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands., Roefs MM; Netherlands Heart Registration, Utrecht, The Netherlands., De Piero ME; Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands., Di Mauro M; Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands., Willers A; Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands., Segers P; Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands., Delnoij T; Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands., van der Horst ICC; Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands., Maessen J; Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; Netherlands Heart Registration, Utrecht, The Netherlands., Lorusso R; Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
مؤلفون مشاركون: Netherlands Heart Registration Cardiothoracic Surgery Registration Committee
المصدر: The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2023 Mar; Vol. 165 (3), pp. 1127-1137.e14. Date of Electronic Publication: 2022 Sep 07.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Mosby Country of Publication: United States NLM ID: 0376343 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-685X (Electronic) Linking ISSN: 00225223 NLM ISO Abbreviation: J Thorac Cardiovasc Surg Subsets: MEDLINE
أسماء مطبوعة: Publication: St. Louis, MO : Mosby
Original Publication: St. Louis.
مواضيع طبية MeSH: Extracorporeal Membrane Oxygenation*/adverse effects , Respiratory Insufficiency* , Renal Insufficiency*, Adult ; Male ; Humans ; Aged ; Female ; Hospital Mortality ; Aftercare ; Netherlands ; Patient Discharge ; Prospective Studies ; Shock, Cardiogenic ; Hospitals ; Retrospective Studies
مستخلص: Objectives: Extracorporeal membrane oxygenation (ECMO) for postcardiotomy cardiogenic shock has been increasingly used without concomitant mortality reduction. This study aims to investigate determinants of in-hospital and postdischarge mortality in patients requiring postcardiotomy ECMO in the Netherlands.
Methods: The Netherlands Heart Registration collects nationwide prospective data from cardiac surgery units. Adults receiving intraoperative or postoperative ECMO included in the register from January 2013 to December 2019 were studied. Survival status was established through the national Personal Records Database. Multivariable logistic regression analyses were used to investigate determinants of in-hospital (3 models) and 12-month postdischarge mortality (4 models). Each model was developed to target specific time points during a patient's clinical course.
Results: Overall, 406 patients (67.2% men, median age, 66.0 years [interquartile range, 55.0-72.0 years]) were included. In-hospital mortality was 51.7%, with death occurring in a median of 5 days (interquartile range, 2-14 days) after surgery. Hospital survivors (n = 196) experienced considerable rates of pulmonary infections, respiratory failure, arrhythmias, and deep sternal wound infections during a hospitalization of median 29 days (interquartile range, 17-51 days). Older age (odds ratio [OR], 1.02; 95% CI, 1.0-1.04) and preoperative higher body mass index (OR, 1.08; 95% CI, 1.02-1.14) were associated with in-hospital death. Within 12 months after discharge, 35.1% of hospital survivors (n = 63) died. Postoperative renal failure (OR, 2.3; 95% CI, 1.6-4.9), respiratory failure (OR, 3.6; 95% CI, 1.3-9.9), and re-thoracotomy (OR, 2.9; 95% CI, 1.3-6.5) were associated with 12-month postdischarge mortality.
Conclusions: In-hospital and postdischarge mortality after postcardiotomy ECMO in adults remains high in the Netherlands. ECMO support in patients with higher age and body mass index, which drive associations with higher in-hospital mortality, should be carefully considered. Further observations suggest that prevention of re-thoracotomies, renal failure, and respiratory failure are targets that may improve postdischarge outcomes.
(Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)
فهرسة مساهمة: Investigator: JA Bekkers, Department of Cardio-Thoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.; WJP Van Boven, Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.; TJ Van Brakel, Department of Cardio-Thoracic Surgery, Leids University Medical Center, Leiden, The Netherlands.; S Bramer, Department of Cardio-Thoracic Surgery, Amphia Hospital, Breda, The Netherlands.; EJ Daeter, Department of Cardio-Thoracic Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands.; GJF Hoohenkerk, Department of Cardio-Thoracic Surgery, Haga Hospital, Den Haag, The Netherlands.; NP Van der Kaaij, Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.; BMJA Koene, Department of Cardio-Thoracic Surgery, Catarina Hospital, Eindhoven, The Netherlands.; WWL Li, Department of Cardio-Thoracic Surgery, Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands.; TALP Markou, Department of Cardio-Thoracic Surgery, Isala Clinic Zwolle, Zwolle, The Netherlands.; YL Douglas, Department of Cardio-Thoracic Surgery, University Medical Center Groningen, Groningen, The Netherlands.; F Porta, Department of Cardio-Thoracic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands.; RGH Speekenbrink, Department of Cardio-Thoracic Surgery, Thoraxcenter Medical Spectrum Twente, Enschede, The Netherlands.; W Stooker, Department of Cardio-Thoracic Surgery, OLVG, Amsterdam, The Netherlands.; ABA Vonk, Department of Cardio-Thoracic Surgery, Amsterdam UMC-Location VUmc, Amsterdam, The Netherlands.
Keywords: acute heart failure; cardiac surgery; extracorporeal life support; extracorporeal membrane oxygenation; mechanical circulatory support; postcardiotomy cardiogenic shock
تواريخ الأحداث: Date Created: 20221013 Date Completed: 20231026 Latest Revision: 20231031
رمز التحديث: 20240628
DOI: 10.1016/j.jtcvs.2022.08.024
PMID: 36229294
قاعدة البيانات: MEDLINE
الوصف
تدمد:1097-685X
DOI:10.1016/j.jtcvs.2022.08.024