Impact of age on outcomes following extracorporeal membrane oxygenation implantation in adult patients with postcardiotomy cardiogenic shock
Cui Yongchao
Du Zhongtao
Jiang Chunjing
Jiang Yu
Yang Feng
Xing Zhichen
Xu Bo
Guo Dong
Xing Jialin
Miao Na
Zhao Yanyan
Hao Xing
Wang Hong
Hou Xiaotong
Abstract：Objective To analyze the impact of age on outcomes in adult patients who underwent venoartieral extracorporeal membrane oxygenation (VA-ECMO) support for postcardiotomy cardiogenic shock (PCCS).Methods Totally 496 adult patients with PCCS who were implanted with VA-ECMO from September 2006 to December 2016 in Beijing Anzhen Hospital,Capital Medical University were retrospectively analyzed.The patients were divided into non-elderly group (18-＜ 65 years old,n =354) and elderly group (≥ 65 years old,n =142).Clinical characteristics,comorbidities,major cardiac procedures,pre-ECMO conditions,weaning and survival from VA-ECMO,ECMO-related complications and postoperative outcomes were assessed.Results The elderly group had significantly higher prevalences of comorbidities including hypertension,hyperlipidemia,coronary heart disease,intra-aortic balloon pump support,surgical history of pulmonary embolism and lower body length (P ＜ 0.05).Weaning from VA-ECMO was achieved in 62.4％ (221/354) of the non-elderly group and 49.3％ (70/142) of the elderly group;survival to discharge was 42.4％ (150/354) among the non-elderly group and 21.8％ (31/142) among the elderly group;the elderly group had a higher incidence of renal function dysfunction requiring continuous renal replacement therapy (CRRT) [44.1％ (156/354) vs 61.3 ％ (87/142)] (x2 =12.013,20.786,11.376;P =0.007,＜ 0.001,0.001).Adverse events including infection,re-exploration for bleeding,severe neurologic complication and severe limb ischemia were comparable in both groups (P ＞ 0.05).Multivariable logistic regression identified that advanced age,renal function dysfunction requiring CRRT,severe neurologic complication and severe limb ischemia were risk factors of in-hospital mortality in adult PCCS patients supported by VA-ECMO (odds ratio =3.38,9.65,11.08,6.14;95％ confidence interval:1.49-8.10,2.75-21.20,3.69-25.79,2.48-16.51;P=0.015,＜0.001,＜0.001,＜0.001).Conclusion VA-ECMO support can be used in adult patients with PCCS with acceptable adverse events.Some elderly patients can benefit from VA-ECMO but advanced age is a risk factor of in-hospital mortality.
Keywords：Cariogenic shockExtracorporeal membrane oxygenationAdvanced age
Publication Date：2019-01-01
Online Publishing Date：2026-09-14(First online date of this platform, not the publication date of the document)
Pages：4( 346-349 )