Extracorporeal membrane oxygenation support in postcardiotomy elderly patients: The Mayo Clinic experience

Pankaj Saxena, James Neal, Lyle D. Joyce, Kevin L. Greason, Hartzell V Schaff, Pramod Guru, William Y. Shi, Harold Burkhart, Zhuo Li, William C. Oliver, Roxann B. Pike, Dawit T. Haile, Gregory J. Schears

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background We conducted a retrospective study to assess whether providing extracorporeal membrane oxygenation (ECMO) support to elderly patients (aged 70 years or more) who failed separation from cardiopulmonary bypass after cardiac surgery was a viable option. Methods From 2003 to 2013, 45 patients aged 70 years or more underwent 47 runs of ECMO postoperatively. Results There were 31 men (68.9%). The mean age was 76.8 years. Five patients were in cardiogenic shock preoperatively. Forty-four patients required venoarterial ECMO support for cardiogenic shock. Mean duration of support was 103.8 ± 74.3 hours. Twenty-one patients (46.6%) died while on ECMO support. Twenty-four patients (53.3%) were weaned off ECMO initially, and 11 patients were discharged from hospital. Inhospital mortality was 75.6%. Postoperative complications included acute kidney injury in 30 patients (44.4%), pneumonia in 12 (26.7%), and sepsis in 11 (24.4%). There were 30 deaths (88.2%) attributable to cardiac causes. Preoperative atrial fibrillation, chronic kidney injury, lactic acidosis on ECMO support, and persistent coagulopathy were associated with higher mortality. Conclusions Postcardiotomy ECMO support in elderly patients is associated with high postoperative morbidity and mortality. Nevertheless, it often provides the last line of therapy for these critically ill patients and may provide positive outcomes in selected subgroups.

Original languageEnglish (US)
Pages (from-to)2053-2060
Number of pages8
JournalAnnals of Thoracic Surgery
Volume99
Issue number6
DOIs
StatePublished - Jun 1 2015

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Extracorporeal Membrane Oxygenation
Cardiogenic Shock
Lactic Acidosis
Mortality
Hospital Mortality
Cardiopulmonary Bypass
Acute Kidney Injury
Critical Illness
Atrial Fibrillation
Thoracic Surgery
Sepsis
Pneumonia
Retrospective Studies
Morbidity
Kidney

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Extracorporeal membrane oxygenation support in postcardiotomy elderly patients : The Mayo Clinic experience. / Saxena, Pankaj; Neal, James; Joyce, Lyle D.; Greason, Kevin L.; Schaff, Hartzell V; Guru, Pramod; Shi, William Y.; Burkhart, Harold; Li, Zhuo; Oliver, William C.; Pike, Roxann B.; Haile, Dawit T.; Schears, Gregory J.

In: Annals of Thoracic Surgery, Vol. 99, No. 6, 01.06.2015, p. 2053-2060.

Research output: Contribution to journalArticle

Saxena, P, Neal, J, Joyce, LD, Greason, KL, Schaff, HV, Guru, P, Shi, WY, Burkhart, H, Li, Z, Oliver, WC, Pike, RB, Haile, DT & Schears, GJ 2015, 'Extracorporeal membrane oxygenation support in postcardiotomy elderly patients: The Mayo Clinic experience', Annals of Thoracic Surgery, vol. 99, no. 6, pp. 2053-2060. https://doi.org/10.1016/j.athoracsur.2014.11.075
Saxena, Pankaj ; Neal, James ; Joyce, Lyle D. ; Greason, Kevin L. ; Schaff, Hartzell V ; Guru, Pramod ; Shi, William Y. ; Burkhart, Harold ; Li, Zhuo ; Oliver, William C. ; Pike, Roxann B. ; Haile, Dawit T. ; Schears, Gregory J. / Extracorporeal membrane oxygenation support in postcardiotomy elderly patients : The Mayo Clinic experience. In: Annals of Thoracic Surgery. 2015 ; Vol. 99, No. 6. pp. 2053-2060.
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abstract = "Background We conducted a retrospective study to assess whether providing extracorporeal membrane oxygenation (ECMO) support to elderly patients (aged 70 years or more) who failed separation from cardiopulmonary bypass after cardiac surgery was a viable option. Methods From 2003 to 2013, 45 patients aged 70 years or more underwent 47 runs of ECMO postoperatively. Results There were 31 men (68.9{\%}). The mean age was 76.8 years. Five patients were in cardiogenic shock preoperatively. Forty-four patients required venoarterial ECMO support for cardiogenic shock. Mean duration of support was 103.8 ± 74.3 hours. Twenty-one patients (46.6{\%}) died while on ECMO support. Twenty-four patients (53.3{\%}) were weaned off ECMO initially, and 11 patients were discharged from hospital. Inhospital mortality was 75.6{\%}. Postoperative complications included acute kidney injury in 30 patients (44.4{\%}), pneumonia in 12 (26.7{\%}), and sepsis in 11 (24.4{\%}). There were 30 deaths (88.2{\%}) attributable to cardiac causes. Preoperative atrial fibrillation, chronic kidney injury, lactic acidosis on ECMO support, and persistent coagulopathy were associated with higher mortality. Conclusions Postcardiotomy ECMO support in elderly patients is associated with high postoperative morbidity and mortality. Nevertheless, it often provides the last line of therapy for these critically ill patients and may provide positive outcomes in selected subgroups.",
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