title: Long-term mortality in patients with chronic obstructive pulmonary disease following extracorporeal membrane oxygenation for cardiac assist after cardiovascular surgery.
abstract: OBJECTIVE
  Information on predisposing risk factors influencing long-term survival after extracorporeal membrane oxygenation (ECMO) support remains scarce. In critically ill patients chronic obstructive pulmonary disease (COPD) is an independent risk factor for mortality and morbidity. We assessed the influence of COPD on cardiovascular and all-cause mortality in patients undergoing ECMO therapy.
  
  
  METHODS
  We prospectively included 191 patients undergoing veno-arterial ECMO therapy following cardiovascular surgery at a university-affiliated tertiary care center into our registry.
  
  
  RESULTS
  The median follow-up time was 51 months (IQR 34-71 months) corresponding to 4,197 overall months of follow-up. A total of 125 patients (65 %) died; 88 % of deaths were due to cardiovascular causes. Long-term survival was decreased in patients with COPD after 1 year (23 % vs. 44 %) and after 6 years (14 % vs. 35 %) compared to patients without COPD. COPD was independently associated with all-cause mortality with a hazard ratio of 4.22 (95 % CI 1.04-17.11, p = 0.04) and cardiovascular mortality with a hazard ratio of 5.87 (95 % CI 1.41-24.47, p = 0.02).
  
  
  CONCLUSIONS
  We identified COPD as a strong and independent predictor of long-term all-cause mortality and cardiovascular mortality in patients undergoing ECMO therapy following cardiovascular surgery. The current study presents valuable information for a comprehensive decision-making process prior to ECMO implantation and helps to identify high-risk patients that may benefit from intensified treatment of co-morbidities and close check-ups after hospital discharge.
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Klaus
authors.initials: K
authors.lastname: Distelmaier
authors.forename: Alexander
authors.initials: A
authors.lastname: Niessner
authors.forename: Dominik
authors.initials: D
authors.lastname: Haider
authors.forename: Irene M
authors.initials: IM
authors.lastname: Lang
authors.forename: Gottfried
authors.initials: G
authors.lastname: Heinz
authors.forename: Gerald
authors.initials: G
authors.lastname: Maurer
authors.forename: Herbert
authors.initials: H
authors.lastname: Koinig
authors.forename: Barbara
authors.initials: B
authors.lastname: Steinlechner
authors.forename: Georg
authors.initials: G
authors.lastname: Goliasch
mesh_terms: D000368:Aged; D013504:Cardiovascular Surgical Procedures; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000628:therapy*; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors