title: Extracorporeal Membrane Oxygenation Support in Postcardiotomy Elderly Patients: The Mayo Clinic Experience.
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.
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors: Pankaj
authors: P
authors: Saxena
authors: Perfusion Services, Mayo Clinic, Rochester, Minnesota.
authors: James
authors: J
authors: Neal
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors: Lyle D
authors: LD
authors: Joyce
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors: Kevin L
authors: KL
authors: Greason
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors: Hartzell V
authors: HV
authors: Schaff
authors: Department of Anesthesiology and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
authors: Pramod
authors: P
authors: Guru
authors: University of Melbourne, Melbourne, Australia.
authors: William Y
authors: WY
authors: Shi
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors: Harold
authors: H
authors: Burkhart
authors: Department of Biostatistics, Mayo Clinic, Rochester, Minnesota.
authors: Zhuo
authors: Z
authors: Li
authors: Department of Anesthesiology and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
authors: William C
authors: WC
authors: Oliver
authors: Department of Anesthesiology and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
authors: Roxann B
authors: RB
authors: Pike
authors: Department of Anesthesiology and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
authors: Dawit T
authors: DT
authors: Haile
authors: Department of Anesthesiology and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: schears.gregory@mayo.edu.
authors: Gregory J
authors: GJ
authors: Schears
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000401:mortality; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D011182:Postoperative Care / Q000379:methods* / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D017211:Treatment Failure