title: Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock in Elderly Patients: Trends in Application and Outcome From the Extracorporeal Life Support Organization (ELSO) Registry.
abstract: BACKGROUND
  Venoarterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock (RCS) is increasingly used in adult patients, but age represents a controversial factor in this setting.
  
  
  METHODS
  Data from the Extracorporeal Life Support Organization registry was analyzed to assess in-hospital survival of elderly patients (≥70 years of age) undergoing VA-ECMO for RCS from 1992 to 2015. In-hospital survival and complications for elderly patients were compared with data in younger adults (≥18 to <70 years of age) supported with VA-ECMO during the same time period for similar indications.
  
  
  RESULTS
  The mean age of the patient cohort (n = 5,408) was 53.0 ± 15.7 years (range, 18 to 91 years). The elderly group included 735 patients (13.6%), with a mean age of 75.2 ± 4.4 years. In the elderly group, pre-ECMO cardiac procedures were performed in 134 cases (18.9%), and 2.2% received VA-ECMO for postcardiotomy support compared with 0.7% in the younger cohort. The mean duration of VA-ECMO in the elderly group was 101 ± 91 h compared with 138 ± 146 h in the younger group (p < 0.001). Overall, survival to hospital discharge for the entire adult cohort was 41.4% (2,240 of 5,408), with 30.5% (224 of 735) in the elderly patient group and 43.1% (2,016 of 4,673) in the younger patient group (p < 0.001). Elderly patients had a higher rate of multiorgan failure. At multivariable analysis age represented an independent negative predictor of in-hospital survival.
  
  
  CONCLUSIONS
  Based on the acceptable survival to hospital discharge in our study, older age alone should not represent an absolute contraindication when considering VA-ECMO support for RCS.
authors.affiliation: Cardio-Thoracic Surgery Unit, Maastricht University Medical Centre, Maastricht, The Netherlands. Electronic address: roberto.lorussobs@gmail.com.
authors.forename: Roberto
authors.initials: R
authors.lastname: Lorusso
authors.affiliation: Cardio-Thoracic Surgery Unit, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Sandro
authors.initials: S
authors.lastname: Gelsomino
authors.affiliation: Cardio-Thoracic Surgery Unit, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Orlando
authors.initials: O
authors.lastname: Parise
authors.affiliation: Division of Geriatrics, University of Arkansas, Little Rock, Arkansas.
authors.forename: Priya
authors.initials: P
authors.lastname: Mendiratta
authors.affiliation: Division of Cardiology, University of Arkansas, Little Rock, Arkansas.
authors.forename: Parthak
authors.initials: P
authors.lastname: Prodhan
authors.affiliation: Extracorporeal Life Support Organization (ELSO), Ann Arbor, Michigan.
authors.forename: Peter
authors.initials: P
authors.lastname: Rycus
authors.affiliation: Cardiothoracic Intensive Care Unit, National University, Singapore.
authors.forename: Graeme
authors.initials: G
authors.lastname: MacLaren
authors.affiliation: Department of Pediatrics, Division of Critical Care, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Brogan
authors.affiliation: Cardiovascular Surgery & Ped Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Yih-Sharng
authors.initials: YS
authors.lastname: Chen
authors.affiliation: Cardio-Thoracic Surgery Unit, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Jos
authors.initials: J
authors.lastname: Maessen
authors.affiliation: Centre for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Xiaotong
authors.initials: X
authors.lastname: Hou
authors.affiliation: Cardiac Intensive Care Unit, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Thiagarajan
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005500:Follow-Up Studies; D014943:Global Health; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012770:Shock, Cardiogenic / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult