title: Venoarterial extracorporeal membrane oxygenation after coronary artery bypass grafting: Results of a multicenter study.
abstract: BACKGROUND
  The evidence of the benefits of using venoarterial extracorporeal membrane oxygenation (VA-ECMO) after coronary artery bypass grafting (CABG) is scarce.
  
  
  METHODS
  We analyzed the outcomes of patients who received VA-ECMO therapy due to cardiac or respiratory failure after isolated CABG in 12 centers between 2005 and 2016. Patients treated preoperatively with ECMO were excluded from this study.
  
  
  RESULTS
  VA-ECMO was employed in 148 patients after CABG for median of 5.0days (mean, 6.4, SD 5.6days). In-hospital mortality was 64.2%. Pooled in-hospital mortality was 65.9% without significant heterogeneity between the centers (I28.6%). The proportion of VA-ECMO in each center did not affect in-hospital mortality (p=0.861). No patients underwent heart transplantation and six patients received a left ventricular assist device. Logistic regression showed that creatinine clearance (p=0.004, OR 0.98, 95% CI 0.97-0.99), pulmonary disease (p=0.018, OR 4.42, 95% CI 1.29-15.15) and pre-VA-ECMO blood lactate (p=0.015, OR 1.10, 95% CI 1.02-1.18) were independent baseline predictors of in-hospital mortality. One-, 2-, and 3-year survival was 31.0%, 27.9%, and 26.1%, respectively.
  
  
  CONCLUSIONS
  One third of patients with need for VA-ECMO after CABG survive to discharge. In view of the burden of resources associated with VA-ECMO treatment and the limited number of patients surviving to discharge, further studies are needed to identify patients who may benefit the most from this treatment.
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland. Electronic address: fausto.biancari@oulu.fi.
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.affiliation: Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Dalén
authors.affiliation: Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France.
authors.forename: Andrea
authors.initials: A
authors.lastname: Perrotti
authors.affiliation: Department of Cardiothoracic Surgery, Henri Mondor University Hospital, AP-HP, Paris-Est University, Créteil, France.
authors.forename: Antonio
authors.initials: A
authors.lastname: Fiore
authors.affiliation: Hamburg University Heart Center, Hamburg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Reichart
authors.affiliation: Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Sorosh
authors.initials: S
authors.lastname: Khodabandeh
authors.affiliation: Hamburg University Heart Center, Hamburg, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Gulbins
authors.affiliation: Hamburg University Heart Center, Hamburg, Germany.
authors.forename: Svante
authors.initials: S
authors.lastname: Zipfel
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany.
authors.forename: Mosab
authors.initials: M
authors.lastname: Al Shakaki
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany.
authors.forename: Henryk
authors.initials: H
authors.lastname: Welp
authors.affiliation: Division of Cardiac Surgery, University of Parma, Parma, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Vezzani
authors.affiliation: Division of Cardiac Surgery, University of Parma, Parma, Italy.
authors.forename: Tiziano
authors.initials: T
authors.lastname: Gherli
authors.affiliation: Cardiac Surgery, Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Jaakko
authors.initials: J
authors.lastname: Lommi
authors.affiliation: Cardiac Surgery, Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Tatu
authors.initials: T
authors.lastname: Juvonen
authors.affiliation: Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Svenarud
authors.affiliation: Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France.
authors.forename: Sidney
authors.initials: S
authors.lastname: Chocron
authors.affiliation: Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France.
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Verhoye
authors.affiliation: Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France.
authors.forename: Karl
authors.initials: K
authors.lastname: Bounader
authors.affiliation: Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gatti
authors.affiliation: Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Gabrielli
authors.affiliation: Department of Cardiac Surgery, Centro Cardiologico-Fondazione Monzino IRCCS, University of Milan, Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Saccocci
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Eeva-Maija
authors.initials: EM
authors.lastname: Kinnunen
authors.affiliation: Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Onorati
authors.affiliation: Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Santarpino
authors.affiliation: Saud Al-Babtain Cardiac Center, Ministry of Health, Dammam, Saudi Arabia.
authors.forename: Khalid
authors.initials: K
authors.lastname: Alkhamees
authors.affiliation: Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France.
authors.forename: Vito G
authors.initials: VG
authors.lastname: Ruggieri
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany.
authors.forename: Angelo M
authors.initials: AM
authors.lastname: Dell'Aquila
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality / Q000639:trends*; D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000639:trends*
keywords: CABG; Coronary artery bypass; ECLS; ECMO; Extracorporeal life support; Extracorporeal membrane oxygenation; Heart failure; Post-cardiotomy