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|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|
|Citation:||Lorusso R., Gelsomino S., Parise O., Mendiratta P., Prodhan P., Rycus P., MacLaren G., Brogan T.V., Chen Y.-S., Maessen J., Hou X., Thiagarajan R.R. (2017-07-01). Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock in Elderly Patients: Trends in Application and Outcome From the Extracorporeal Life Support Organization (ELSO) Registry. Annals of Thoracic Surgery 104 (1) : 62-69. ScholarBank@NUS Repository. https://doi.org/10.1016/j.athoracsur.2016.10.023|
|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. � 2017 The Society of Thoracic Surgeons|
|Source Title:||Annals of Thoracic Surgery|
|Appears in Collections:||Staff Publications|
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