Inter-institutional analysis of the outcome after postcardiotomy veno-arterial extracorporeal membrane oxygenation.

IF 16.4 1区 化学 Q1 CHEMISTRY, MULTIDISCIPLINARY
Accounts of Chemical Research Pub Date : 2024-01-01 Epub Date: 2023-12-05 DOI:10.1177/03913988231214934
Fausto Biancari, Timo Mäkikallio, Antonio Loforte, Alexander Kaserer, Vito G Ruggieri, Sung-Min Cho, Jin Kook Kang, Magnus Dalén, Henryk Welp, Kristján Jónsson, Sigurdur Ragnarsson, Francisco J Hernández Pérez, Giuseppe Gatti, Khalid Alkhamees, Antonio Fiore, Andrea Lechiancole, Stefano Rosato, Cristiano Spadaccio, Matteo Pettinari, Andrea Perrotti, Sebastian D Sahli, Camilla L'Acqua, Amr A Arafat, Monirah A Albabtain, Mohammed M AlBarak, Mohamed Laimoud, Ilija Djordjevic, Ihor Krasivskyi, Robertas Samalavicius, Agne Jankuviene, Marta Alonso-Fernandez-Gatta, Markus J Wilhelm, Tatu Juvonen, Giovanni Mariscalco
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引用次数: 0

Abstract

Introduction: Patients requiring postcardiotomy veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) have a high risk of early mortality. In this analysis, we evaluated whether any interinstitutional difference exists in the results of postcardiotomy V-A-ECMO.

Methods: Studies on postcardiotomy V-A-ECMO were identified through a systematic review for individual patient data (IPD) meta-analysis. Analysis of interinstitutional results was performed using direct standardization, estimation of observed/expected in-hospital mortality ratio and propensity score matching.

Results: Systematic review of the literature yielded 31 studies. Data from 10 studies on 1269 patients treated at 25 hospitals were available for the present analysis. In-hospital mortality was 66.7%. The relative risk of in-hospital mortality was significantly higher in six hospitals. Observed versus expected in-hospital mortality ratio showed that four hospitals were outliers with significantly increased mortality rates, and one hospital had significantly lower in-hospital mortality rate. Participating hospitals were classified as underperforming and overperforming hospitals if their observed/expected in-hospital mortality was higher or lower than 1.0, respectively. Among 395 propensity score matched pairs, the overperforming hospitals had significantly lower in-hospital mortality (60.3% vs 71.4%, p = 0.001) than underperforming hospitals. Low annual volume of postcardiotomy V-A-ECMO tended to be predictive of poor outcome only when adjusted for patients' risk profile.

Conclusions: In-hospital mortality after postcardiotomy V-A-ECMO differed significantly between participating hospitals. These findings suggest that in many centers there is room for improvement of the results of postcardiotomy V-A-ECMO.

心肌梗死术后静脉-动脉体外膜肺氧合术后疗效的机构间分析。
简介需要进行心肌切开术后静脉-动脉体外膜氧合(V-A-ECMO)的患者早期死亡的风险很高。在这项分析中,我们评估了心肌切开术后 V-A-ECMO 的结果是否存在机构间差异:方法:通过对患者个体数据(IPD)荟萃分析的系统性回顾,确定了有关心肌切开术后 V-A-ECMO 的研究。采用直接标准化、估计观察/预期院内死亡率和倾向评分匹配等方法对机构间结果进行分析:结果:对文献进行系统回顾后得出了 31 项研究结果。本分析可获得 10 项研究的数据,这些数据涉及 25 家医院治疗的 1269 名患者。院内死亡率为 66.7%。六家医院的院内死亡率相对风险明显更高。观察到的院内死亡率与预期的院内死亡率之比显示,有四家医院属于异常值,死亡率明显升高,一家医院的院内死亡率明显降低。如果参与医院的观察/预期院内死亡率分别高于或低于 1.0,则将其分为表现不佳医院和表现不佳医院。在 395 对倾向得分匹配的医院中,表现优异的医院的院内死亡率(60.3% vs 71.4%,p = 0.001)明显低于表现不佳的医院。只有在对患者的风险状况进行调整后,心肌梗死术后V-A-ECMO的年手术量低才有可能预测不良预后:结论:参与研究的医院之间在心肌梗死术后V-A-ECMO的院内死亡率方面存在显著差异。这些研究结果表明,在许多中心,开胸术后V-A-ECMO的效果还有待提高。
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来源期刊
Accounts of Chemical Research
Accounts of Chemical Research 化学-化学综合
CiteScore
31.40
自引率
1.10%
发文量
312
审稿时长
2 months
期刊介绍: Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.
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