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

IF 1.4 4区 医学 Q4 ENGINEERING, BIOMEDICAL
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。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
International Journal of Artificial Organs
International Journal of Artificial Organs 医学-工程:生物医学
CiteScore
3.40
自引率
5.90%
发文量
92
审稿时长
3 months
期刊介绍: The International Journal of Artificial Organs (IJAO) publishes peer-reviewed research and clinical, experimental and theoretical, contributions to the field of artificial, bioartificial and tissue-engineered organs. The mission of the IJAO is to foster the development and optimization of artificial, bioartificial and tissue-engineered organs, for implantation or use in procedures, to treat functional deficits of all human tissues and organs.
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