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Long-term mortality in patients with chronic obstructive pulmonary disease following extracorporeal membrane oxygenation for cardiac assist after cardiovascular surgery

Klaus Distelmaier| Alexander Niessner| Dominik Haider| Irene M. Lang| Gottfried Heinz| Gerald Maurer| Herbert Koinig| Barbara Steinlechner| Georg Goliasch
Original: Postoperative Critical Care
Volume 39, Issue 8 / August , 2013

Pages 1444 - 1451

Abstract

Purpose

Information on predisposing risk factors influencing long-term survival after extracorporeal membrane oxygenation (ECMO) support remains scarce. In critically ill patients chronic obstructive pulmonary disease (COPD) is an independent risk factor for mortality and morbidity. We assessed the influence of COPD on cardiovascular and all-cause mortality in patients undergoing ECMO therapy.

Methods

We prospectively included 191 patients undergoing veno-arterial ECMO therapy following cardiovascular surgery at a university-affiliated tertiary care center into our registry.

Results

The median follow-up time was 51 months (IQR 34–71 months) corresponding to 4,197 overall months of follow-up. A total of 125 patients (65 %) died; 88 % of deaths were due to cardiovascular causes. Long-term survival was decreased in patients with COPD after 1 year (23 % vs. 44 %) and after 6 years (14 % vs. 35 %) compared to patients without COPD. COPD was independently associated with all-cause mortality with a hazard ratio of 4.22 (95 % CI 1.04–17.11, p = 0.04) and cardiovascular mortality with a hazard ratio of 5.87 (95 % CI 1.41–24.47, p = 0.02).

Conclusions

We identified COPD as a strong and independent predictor of long-term all-cause mortality and cardiovascular mortality in patients undergoing ECMO therapy following cardiovascular surgery. The current study presents valuable information for a comprehensive decision-making process prior to ECMO implantation and helps to identify high-risk patients that may benefit from intensified treatment of co-morbidities and close check-ups after hospital discharge.

Keywords

References

  1. Bartlett RH, Roloff DW, Custer JR, Younger JG, Hirschl RB (2000) Extracorporeal life support: the University of Michigan experience. JAMA 283:904–908
    • View reference on PubMed
    • View reference on publisher's website
  2. Combes A, Leprince P, Luyt CE, Bonnet N, Trouillet JL, Leger P, Pavie A, Chastre J (2008) Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Crit Care Med 36:1404–1411
    • View reference on PubMed
    • View reference on publisher's website
  3. Rastan AJ, Dege A, Mohr M, Doll N, Falk V, Walther T, Mohr FW (2010) Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. J Thorac Cardiovasc Surg 139:302–311, e1
  4. Smedira NG, Blackstone EH (2001) Postcardiotomy mechanical support: risk factors and outcomes. Ann Thorac Surg 71:S60–S66 (discussion S82–65)
    • View reference on PubMed
    • View reference on publisher's website
  5. Angouras DC, Anagnostopoulos CE, Chamogeorgakis TP, Rokkas CK, Swistel DG, Connery CP, Toumpoulis IK (2010) Postoperative and long-term outcome of patients with chronic obstructive pulmonary disease undergoing coronary artery bypass grafting. Ann Thorac Surg 89:1112–1118
    • View reference on PubMed
    • View reference on publisher's website
  6. O’Boyle F, Mediratta N, Chalmers J, Al-Rawi O, Mohan K, Shaw M, Poullis M (2013) Long-term survival of patients with pulmonary disease undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg 43:697–703
    • View reference on PubMed
    • View reference on publisher's website
  7. Rady MY, Ryan T (1999) Perioperative predictors of extubation failure and the effect on clinical outcome after cardiac surgery. Crit Care Med 27:340–347
    • View reference on PubMed
    • View reference on publisher's website
  8. Samuels LE, Kaufman MS, Morris RJ, Promisloff R, Brockman SK (1998) Coronary artery bypass grafting in patients with COPD. Chest 113:878–882
    • View reference on PubMed
    • View reference on publisher's website
  9. Funk GC, Bauer P, Burghuber OC, Fazekas A, Hartl S, Hochrieser H, Schmutz R, Metnitz P (2012) Prevalence and prognosis of chronic obstructive pulmonary disease in critically ill patients between 1998 and 2008. Eur Respir J 41:792–799
    • View reference on PubMed
    • View reference on publisher's website
  10. Sellares J, Ferrer M, Cano E, Loureiro H, Valencia M, Torres A (2011) Predictors of prolonged weaning and survival during ventilator weaning in a respiratory ICU. Intensive Care Med 37:775–784
  11. Vestbo J, Hurd SS, Agusti AG, Jones PW, Vogelmeier C, Anzueto A, Barnes PJ, Fabbri LM, Martinez FJ, Nishimura M, Stockley RA, Sin DD, Rodriguez-Roisin R (2013) Global Strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease, GOLD executive summary. Am J Respir Crit Care Med 187:347–365
    • View reference on PubMed
    • View reference on publisher's website
  12. MacLaren G, Combes A, Bartlett RH (2012) Contemporary extracorporeal membrane oxygenation for adult respiratory failure: life support in the new era. Intensive Care Med 38:210–220
  13. Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, Hibbert CL, Truesdale A, Clemens F, Cooper N, Firmin RK, Elbourne D (2009) Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 374:1351–1363
    • View reference on PubMed
    • View reference on publisher's website
  14. The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308
  15. Gattinoni L, Pesenti A, Mascheroni D, Marcolin R, Fumagalli R, Rossi F, Iapichino G, Romagnoli G, Uziel L, Agostoni A et al (1986) Low-frequency positive-pressure ventilation with extracorporeal CO2 removal in severe acute respiratory failure. JAMA 256:881–886
    • View reference on PubMed
    • View reference on publisher's website
  16. Antonelli M, Bonten M, Cecconi M, Chastre J, Citerio G, Conti G, Curtis JR, Hedenstierna G, Joannidis M, Macrae D, Maggiore SM, Mancebo J, Mebazaa A, Preiser JC, Rocco P, Timsit JF, Wernerman J, Zhang H (2013) Year in review in Intensive Care Medicine 2012: III. Noninvasive ventilation, monitoring and patient-ventilator interactions, acute respiratory distress syndrome, sedation, paediatrics and miscellanea. Intensive Care Med 39:543–557
  17. Aissaoui N, Luyt CE, Leprince P, Trouillet JL, Leger P, Pavie A, Diebold B, Chastre J, Combes A (2011) Predictors of successful extracorporeal membrane oxygenation (ECMO) weaning after assistance for refractory cardiogenic shock. Intensive Care Med 37:1738–1745
  18. Roques F, Nashef SA, Michel P, Gauducheau E, de Vincentiis C, Baudet E, Cortina J, David M, Faichney A, Gabrielle F, Gams E, Harjula A, Jones MT, Pintor PP, Salamon R, Thulin L (1999) Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg 15:816–822 (discussion 822–813)
    • View reference on PubMed
    • View reference on publisher's website
  19. Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963
    • View reference on PubMed
    • View reference on publisher's website
  20. Grønnesby JK, Borgan O (1996) A method for checking regression models in survival analysis based on the risk score. Lifetime Data Anal 2:315–328
    • View reference on PubMed
    • View reference on publisher's website
  21. Nishiyama K, Morimoto T, Furukawa Y, Nakagawa Y, Ehara N, Taniguchi R, Ozasa N, Saito N, Hoshino K, Touma M, Tamura T, Haruna Y, Shizuta S, Doi T, Fukushima M, Kita T, Kimura T (2010) Chronic obstructive pulmonary disease–an independent risk factor for long-term cardiac and cardiovascular mortality in patients with ischemic heart disease. Int J Cardiol 143:178–183
    • View reference on PubMed
    • View reference on publisher's website
  22. Campo G, Guastaroba P, Marzocchi A, Santarelli A, Varani E, Vignali L, Sangiorgio P, Tondi S, Serenelli C, De Palma R, Saia F (2013) Impact of chronic obstructive pulmonary disease on long-term outcome after ST-segment elevation myocardial Infarction receiving primary percutaneous coronary intervention. Chest. doi:10.1378/chest.12-2313
  23. Engstrom G, Melander O, Hedblad B (2010) Population-based study of lung function and incidence of heart failure hospitalisations. Thorax 65:633–638
    • View reference on PubMed
    • View reference on publisher's website
  24. Sin DD, Wu L, Man SF (2005) The relationship between reduced lung function and cardiovascular mortality: a population-based study and a systematic review of the literature. Chest 127:1952–1959
    • View reference on PubMed
    • View reference on publisher's website
  25. Clarenbach CF, Senn O, Sievi NA, Camen G, van Gestel AJ, Rossi VA, Puhan MA, Thurnheer R, Russi EW, Kohler M (2013) Determinants of endothelial function in patients with COPD. Eur Respir J (in press)
  26. Farooq V, Serruys PW, Bourantas C, Vranckx P, Diletti R, Garcia Garcia HM, Holmes DR, Kappetein AP, Mack M, Feldman T, Morice MC, Colombo A, Morel MA, de Vries T, van Es GA, Steyerberg EW, Dawkins KD, Mohr FW, James S, Stahle E (2012) Incidence and multivariable correlates of long-term mortality in patients treated with surgical or percutaneous revascularization in the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) trial. Eur Heart J 33:3105–3113
    • View reference on PubMed
    • View reference on publisher's website
  27. Wu C, Camacho FT, Wechsler AS, Lahey S, Culliford AT, Jordan D, Gold JP, Higgins RS, Smith CR, Hannan EL (2012) Risk score for predicting long-term mortality after coronary artery bypass graft surgery. Circulation 125:2423–2430
    • View reference on PubMed
    • View reference on publisher's website
  28. Gupta H, Ramanan B, Gupta PK, Fang X, Polich A, Modrykamien A, Schuller D, Morrow LE (2013) Impact of chronic obstructive pulmonary disease on postoperative outcomes: results from a national database. Chest. doi:10.1378/chest.12-1499
  29. Bailey ML, Richter SM, Mullany DV, Tesar PJ, Fraser JF (2011) Risk factors and survival in patients with respiratory failure after cardiac operations. Ann Thorac Surg 92:1573–1579
    • View reference on PubMed
    • View reference on publisher's website
  30. Filsoufi F, Rahmanian PB, Castillo JG, Chikwe J, Adams DH (2008) Predictors and early and late outcomes of respiratory failure in contemporary cardiac surgery. Chest 133:713–721
    • View reference on PubMed
    • View reference on publisher's website
  31. Hein OV, Birnbaum J, Wernecke KD, Konertz W, Jain U, Spies C (2006) Three-year survival after four major post-cardiac operative complications. Crit Care Med 34:2729–2737
    • View reference on PubMed
    • View reference on publisher's website
  32. Peek GJ, Killer HM, Reeves R, Sosnowski AW, Firmin RK (2002) Early experience with a polymethyl pentene oxygenator for adult extracorporeal life support. ASAIO J 48:480–482
    • View reference on PubMed
    • View reference on publisher's website
  33. Khoshbin E, Dux AE, Killer H, Sosnowski AW, Firmin RK, Peek GJ (2007) A comparison of radiographic signs of pulmonary inflammation during ECMO between silicon and poly-methyl pentene oxygenators. Perfusion 22:15–21
    • View reference on PubMed
    • View reference on publisher's website
  34. Khoshbin E, Roberts N, Harvey C, Machin D, Killer H, Peek GJ, Sosnowski AW, Firmin RK (2005) Poly-methyl pentene oxygenators have improved gas exchange capability and reduced transfusion requirements in adult extracorporeal membrane oxygenation. ASAIO J 51:281–287
    • View reference on PubMed
    • View reference on publisher's website
  35. Chen YS, Lin JW, Yu HY, Ko WJ, Jerng JS, Chang WT, Chen WJ, Huang SC, Chi NH, Wang CH, Chen LC, Tsai PR, Wang SS, Hwang JJ, Lin FY (2008) Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. Lancet 372:554–561
    • View reference on PubMed
    • View reference on publisher's website
  36. Morris MC, Ittenbach RF, Godinez RI, Portnoy JD, Tabbutt S, Hanna BD, Hoffman TM, Gaynor JW, Connelly JT, Helfaer MA, Spray TL, Wernovsky G (2004) Risk factors for mortality in 137 pediatric cardiac intensive care unit patients managed with extracorporeal membrane oxygenation. Crit Care Med 32:1061–1069
    • View reference on PubMed
    • View reference on publisher's website
  37. Jan SL, Lin SJ, Fu YC, Chi CS, Wang CC, Wei HJ, Chang Y, Hwang B, Chen PY, Huang FL, Lin MC (2010) Extracorporeal life support for treatment of children with enterovirus 71 infection-related cardiopulmonary failure. Intensive Care Med 36:520–527
  38. Schmidt M, Tachon G, Devilliers C, Muller G, Hekimian G, Brechot N, Merceron S, Luyt CE, Trouillet JL, Chastre J, Leprince P, Combes A (2013) Blood oxygenation and decarboxylation determinants during venovenous ECMO for respiratory failure in adults. Intensive Care Med 39:838–846

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