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Delnoij TSR, Suverein MM, Essers BAB, Hermanides RC, Otterspoor L, Elzo Kraemer CV, Vlaar APJ, van der Heijden JJ, Scholten E, den Uil C, Akin S, de Metz J, van der Horst ICC, Maessen JG, Lorusso R, van de Poll MCG. Cost-effectiveness of extracorporeal cardiopulmonary resuscitation vs. conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a pre-planned, trial-based economic evaluation. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:484-492. [PMID: 38652269 DOI: 10.1093/ehjacc/zuae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 04/25/2024]
Abstract
AIMS When out-of-hospital cardiac arrest (OHCA) becomes refractory, extracorporeal cardiopulmonary resuscitation (ECPR) is a potential option to restore circulation and improve the patient's outcome. However, ECPR requires specific materials and highly skilled personnel, and it is unclear whether increased survival and health-related quality of life (HRQOL) justify these costs. METHODS AND RESULTS This cost-effectiveness study was part of the INCEPTION study, a multi-centre, pragmatic randomized trial comparing hospital-based ECPR to conventional CPR (CCPR) in patients with refractory OHCA in 10 cardiosurgical centres in the Netherlands. We analysed healthcare costs in the first year and measured HRQOL using the EQ-5D-5L at 1, 3, 6, and 12 months. Incremental cost-effectiveness ratios (ICERs), cost-effectiveness planes, and acceptability curves were calculated. Sensitivity analyses were performed for per-protocol and as-treated subgroups as well as imputed productivity loss in deceased patients. In total, 132 patients were enrolled: 62 in the CCPR and 70 in the ECPR group. The difference in mean costs after 1 year was €5109 (95% confidence interval -7264 to 15 764). Mean quality-adjusted life year (QALY) after 1 year was 0.15 in the ECPR group and 0.11 in the CCPR group, resulting in an ICER of €121 643 per additional QALY gained. The acceptability curve shows that at a willingness-to-pay threshold of €80.000, the probability of ECPR being cost-effective compared with CCPR is 36%. Sensitivity analysis showed increasing ICER in the per-protocol and as-treated groups and lower probabilities of acceptance. CONCLUSION Hospital-based ECPR in refractory OHCA has a low probability of being cost-effective in a trial-based economic evaluation.
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Affiliation(s)
- Thijs S R Delnoij
- Department of Intensive Care Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Martje M Suverein
- Department of Intensive Care Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Brigitte A B Essers
- Department of Clinical Epidemiology and Medical Technical Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Luuk Otterspoor
- Department of Intensive Care Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Carlos V Elzo Kraemer
- Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Care Medicine, Amsterdam University Medical Center location AMC, Amsterdam, The Netherlands
- Department of Intensive Care Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Joris J van der Heijden
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Erik Scholten
- Department of Intensive Care Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Corstiaan den Uil
- Department of Intensive Care Medicine and Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sakir Akin
- Department of Intensive Care Medicine, HagaZiekenhuis, The Hague, The Netherlands
| | - Jesse de Metz
- Department of Intensive Care Medicine, OLVG, Amsterdam, The Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jos G Maessen
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Roberto Lorusso
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marcel C G van de Poll
- Department of Intensive Care Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
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de Vlugt R, Spek B, van de Pol I, Rigter S. Quality of life after extra corporeal life support therapy. Perfusion 2023; 38:1189-1195. [PMID: 35656759 DOI: 10.1177/02676591221106148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Extra Corporeal Life Support (ECLS) may be a life-saving treatment for patients with reversible cardiac and/or respiratory failure. ECLS is associated with a high risk of complications and mortality. Because only a small number of studies have been conducted into the long-term effects of ECLS, we investigated the difference in quality of life, anxiety and depressive complaints and PTSD 3 months after ICU discharge. METHOD It is a retrospective case-control study covering the period January 2012 to December 2017. The ECLS patient group was compared to a matched similar patient group in the Intensive Care (IC) that did not have ECLS therapy. Quality of life was measured with the Short-Form-36 (SF-36) questionnaire, anxiety and depression was measured with the Hospital Anxiety and Depression Scale (HADS) questionnaire and for PTSD the Impact of Events Scale (IES) questionnaire was used, comparing sum scores and cut-off points of scores from both groups. RESULTS Included were 19 patients in the ECLS group and 38 in the control group. The mean sum scores on the sub scales of the SF36 questionnaire were the same for both groups. Only the mean score of 66.2 (scale 0-100) on the domain 'general health experience' was statistically significantly different in the ECLS group than in the control group (56.8, p = .02). There was no significant difference between the sum scores of both groups on anxiety and depressive complaints. In the ECLS group 32% of the patients may have a depressive disorder versus 18% from the control group (p = .32). And 26% of the patients from the ECLS group may have an anxiety disorder versus 7% from the control group (p = .51). The incidence of PTSD was 42% in the ECLS group and 24% in the control group (p = .22). CONCLUSION We found no statistically significant difference in quality of life, anxiety and depressive symptoms and PTSD symptoms between ECLS patients and the matched control group - 3 months after the ICU discharge. The incidence of anxiety and depressive symptoms and PTSD in the ECLS group is higher than in the control group, however, this difference is not significant.
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Affiliation(s)
- Roos de Vlugt
- Intensive Care, St. Antonius hospital, Nieuwegein, Netherlands
| | - Bea Spek
- Department Epidemiology and Data Science, Amsterdam UMC, Amsterdam, Netherlands
| | | | - Sander Rigter
- Department of anesthesiology and ICU, St Antonius Ziekenhuis, Nieuwegein, Netherlands
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3
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Oude Lansink-Hartgring A, Miranda DDR, Mandigers L, Delnoij T, Lorusso R, Maas JJ, Elzo Kraemer CV, Vlaar APJ, Raasveld SJ, Donker DW, Scholten E, Balzereit A, van den Brule J, Kuijpers M, Vermeulen KM, van den Bergh WM. Health-related quality of life, one-year costs and economic evaluation in extracorporeal membrane oxygenation in critically ill adults. J Crit Care 2023; 73:154215. [PMID: 36402123 DOI: 10.1016/j.jcrc.2022.154215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 09/23/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE This study reports on survival and health related quality of life (HRQOL) after extracorporeal membrane oxygenation (ECMO) treatment and the associated costs in the first year. MATERIALS AND METHODS Prospective observational cohort study patients receiving ECMO in the intensive care unit during August 2017 and July 2019. We analyzed all healthcare costs in the first year after index admission. Follow-up included a HRQOL analysis using the EQ-5D-5L at 6 and 12 months. RESULTS The study enrolled 428 patients with an ECMO run during their critical care admission. The one-year mortality was 50%. Follow up was available for 124 patients at 12 months. Survivors reported a favorable mean HRQOL (utility) of 0.71 (scale 0-1) at 12 months of 0.77. The overall health status (VAS, scale 0-100) was reported as 73.6 at 12 months. Mean total costs during the first year were $204,513 ± 211,590 with hospital costs as the major factor contributing to the total costs. Follow up costs were $53,752 ± 65,051 and costs of absenteeism were $7317 ± 17,036. CONCLUSIONS At one year after hospital admission requiring ECMO the health-related quality of life is favorable with substantial costs but considering the survival might be acceptable. However, our results are limited by loss of follow up. So it may be possible that only the best-recovered patients returned their questionnaires. This potential bias might lead to higher costs and worse HRQOL in a real-life scenario.
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Affiliation(s)
| | | | - Loes Mandigers
- Adult Intensive Care Unit, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Thijs Delnoij
- Department of Intensive Care, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jacinta J Maas
- Adult Intensive Care Unit, Leiden University Medical Center, Leiden, the Netherlands
| | - Carlos V Elzo Kraemer
- Adult Intensive Care Unit, Leiden University Medical Center, Leiden, the Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Unit, Amsterdam University Medical Centers, Academic Medical Centers, Amsterdam, the Netherlands
| | - S Jorinde Raasveld
- Department of Intensive Unit, Amsterdam University Medical Centers, Academic Medical Centers, Amsterdam, the Netherlands
| | - Dirk W Donker
- Department of Critical Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Cardiovascular and Respiratory Physiology Group, TechMed Centre, University of Twente, Enschede, the Netherlands
| | - Erik Scholten
- Department of Intensive Care, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Anja Balzereit
- Department of Critical Care, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Judith van den Brule
- Department of Intensive Care, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Marijn Kuijpers
- Department of Intensive Care, Isala Klinieken, Zwolle, the Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Walter M van den Bergh
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Maine RG, Strassle P, Orleans B, Bryant MK, Raff L, Reid T, Charles A. Inpatient Mortality Among Patients With Acute Respiratory Distress Syndrome at ECMO and Non-ECMO Centers in the United States. Am Surg 2021:31348211063530. [PMID: 34957856 DOI: 10.1177/00031348211063530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A 2009 randomized control trial found patients with severe acute respiratory distress syndrome (ARDS) who transferred to an extra-corporeal membrane oxygenation therapy (ECMO) center had better survival, even if they did not receive ECMO. This study aimed to use a national US database to determine if care at ECMO centers offer a survival advantage in patients with ARDS with mechanical ventilation only. METHODS Hospitalizations of patients 18-64 years old who had ARDS and mechanical ventilation in the 2010-2016 Health care Cost and Utilization Project National Readmission Database were included. ECMO centers performed at least 1 veno-venous ECMO hospitalization annually; or >5, >20, and >50 on sensitivity analysis. Multivariable logistic regression compared inpatient mortality, after adjusting for timing of hospitalization, patient demographics, comorbidities, and hospital characteristics. RESULTS Of the 1 224 447 ARDS hospitalizations and mechanical ventilation, 41% were at ECMO centers. ECMO centers were more likely to be larger, private, non-profit, teaching hospitals. ARDS at admission was more common at non-ECMO centers (31% vs 23%, P < .0001); however, other patient demographics and comorbidities did not differ. After adjustment, no difference in inpatient mortality was seen between ECMO and non-ECMO centers (OR 0.99, 95% CI: 0.97, 1.02). This relationship did not change in sensitivity analyses. DISCUSSION Adult patients with ARDS requiring mechanical ventilation may not have improved outcomes if treated at an ECMO center and suggest that early transfer of all ARDS patients to ECMO centers may not be warranted. Further evaluation of ECMO center volume and illness severity is needed.
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Affiliation(s)
- Rebecca G Maine
- Department of Surgery, 2332University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paula Strassle
- Department of Surgery, 2332University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brian Orleans
- Department of Surgery, 2332University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Biostatistics, 2332University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mary K Bryant
- Department of Surgery, 2332University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lauren Raff
- Department of Surgery, 2332University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Trista Reid
- Department of Surgery, 2332University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anthony Charles
- Department of Surgery, 2332University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Cheng W, Ma XD, Su LX, He HW, Wang L, Tang B, Du W, Zhou YK, Wang H, Cui N, Long Y, Liu DW, Guo YH, Wang Y, Shan GL, Zhou X, Zhang SY, Zhao YP. Cross-sectional study for the clinical application of extracorporeal membrane oxygenation in Mainland China, 2018. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:554. [PMID: 32917257 PMCID: PMC7484920 DOI: 10.1186/s13054-020-03270-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 09/02/2020] [Indexed: 01/19/2023]
Abstract
Background To investigate the epidemiology and in-hospital mortality of veno-venous (VV) and veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) in Mainland China throughout 2018. Methods Patients supported by ECMO from 1700 tertiary hospitals in 31 provinces from January 1 to December 31, 2018, were selected from the National Clinical Improvement System database. Results The 1700 included hospitals had 2073 cases of ECMO in 2018, including 714 VV and 1359 VA ECMOs. The average patient age was 50 years (IQR 31–63), and 1346 were male. The average hospital stay was 17 days (IQR 7–30), and the average costs per case was $36,334 (IQR 22,547–56,714). The three provinces with the highest number of ECMO cases were Guangdong, Beijing, and Zhejiang; the southeast coastal areas and regions with higher GDP levels had more cases. Overall in-hospital mortality was 29.6%. Mortality was higher among patients who were male, over 70 years old, living in underdeveloped areas, and who were treated during the summer. Mortality in provinces with more ECMO cases was relatively low. The co-existence of congenital malformations, blood system abnormalities, or nervous system abnormalities increased in-hospital mortality. Conclusions Mortality and medical expenses of ECMO among patients in China were relatively low, but large regional and seasonal differences were present. Risk factors for higher in-hospital mortality were older age, male sex, in underdeveloped areas, and treatment during the summer. Additionally, congenital malformations and blood system and nervous system abnormalities were associated with in-hospital mortality.
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Affiliation(s)
- Wei Cheng
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Xu-Dong Ma
- Department of Medical Administration, National Health Commission of the People's Republic of China, Beijing, 100044, China
| | - Long-Xiang Su
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Huai-Wu He
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Lu Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Bo Tang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Wei Du
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Yuan-Kai Zhou
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Hao Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Na Cui
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Yun Long
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Da-Wei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Yan-Hong Guo
- Department of Medical Administration, National Health Commission of the People's Republic of China, Beijing, 100044, China
| | - Ye Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences (CAMS) & School of Basic Medicine, Peking Union Medical College, Beijing, 100730, China
| | - Guang-Liang Shan
- Department of Epidemiology and Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences (CAMS) & School of Basic Medicine, Peking Union Medical College, Beijing, 100730, China
| | - Xiang Zhou
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China.
| | - Shu-Yang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Yu-Pei Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China
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Less Data for More Outcome. Crit Care Med 2020; 47:1662-1664. [PMID: 31609264 DOI: 10.1097/ccm.0000000000003989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abrams D, Curtis JR, Prager KM, Garan AR, Hastie J, Brodie D. Ethical Considerations for Mechanical Support. Anesthesiol Clin 2019; 37:661-673. [PMID: 31677684 DOI: 10.1016/j.anclin.2019.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Extracorporeal life support can support patients with severe forms of cardiac and respiratory failure. Uncertainty remains about its optimal use owing in large part to its resource-intensive nature and the high acuity illness in supported patients. Specific issues include the identification of patients most likely to benefit, the appropriate duration of support when prognosis is uncertain, and what to do when patients become dependent on extracorporeal life support but no longer have hope for recovery or transplantation. Careful deliberation of ethical principles and potential dilemmas should be made when considering the use of extracorporeal life support in advanced cardiopulmonary failure.
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Affiliation(s)
- Darryl Abrams
- Division of Pulmonary, Allergy, and Critical Care, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH 8E, 101, New York, NY 10032, USA.
| | - J Randall Curtis
- Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359762, Seattle, WA 98104, USA
| | - Kenneth M Prager
- Division of Pulmonary, Allergy, and Critical Care, Columbia University College of Physicians and Surgeons, 161 Ft. Washington Avenue, Room 307, New York, NY 10032, USA
| | - A Reshad Garan
- Division of Cardiology, Columbia University College of Physicians and Surgeons, 177 Ft. Washington Avenue, 5th Floor, Room 5-435, New York, NY 10032, USA
| | - Jonathan Hastie
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH 5-505, New York, NY 10032, USA
| | - Daniel Brodie
- Division of Pulmonary, Allergy, and Critical Care, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH 8E, 101, New York, NY 10032, USA
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Biancari F, Saeed D, Fiore A, Dalén M, Ruggieri VG, Jónsson K, Gatti G, Zipfel S, Dell’Aquila AM, Chocron S, Bounader K, Amr G, Settembre N, Pälve K, Loforte A, Gabrielli M, Livi U, Lechiancole A, Pol M, Netuka I, Spadaccio C, Pettinari M, De Keyzer D, Reichart D, Ragnarsson S, Alkhamees K, Lichtenberg A, Fux T, El Dean Z, Fiorentino M, Mariscalco G, Jeppsson A, Welp H, Perrotti A. Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation in Patients Aged 70 Years or Older. Ann Thorac Surg 2019; 108:1257-1264. [DOI: 10.1016/j.athoracsur.2019.04.063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/01/2019] [Accepted: 04/15/2019] [Indexed: 12/13/2022]
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