Outcomes' predictors in Post-Cardiac Surgery Extracorporeal Life Support. An observational prospective cohort study

Massimo Bonacchi*, Francesco Cabrucci, Marco Bugetti, Aleksander Dokollari, Orlando Parise, Guido Sani, Edvin Prifti, Sandro Gelsomino

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

9 Citations (Web of Science)

Abstract

Objectives: Extracorporeal Life Support (ECLS) may provide pulmonary and circulatory support for patients with acute heart failure refractory to conventional medical therapy. However, indications and effectiveness of ECLS engagement post-cardiac surgery remains a concern. We sought to analyze indications, modality and outcomes of Post-Cardiac Surgery Extracorporeal Life Support (PS-ECLS), to identify predictors of early and midterm survival after PS-ECLS.

Methods: Prospective, multicenter analysis of 209 consecutive PS-ECLS patients between January 2004 and December 2018. Demographic and clinical data before, during and after PS-ECLS were collected and their influence on hospital mortality and outcomes (early and midterm) were analyzed.

Results: Mean PS-ECLS duration was 5.3 +/- 9.6 days. Multivariate analysis of pre PS-ECLS implantation factors revealed age >70years, female, insulin-dependent diabetes, severe pulmonary hypertension, STS score >35, type/A aortic dissection, aortic cross-clamp time >150 min and pre-ECLS blood lactate >15 mmol/L as risk factors of in-hospital mortality. Instead coronary artery disease (CAD), intra-aortic balloon pump (IABP) implantation, ECLS start in the operating room, and transapical left ventricular venting, were associated with a better outcome. Weaning from ECLS was possible in 56.8% of cases and survival at discharge was 42.6%. Overall, survival was 37.3%, 32.1% and 25.2%, at 6-months, 1-year and 5-years, respectively. Midterm outcome was influenced positively by younger age and CAD, negatively by diabetes, left ventricular ejection fraction (LVEF) <35% and neurological dysfunction.

Conclusions: PS-ECLS is a valuable option when conventional medical therapies are insufficient. The outcome predictors identified in the study could be an operative support for PS-ECLS indication and management.

Original languageEnglish
Pages (from-to)56-63
Number of pages8
JournalInternational Journal of Surgery
Volume82
DOIs
Publication statusPublished - Oct 2020

Keywords

  • Extracorporeal-life support
  • ECLS
  • ECMO
  • Post-surgical
  • Outcomes
  • Predictors
  • Indications
  • MEMBRANE-OXYGENATION
  • ADULT PATIENTS
  • SURVIVAL
  • DEFINITION
  • EXPERIENCE
  • STATEMENT
  • STRATEGY
  • THERAPY
  • SCORE

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