Examining Noncardiac Surgical Procedures in Patients on Extracorporeal Membrane Oxygenation

Abstract

As extracorporeal membrane oxygenation (ECMO) is increasingly used for patients with cardiac and/or pulmonary failure, the need for noncardiac surgical procedures (NCSPs) in these patients will continue to increase. This study examined the NCSP required in patients supported with ECMO and determined which variables affect outcomes. The National Inpatient Sample Database was examined for patients supported with ECMO from 2007 to 2010. There were 563 patients requiring ECMO during the study period. Of these, 269 (47.8%) required 380 NCSPs. There were 149 (39.2%) general surgical procedures, with abdominal exploration/bowel resection (18.2%) being most common. Vascular (29.5%) and thoracic procedures (23.4%) were also common. Patients requiring NCSP had longer median length of stay (15.5 vs. 9.2 days, p = 0.001), more wound infections (7.4% vs. 3.7%, p = 0.02), and more bleeding complications (27.9% vs. 17.3%, p = 0.01). The incidences of other complications and inpatient mortality (54.3% vs. 58.2%, p = 0.54) were similar. On logistic regression, the requirement of NCSPs was not associated with mortality (odds ratio [OR]: 0.91, 95% confidence interval [CI]: 0.68-1.23, p = 0.17). However, requirement of blood transfusion was associated with mortality (OR: 1.70, 95% CI: 1.06-2.74, p = 0.03). Although NCSPs in patients supported with ECMO does not increase mortality, it results in increased morbidity and longer hospital stay.

Noncardiac Surgical Procedures After Left Ventricular Assist Device Implantation

“…This is corroborated by other studies, as the use of eCMO is a known risk factor for vascular complications. 21 However, only a small number of patients requiring vascular procedures (6.1%) were on eCMO before LVAD implantation, which suggests that vascular complications cannot be solely attributed to the use of eCMO. The most common noncardiac, thoracic procedures were exploratory thoracotomy/thoracoscopy and chest wall procedures.…”

Nicht elektive thoraxchirurgische Operationen bei Patienten mit respiratorischer Insuffizienz und Einsatz einer venovenösen extrakorporalen Membranoxygenierung

“…Eine andere Studie berichtete über einen deutlich höheren Anteil operativ versorgter ECMO-Patienten, teils bis zu 48 % [21]. Davon handelte es sich bei 23,4 % um TCH-OPs.…”

“…Davon handelte es sich bei 23,4 % um TCH-OPs. Die Patienten mit Operationen hatten ähnlich zu unserer Studie auch einen signifikant längeren Krankenhausaufenthalt, mehr Wundinfektionen sowie häufiger Blutungskomplikationen [21]. Blutungskomplikatio- ALV postoperativ (n; %) 78 (18,7)…”

Abdominal Surgery Needs Extracorporeal Life Support as a Final Back-up

“…Although ECMO may be used to rescue patients, general surgeons or critical care physicians often fear that ECMO-related complications may result in 3 even more catastrophic consequences, such as massive surgical site bleeding haemorrhage or major thromboembolic events [3]. Therefore, despite many advances in ECMO technology in the past few years [4] and its expanded use in thoracic surgery, ARDS caused by lung infection or fulminant myocarditis [5][6][7], there are very limited data published regarding the use of ECMO support in catastrophic events after abdominal surgery [8,9]. In our institute, there are more than 5000 abdominal surgeries performed by 30 general surgeons each year in our institute.…”