Outcomes after extracorporeal life support for postcardiotomy cardiogenic shock

Abstract

Background and Aim of the Study Extracorporeal life support (ECLS) may be necessary in refractory postcardiotomy cardiogenic shock (PCS) unresponsive to optimal medical treatment. We sought to analyze the results and temporal outcomes of ECLS for PCS. Methods We performed an observational analysis of our prospective database. In order to analyze the temporal trends of ECLS for PCS, patients were divided into two groups according to the period of ECLS implantation: Group I from January 2007‐June 2012, Group II from July 2012‐December 2017. The primary endpoint was survival to hospital discharge. Results During the study period, 90 patients required ECLS for PCS (Group I n = 29, 32%; Group II n = 61, 68%). Mean age was 57.5 ± 15.0 years with 62% of males. Preoperative characteristics were comparable over the two periods. A high proportion of patients were in NYHA class III/IV (61%) or cardiogenic shock (22%). Group II showed a significantly higher proportion of miscellaneous cardiac surgery operations (23 vs 3%, P = 0.031). Crossclamp and cardiopulmonary bypass times were significantly shorter in Group II (85.4 vs 114.2 min, P = 0.023 and 135.2 vs 184.2 min, P = 0.022, respectively). The complication rate during ECLS support was comparable between both groups. Successful weaning from ECLS could be accomplished in 45 (50%) patients (Group I = 52% vs Group II = 49%, P = 0.822) after a mean support of 6.4 days. Thirty‐five (39%) patients survived to hospital discharge (Group I = 41% vs Group II = 38%, P = 0.738). Conclusions Outcomes following ECLS remained stable over an 11‐year period. ECLS may be limited in patients with severe preoperative cardiac dysfunction. Our data suggest that these patients may be better served with less invasive, percutaneous procedures.

Clinical outcomes of venoarterial extracorporeal life support in 462 patients: Single‐center experience

“…The median cardiac arrest duration was 25 minutes (15‐35). Furthermore, CPR duration > 30 minutes was identified as a predictor of in‐hospital mortality, which is in accordance with other studies . The beginning of VA‐ECLS after 30 minutes of conventional CPR is associated with poor survival .…”

“…However, this registry comprises only nonPCS patients. Pozzi et al report 39% in‐hospital survival after VA‐ECLS for PCS in a relatively young cohort of 90 patients (mean age 57.5 ± 15.0 years). Successful weaning from ECLS was accomplished in 45 (50%) patients.…”

Impact of age on outcomes of patients assisted by veno-arterial or veno-venous extra-corporeal membrane oxygenation: 403 patients between 2005 and 2015

“…The viability of VA ECMO as a bridge to recovery should be considered while discussing elderly surgical candidates at increased risk of post-cardiotomy myocardial failure; the limited number of similar cases in the literature prevents dedicated analyses. 23 Based on patients' baseline profile, the hard question of whether ECMO use is appropriate has to be approached with patients and families before surgery in cases at risk of postoperative myocardial failure. The goal of predicting survival after VV ECMO/VA ECMO support is currently a subject of debate in the literature.…”

Weaning-Related Shock in Patients With ECMO: Incidence, Mortality, and Predisposing Factors

“…8 Nevertheless, the morbidity rate in patients with ECMO is significant, often associated with prolonged hospital stays and poor quality of life for the survivors after hospital discharge. [9][10][11][12][13] Moreover, in-hospital mortality is about 60% 14,15 and 1-year survival is estimated to be 30%. 15 Latest studies showed that patients who have benefited from VA-ECMO for refractory cardiogenic shock after cardiotomy can be weaned off in 48% to 60% of cases.…”