Outcomes' predictors in Post-Cardiac Surgery Extracorporeal Life Support. An observational prospective cohort study. (October 2020)

• Record Type: Journal Article
• Authors: Bonacchi, Massimo; Cabrucci, Francesco; Bugetti, Marco; Dokollari, Aleksander; Parise, Orlando; Sani, Guido; Prifti, Edvin; Gelsomino, Sandro
• Is Part Of: International journal of surgery. Volume 82(2020)
• Page Start: 56
• Page End: 63
• Publication Date: 2020-10
• Subjects: Extracorporeal-life support -- ECLS -- ECMO -- Post-surgical -- Outcomes -- Predictors -- Indications; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2020.07.063
• Languages: English
• ISSNs: 1743-9191

Abstract

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. Highlights: ECLS is a valuable option when conventional therapies are insufficient. Indications and effectiveness of PC-ECLS remains a concern. Careful patient selection for PS-ECLS is critical to achieving better resource allocation and optimization of outcomes. The identified outcome predictors could be an operational support to improve the indication and management of PS-ECLS.