In-hospital outcome of post-cardiotomy extracorporeal life support in adult patients: the 2007-2017 Maastricht experience

Abstract

Objectives: The use of post-cardiotomy extracorporeal life support (PC-ECLS) has increased worldwide over the past years but a concurrent decrease in survival to hospital discharge has also been observed. We analysed use and outcome of PC-ECLS at the Maastricht University Medical Center.

Design: A retrospective study of a single-centre PC-ECLS cohort. Patient characteristics and in-hospital outcomes were evaluated.

Setting: Patients who underwent PC-ECLS due to intra- or peri-operative cardiogenic shock or cardiac arrest were included. Descriptive statistics were analysed and frequency analysis and testing of group differences were performed.

Participants: Eighty-six patients who received PC-ECLS between October 2007 and June 2017 were included. The mean age of the population was 65 years (range, 31-86 years), and 65% were men.

Main outcome measures: Survival rates were calculated and PC-ECLS management data and complications were assessed.

Results: Pre-ECLS procedures were isolated coronary artery bypass grafting (CABG) (22%), isolated valve surgery (16%), thoracic aorta surgery (4%), a combination of CABG and valve surgery (21%) or other surgery (24%). PC-ECLS was achieved via central cannulation in 17%, peripheral cannulation in 65%, or by a combination in 17%. The median duration of PC-ECLS was 5.0 days (IQR, 6.0 days). Weaning was achieved in 49% of patients, and 37% survived to discharge. Post-operative bleeding (overall rate, 42%) showed a trend towards a reduced rate over more recent years.

Conclusions: Our experience confirms an increased use of PC-ECLS during the last 10 years and shows that, by carefully addressing patient management and complications, survival rat e may be satisfactory, and improved outcome may be achieved in such a challenging ECLS setting.