Structured review of post-cardiotomy extracorporeal membrane oxygenation: part 1-Adult patients

Abstract

Cardiogenic shock, cardiac arrest, acute respiratory failure, or a combination of such events, are all potential complications after cardiac surgery which lead to high mortality. Use of extracorporeal temporary cardio-circulatory and respiratory support for progressive clinical deterioration can facilitate bridging the patient to recovery or to more durable support. Over the last decade, extracorporeal membrane oxygenation (ECMO) has emerged as the preferred temporary artificial support system in such circumstances. Many factors have contributed to widespread ECMO use, including the relative ease of implantation, effectiveness, versatility, low cost relative to alternative devices, and potential for full, not just partial circulatory support. While there have been numerous publications detailing the short and midterm outcomes of ECMO support, specific reports about post-cardiotomy ECMO (PC-ECMO), are limited, single-center experiences. Etiology of cardiorespiratory failure leading to ECMO implantation, associated ECMO complications, and overall patient outcomes may be unique to the PC-ECMO population. Despite the rise in PC-ECMO use over the past decade, short-term survival has not improved. This report, therefore, aims to present a comprehensive overview of the literature with respect to the prevalence of ECMO use, patient characteristics, ECMO management, and in-hospital and early post-discharge patient outcomes for those treated for post-cardiotomy heart, lung, or heart-lung failure.

Keywords: cardiac surgery; cardiogenic shock; extracorporeal life support; extracorporeal membrane oxygenation; postoperative complications.

Figure 1.

Post-cardiotomy ECMO approaches for cannulation: peripheral cannulation with femoral artery and vein access, associated with distal limb arterial perfusion.

Figure 2.

Post-cardiotomy ECMO approaches for cannulation: cannulation of the right axillary artery for reperfusion. Femoral vein or right atrial access can be used for venous drainage.

Figure 3.

Post-cardiotomy ECMO approaches for cannulation: central cannulation (right atrium and ascending aorta cannulation) with a subxyphoid exit port for the cannulas.

Figure 4.

Post-cardiotomy ECMO approaches for cannulation: central cannulation (right atrium and ascending aorta cannulation) with jugular exit port for the cannulas.

Figure 5.

Post-cardiotomy ECMO approaches for cannulation: central cannulation with access through a left mini-thoracotomy, avoiding median sternotomy.