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Observational Study
. 2024 Nov;48(11):1355-1365.
doi: 10.1111/aor.14818. Epub 2024 Jul 15.

Post-cardiotomy extracorporeal life support: A cohort of cannulation in the general ward

Gabor Bari  1   2 , Silvia Mariani  2   3 , Bas C T van Bussel  2 , Justine Ravaux  2 , Michele Di Mauro  2 , Anne Schaefer  4 , Jawad Khalil  5 , Matteo Pozzi  6 , Luca Botta  7 , Davide Pacini  7 , Udo Boeken  8 , Robertas Samalavicius  9 , Karl Bounader  10 , Xiaotong Hou  11 , Jeroen J H Bunge  12 , Hergen Buscher  13 , Leonardo Salazar  14 , Bart Meyns  15 , Michael Mazeffi  16 , Sacha Matteucci  17 , Sandro Sponga  18 , Graeme MacLaren  19 , Claudio Russo  20 , Francesco Formica  3   21 , Pranya Sakiyalak  22 , Antonio Fiore  23 , Daniele Camboni  24 , Giuseppe Maria Raffa  25 , Rodrigo Diaz  26 , I-Wen Wang  27 , Jae-Seung Jung  28 , Jan Belohlavek  29 , Vin Pellegrino  30 , Giacomo Bianchi  31 , Matteo Pettinari  32 , Alessandro Barbone  33 , José P Garcia  34 , Kiran Shekar  35 , Glenn Whitman  36 , Roberto Lorusso  2 ; PELS Investigators
Affiliations
Observational Study

Post-cardiotomy extracorporeal life support: A cohort of cannulation in the general ward

Gabor Bari et al. Artif Organs. 2024 Nov.

Abstract

Objectives: Post-cardiotomy extracorporeal life support (ECLS) cannulation might occur in a general post-operative ward due to emergent conditions. Its characteristics have been poorly reported and investigated This study investigates the characteristics and outcomes of adult patients receiving ECLS cannulation in a general post-operative cardiac ward.

Methods: The Post-cardiotomy Extracorporeal Life Support (PELS) is a retrospective (2000-2020), multicenter (34 centers), observational study including adult patients who required ECLS for post-cardiotomy shock. This PELS sub-analysis analyzed patients´ characteristics, in-hospital outcomes, and long-term survival in patients cannulated for veno-arterial ECLS in the general ward, and further compared in-hospital survivors and non-survivors.

Results: The PELS study included 2058 patients of whom 39 (1.9%) were cannulated in the general ward. Most patients underwent isolated coronary bypass grafting (CABG, n = 15, 38.5%) or isolated non-CABG operations (n = 20, 51.3%). The main indications to initiate ECLS included cardiac arrest (n = 17, 44.7%) and cardiogenic shock (n = 14, 35.9%). ECLS cannulation occurred after a median time of 4 (2-7) days post-operatively. Most patients' courses were complicated by acute kidney injury (n = 23, 59%), arrhythmias (n = 19, 48.7%), and postoperative bleeding (n = 20, 51.3%). In-hospital mortality was 84.6% (n = 33) with persistent heart failure (n = 11, 28.2%) as the most common cause of death. No peculiar differences were observed between in-hospital survivors and nonsurvivors.

Conclusions: This study demonstrates that ECLS cannulation due to post-cardiotomy emergent adverse events in the general ward is rare, mainly occurring in preoperative low-risk patients and after a postoperative cardiac arrest. High complication rates and low in-hospital survival require further investigations to identify patients at risk for such a complication, optimize resources, enhance intervention, and improve outcomes.

Keywords: cardiac arrest; cardiac surgery; complications; extracorporeal life support; shock; ward.

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References

REFERENCES

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