Bleeding and thrombotic events in post-cardiotomy extracorporeal life support

Abstract

OBJECTIVES Hemorrhagic and thrombotic complications are known obstacles in extracorporeal life support (ECLS), and patients requiring postcardiotomy ECLS are particularly prone. The objective of the study was to characterize incidence, type and clinical relevance of bleeding and thrombotic events on PC-ECLS. METHODS 504 patients receiving PC-ECLS between 2000–2021 at a single center were included in a retrospective analysis. Incidence and type of hemorrhagic and thrombotic complications on PC-ECLS were assessed. Overall survival was compared and perioperative risk factors for bleeding and thrombotic events assessed by binary logistic regression. RESULTS Of 504 patients requiring PC-ECLS, 196 patients(38.9%) had 235 bleeding events (surgical site: n = 135(26.8%); cannulation site: n = 68(13.4%); requiring surgical revision, n = 39(7.7%) cannulation site change: n = 17(3.4%), fatal cannulation site bleeding: n = 4(0.8%); intracranial haemorrhage: n = 11(2.1%); gastrointestinal: n = 8(1.6%); pulmonary: n = 8(1.6%), and intra-abdominal/retroperitoneal: n = 5 (1%)). Overall mortality was higher in patients with major bleeding complications than in patients without bleeding complications (p < 0.0001). 74 patients (14.7%) had 84 thrombotic events (ischaemic stroke n = 39 (7.7%); cannula/circuit thrombosis n = 26 (5.2%); peripheral embolism n = 11 (2.2%), device exchange for hemolysis n = 8 (1.6%)). 246 patients (48.8%) had at least one hemocompatibility-related adverse event. Preoperative dual antiplatelet therapy (adjusted OR: 1.83, 95% CI: 1.063–3.137) and ECLS duration (adjusted OR: 1.14, 95% CI: 1.086–1.197) were identified as independent risk factors for haemorrhage, and prior stroke/transient ischaemic attack (adjusted OR: 1.91, 95% CI: 1.08–3.83) and ECLS duration (adjusted OR: 1.09, 95% CI: 1.04–1.15) were identified as risk factors for thrombotic events. CONCLUSIONS Bleeding complications on ECLS are common and significantly impair survival. Nearly half of patients were affected by any hemocompatibility-related event.