ECMO after cardiac surgery: a single center study on survival and optimizing outcomes

Abstract

Background The study purpose is to examine survival prognostic and extracorporeal membrane oxygenation (ECMO) application outcomes at our tertiary care center. Methods This is a retrospective analysis, January 2014 to September 2019. We analyzed 60 patients who underwent cardiac surgery and required peri-operative ECMO. All inpatients with demographic and intervention data was examined. 52 patients (86.6%) had refractory cardiogenic shock, 7 patients (11.6%) had pulmonary insufficiency, and 1 patient (1.6%) had hemorrhagic shock, all patients required either venous-arterial (VA) (n = 53, 88.3%), venous-venous (VV) (n = 5, 8.3%) or venous-arterial-venous (VAV) (n = 2, 3.3%) ECMO for hemodynamic support. ECMO parameters were analyzed and common postoperative complications were examined in the setting of survival with comorbidities. Results In-hospital mortality was 60.7% (n = 37). Patients who survived were younger (52 ± 3.3 vs 66 ± 1.5, p < 0.001) with longer hospital stays (35 ± 4.0 vs 20 ± 1.5, p < 0.03). Survivors required fewer blood products (13 ± 2.3 vs 25 ± 2.3, p = 0.02) with a net negative fluid balance (− 3.5 ± 1.6 vs 3.4 ± 1.6, p = 0.01). Cardiac re-operations worsened survival. Conclusion ECMO is a viable rescue strategy for cardiac surgery patients with a 40% survival to discharge rate. Careful attention to volume management and blood transfusion are important markers for potential survival.

Postcardiotomy VA ECMO in adult patients: Italian single center experience in 2021

“…As stated by Brewer et al. 2 a negative net fluid balance while on ECMO was more likely to be achieved in the patients who survived (67% in survivors vs 8% in non-survivors).…”

A model for delivery of extracorporeal life support in a stand‐alone veterans affairs medical center

“…PCCS is the most likely reason a patient would require emergent postoperative ECLS 10 . Survival varies, with individual centers reporting rates between 29% and 44% for patients requiring emergent unplanned cannulation 11–13 . The rate of complications in VA ECMO for PCCS; however, can be as high as 89% 11 .…”

“…10 Survival varies, with individual centers reporting rates between 29% and 44% for patients requiring emergent unplanned cannulation. [11][12][13] The rate of complications in VA ECMO for PCCS; however, can be as high as 89%. 11 A comparison of outcomes between patients with PCCS after emergent versus elective cardiac surgery revealed no significant difference in length of stay or 1-year survival.…”

The efficiency of the preoperative extracorporeal membrane oxygenation in the setting of postinfarction ventricular septal defect and how to optimize outcomes: A single center case series

“…After the catheter insertion, the left‐to right shunt significantly decreased, as also the LV and RV wall stress. It is unclear if this off‐loading should be done for all patients preemptively when placed on ECMO support or if only cardiac ECHO suggests that the LV is distended 29 . We generally employ off‐loading when it is indicated by ECHO, but at this point we do not have any standard policy.…”

“…24 Recently, a small meta-analysis by Kotronias et al 26 LV is distended. 29 We generally employ off-loading when it is indicated by ECHO, but at this point we do not have any standard policy. Going forward, this would be an interesting topic of research and standardization.…”