ECMO After Cardiac Surgery: A Single Center Study On Survival And Optimizing Outcomes

Abstract

BackgroundThe study purpose is to examine survival prognostic and extracorporeal membrane oxygenation (ECMO) application outcomes at our tertiary care center.MethodsThis is a retrospective analysis, January 2014 to September 2019. We analyzed 60 patients who underwent ECMO after cardiac surgery. 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.ResultsIn-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.ConclusionECMO 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).…”