Follow-up on ECMO after Cardiac Surgery: How Can We Evaluate Therapy?

et al. 2021

Preprint

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.

Section: Discussionmentioning

confidence: 99%

“…Patients are typically separated from cardiopulmonary bypass with inotropes/vasopressors or intra-aortic balloon counterpulsation (3)(4)(5). In the event of refractory cardiac and/or pulmonary dysfunction additional mechanical circulatory support may be required.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

Preprint

“…Our patients required similar rates of red blood cell transfusions compared to prior studies [ 15 – 17 ]. Directed resuscitation with appropriate blood product use improves survival, but to our knowledge there have been no other studies measuring volume status and blood product usage [ 3 , 10 , 18 ]. Our study unmasks this potential link, therefore we suggest, appropriate diuresis and directed resuscitation suggest an important therapy to bridge a distressed myocardium and may aid the efforts of ECMO support.…”

Section: Discussionmentioning

confidence: 99%

“…Myocardial dysfunction after cardiac surgical intervention occurs in about 3–8% of patients [ 1 , 2 ]. Patients are typically separated from cardiopulmonary bypass with inotropes/vasopressors or intra-aortic balloon counterpulsation [ 3 – 5 ]. In the event of refractory cardiac and/or pulmonary dysfunction additional mechanical circulatory support may be required.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

J Cardiothorac Surg

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.

“…18 Acute Adult Respiratory Distress Syndrome as a sequela of trauma develops in approximately 4.6% of adult patients, with a mortality of up to 40% when managed with conventional ventilatory support. 14,17,[19][20][21] Adult Respiratory Distress Syndrome can also complicate the course of many acute care surgery pathologies, the most studied among them being acute pancreatitis, where it affects up to 30% of patients. 13 In patients with severe ARDS, there is a high mortality risk with conventional treatment.…”

Section: Discussionmentioning

confidence: 99%

Application and outcomes of extracorporeal life support in emergency general surgery and trauma

et al. 2021

Perfusion

Background: We analyzed the use of Extracorporeal Membranous Oxygenation (ECMO) in acute care surgery patients at our Level-1 trauma center. We hypothesized that this patient population has improved ECMO outcomes. Methods: This was a retrospective analysis of emergency general surgery and trauma patients placed on ECMO between the periods of October 2013 and February 2020. There were 10 surgical and 12 trauma patients studied, who eventually required ECMO support. ECMO support and ECMO type/modality were analyzed with injury and survival prognostic scores examined. Main results: Overall, 16 of the 22 patients survived to hospital discharge, for a survival rate of 73%. Mean age was 34.18 years. Mean hospital length of stay was 23.4 days with mean days on ECMO equal to 7.5. The net negative fluid balance was 5.36 L. Conclusions: The survival of our ECMO cohort is notably higher than previously cited studies. Our group demonstrated decreased length of time on ECMO, decreased length of stay in the hospital, and similar rates of complications compared to prior reports. ECMO is a useful modality in acute care surgical patients and should be considered in these patient populations. Our focus on net negative fluid balance for ECMO patients demonstrates improved survival. ECMO should be considered early in surgical patients and early in advanced trauma life support.