Outcomes of noncardiotomy patients requiring postoperative extracorporeal membrane oxygenation

Abstract

Background The use of extracorporeal membrane oxygenation (ECMO) in the postoperative period has expanded to include a variety of noncardiotomy procedures. It is important to investigate outcomes for this uniquely ill subset of patients as currently published data on this subject is limited. Methods All ECMO events at our institution from 2006 to 2017 were retrospectively considered. Patients were grouped into a postoperative noncardiotomy (PNC) cohort (n = 20) and a larger control cohort (n = 220). For additional analysis, the PNC cohort was further split into a liver transplant group (n = 4) and thoracic surgery group (n = 10). Basic demographics, medical history, type of operation performed, indication for support, and survival data were collected on all patients. Appropriate statistical analyses were performed and a P < .05 was considered statistically significant. Results Twenty PNC‐ECMO patients were identified. The indications for support were respiratory failure, cardiac arrest, and cardiogenic shock. PNC patient survival was similar to our control cohort, as well as extracorporeal life support organization (ELSO) published data with 55% weaning off ECMO and 50% surviving to discharge. Twelve‐month predicted survival was 40%. Post thoracic surgical patients were reviewed, and their survival rates were similar to the larger control cohort as well. There were no survivors in the liver transplant group. Conclusions Despite recent noncardiotomy surgery, patients who required ECMO for salvage in the postoperative period showed similar outcomes compared to our larger cohort and to published ELSO data, and reasonable long‐term survival outcomes. This suggests that ECMO may be applied to a variety of postoperative settings with outcomes on par with nationally published results.

Extracorporeal membrane oxygenation for postoperative complications in general thoracic surgery: a ten years experience of a university referral centre

“…Finally, a study on 20 postoperative ECMO applied in non-cardiotomy patients counted 10 cases who underwent general thoracic surgery over an eleven years period. The indications for extracorporeal support were respiratory failure (80%) and cardiogenic shock (20%) with a length of time between surgery to ECMO of 4 days and ECMO length of time of 8 days (13). The survival to hospital discharge was 60%.…”