Outcomes' predictors in Post-Cardiac Surgery Extracorporeal Life Support. An observational prospective cohort study

Massimo Bonacchi; Francesco Cabrucci; Marco Bugetti; Aleksander Dokollari; Orlando Parise; Guido Sani; Edvin Prifti; Sandro Gelsomino

doi:10.1016/j.ijsu.2020.07.063

Outcomes' predictors in Post-Cardiac Surgery Extracorporeal Life Support. An observational prospective cohort study

Int J Surg. 2020 Oct:82:56-63. doi: 10.1016/j.ijsu.2020.07.063. Epub 2020 Aug 21.

Authors

Massimo Bonacchi¹, Francesco Cabrucci², Marco Bugetti², Aleksander Dokollari³, Orlando Parise⁴, Guido Sani⁵, Edvin Prifti⁶, Sandro Gelsomino⁴

Affiliations

¹ Cardiac Surgery Unit, Experimental and Clinical Medicine Department, University of Florence, Firenze, Italy. Electronic address: mbonacchi@unifi.it.
² Cardiac Surgery Unit, Experimental and Clinical Medicine Department, University of Florence, Firenze, Italy.
³ Cardiac Surgery, St. Michael's Hospital, University of Toronto, Canada.
⁴ Maastricht University Medical Center, Maastricht, Netherlands.
⁵ Cardiac Surgery, Siena University Hospital, Italy.
⁶ Division of Cardiac Surgery,University Hospital Center of Tirana, Tirana, Albania.

PMID: 32828981
DOI: 10.1016/j.ijsu.2020.07.063

Abstract

Objectives: Extracorporeal Life Support (ECLS) may provide pulmonary and circulatory support for patients with acute heart failure refractory to conventional medical therapy. However, indications and effectiveness of ECLS engagement post-cardiac surgery remains a concern. We sought to analyze indications, modality and outcomes of Post-Cardiac Surgery Extracorporeal Life Support (PS-ECLS), to identify predictors of early and midterm survival after PS-ECLS.

Methods: Prospective, multicenter analysis of 209 consecutive PS-ECLS patients between January 2004 and December 2018. Demographic and clinical data before, during and after PS-ECLS were collected and their influence on hospital mortality and outcomes (early and midterm) were analyzed.

Results: Mean PS-ECLS duration was 5.3 ± 9.6 days. Multivariate analysis of pre PS-ECLS implantation factors revealed age >70years, female, insulin-dependent diabetes, severe pulmonary hypertension, STS score >35, type/A aortic dissection, aortic cross-clamp time >150 min and pre-ECLS blood lactate >15 mmol/L as risk factors of in-hospital mortality. Instead coronary artery disease (CAD), intra-aortic balloon pump (IABP) implantation, ECLS start in the operating room, and transapical left ventricular venting, were associated with a better outcome. Weaning from ECLS was possible in 56.8% of cases and survival at discharge was 42.6%. Overall, survival was 37.3%, 32.1% and 25.2%, at 6-months, 1-year and 5-years, respectively. Midterm outcome was influenced positively by younger age and CAD, negatively by diabetes, left ventricular ejection fraction (LVEF) < 35% and neurological dysfunction.

Conclusions: PS-ECLS is a valuable option when conventional medical therapies are insufficient. The outcome predictors identified in the study could be an operative support for PS-ECLS indication and management.

Keywords: ECLS; ECMO; Extracorporeal-life support; Indications; Outcomes; Post-surgical; Predictors.

Publication types

Multicenter Study
Observational Study

MeSH terms

Adult
Aged
Cardiac Surgical Procedures
Extracorporeal Membrane Oxygenation / mortality*
Female
Heart Failure / mortality
Heart Failure / therapy*
Heart-Assist Devices
Hospital Mortality
Humans
Male
Middle Aged
Multivariate Analysis
Postoperative Period
Prognosis
Prospective Studies
Risk Factors
Stroke Volume
Treatment Outcome
Ventricular Function, Left