Extracorporeal Life Support in Cardiac Surgery Patients—Does Scenario of Support Affect Outcome? Experience of 235 Cases

Introduction: Extracorporeal hemodynamic support is a valuable option for patients with low cardiac output after cardiac surgery. This study analyses weaning and outcome related to scenarios of extracorporeal life support (ECLS) start after cardiac surgery.

Methods: From March 2006 to December 2017, 235 patients received venoarterial hemodynamic support postoperatively. Patients with ECLS not related to surgery were excluded. Three treatment groups were analyzed: ECLS was started due to (1) no weaning from cardiopulmonary bypass (n = 95), (2) postoperative low cardiac output (n = 55), and (3) postoperative cardiopulmonary resuscitation (n = 85).

Results: Overall, 30-day survival in the analyzed cohort was 39.6% (n = 93). Overall weaning from extracorporeal support was 57.0% (n = 134). Eight patients (3.4%) could not be weaned but survived after successful heart transplantation/ventricular assist device implantation. In group I, weaning was 59.0% (n = 56), and 30-day survival was 36.8% (n = 35). In group II, 33 patients (60%) were weaned from support, 30-day survival was 34.5% (n = 19). Patients after postoperative resuscitation (group III) could be weaned in 52.9% (n = 45). Fourteen patients (16.5%) deceased after weaning leading to a survival of 36.5% (n = 34). Most frequent cause leading to CPR were myocardial infarction and pericardial tamponade/bleeding, both 23.5% (n = 20) followed by ventricular fibrillation/tachycardia (n = 16, 18.8%) and cardiopulmonary instability requiring CPR after initial successful weaning from CPB (n = 15, 17.6%). Increased incidence of ischemic/hemorrhagic stroke could be recorded in the group III (31.8 vs. 24.2% in group I and 20.0% in group II). Ninety-two patients (60.2%) deceased on ECLS. In these patients, the most frequent causes of death were refractory low cardiac output (50.0%), multiorgan failure (21.7%), and severe cerebral hypoxia (11.9%). In the patients after weaning from ECLS, the most frequent causes of death were recurrent low cardiac output (30.0%), multiorgan failure (22.0%), severe cerebral hypoxia (20.0%), and septic shock (14.0%).

Conclusion: After cardiac surgery, need for extracorporeal hemodynamic support is associated with high mortality. Patients receiving ECLS due to failed weaning from CPB, due to postoperative LCO, and due to postoperative cardiopulmonary resuscitation have comparable 30-day mortality. The incidence of cerebral ischemia/bleeding is greater in the patients after CPR.