Thorac Cardiovasc Surg 2021; 69(03): 271-278
DOI: 10.1055/s-0040-1714746
Original Cardiovascular

Extracorporeal Life Support in Postcardiotomy Cardiogenic Shock: A View on Scenario, Outcome, and Risk Factors in 261 Patients

Zdenek Provaznik
1  Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Alois Philipp
1  Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Florian Zeman
2  Department of Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
,
Daniele Camboni
1  Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Christof Schmid
1  Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Bernhard Floerchinger
1  Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
› Author Affiliations

Abstract

Background Weaning failure from cardiopulmonary bypass, postoperative low cardiac output (LCO), and cardiopulmonary resuscitation (CPR) are common scenarios preceding extracorporeal life support (ECLS) implantation after cardiac surgery. The impact of these scenarios on short- and long-term outcome are not well described.

Methods Between March 2006 and December 2018, 261 patients received ECLS support after cardiac surgery. Data of patients with weaning failure (NW), postoperative LCO, and CPR leading to ECLS implantation were retrospectively analyzed regarding outcome. Risk factors for outcome after postcardiotomy ECLS were assessed by uni- or multivariate regression analysis.

Results Median duration of extracorporeal support was 5.5 ± 8.5 days. Overall mortality on ECLS was 39.1%. Scenario analysis revealed weaning failure from cardiopulmonary bypass in 40.6%, postoperative LCO in 24.5%, and postoperative CPR in 34.9% leading to initiation of ECLS. Most common cause of death was refractory LCO (25.3%). Overall follow-up survival was 23.7%. Survival after weaning and during follow-up in all subgroups was 9.2% (CPR), 5.0% (LCO), and 9.6% (NW), respectively. Uni- or multivariate regression analysis revealed age, aortic surgery, and vasopressor medication level on day 1 as risk for death on support, as well as postoperative renal failure, and body mass index (BMI) as risk factors for death during follow-up.

Conclusion Mortality after postcardiotomy ECLS is high. Overall, outcome after CPR, NW, weaning failure and LCO is comparable. Postoperative resuscitation does not negatively affect outcome after postcardiotomy ECLS. Neurological status of ECLS survivors is good.

Note

This study has been presented at the annual DGTHG meeting 2019 (presentation number V144).




Publication History

Received: 19 March 2020

Accepted: 08 June 2020

Publication Date:
04 September 2020 (online)

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