Outcomes' predictors in Post-Cardiac Surgery Extracorporeal Life Support. An observational prospective cohort study.
Int J Surg
; 82: 56-63, 2020 Oct.
Article
em En
| MEDLINE
| ID: mdl-32828981
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Temas:
Geral
/
Cirurgia_oncologica
Base de dados:
MEDLINE
Assunto principal:
Oxigenação por Membrana Extracorpórea
/
Insuficiência Cardíaca
Tipo de estudo:
Clinical_trials
/
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Int J Surg
Ano de publicação:
2020
Tipo de documento:
Article