Abstract：
OBJECTIVE: Post-cardiotomy extracorporeal life support (ECLS) cannulation might occur in a general post-operative ward due to emergent conditions. Its characteristics have been poorly reported and investigated This study investigates the characteristics and outcomes of adult patients receiving ECLS cannulation in a general post-operative cardiac ward.
METHODS: The Post-cardiotomy Extracorporeal Life Support (PELS) is a retrospective (2000-2020), multicenter (34 centers), observational study including adult patients who required ECLS for post-cardiotomy shock. This PELS sub-analysis analyzed patients´ characteristics, in-hospital outcomes, and long-term survival in patients cannulated for veno-arterial ECLS in the general ward, and further compared in-hospital survivors and non-survivors.
RESULTS: The PELS study included 2058 patients of whom 39 (1.9%) were cannulated in the general ward. Most patients underwent isolated coronary bypass grafting (CABG, n = 15, 38.5%) or isolated non-CABG operations (n = 20, 51.3%). The main indications to initiate ECLS included cardiac arrest (n = 17, 44.7%) and cardiogenic shock (n = 14, 35.9%). ECLS cannulation occurred after a median time of 4 (2-7) days post-operatively. Most patients\' courses were complicated by acute kidney injury (n = 23, 59%), arrhythmias (n = 19, 48.7%), and postoperative bleeding (n = 20, 51.3%). In-hospital mortality was 84.6% (n = 33) with persistent heart failure (n = 11, 28.2%) as the most common cause of death. No peculiar differences were observed between in-hospital survivors and nonsurvivors.
CONCLUSIONS: This study demonstrates that ECLS cannulation due to post-cardiotomy emergent adverse events in the general ward is rare, mainly occurring in preoperative low-risk patients and after a postoperative cardiac arrest. High complication rates and low in-hospital survival require further investigations to identify patients at risk for such a complication, optimize resources, enhance intervention, and improve outcomes.
METHODS: The Post-cardiotomy Extracorporeal Life Support (PELS) is a retrospective (2000-2020), multicenter (34 centers), observational study including adult patients who required ECLS for post-cardiotomy shock. This PELS sub-analysis analyzed patients´ characteristics, in-hospital outcomes, and long-term survival in patients cannulated for veno-arterial ECLS in the general ward, and further compared in-hospital survivors and non-survivors.
RESULTS: The PELS study included 2058 patients of whom 39 (1.9%) were cannulated in the general ward. Most patients underwent isolated coronary bypass grafting (CABG, n = 15, 38.5%) or isolated non-CABG operations (n = 20, 51.3%). The main indications to initiate ECLS included cardiac arrest (n = 17, 44.7%) and cardiogenic shock (n = 14, 35.9%). ECLS cannulation occurred after a median time of 4 (2-7) days post-operatively. Most patients\' courses were complicated by acute kidney injury (n = 23, 59%), arrhythmias (n = 19, 48.7%), and postoperative bleeding (n = 20, 51.3%). In-hospital mortality was 84.6% (n = 33) with persistent heart failure (n = 11, 28.2%) as the most common cause of death. No peculiar differences were observed between in-hospital survivors and nonsurvivors.
CONCLUSIONS: This study demonstrates that ECLS cannulation due to post-cardiotomy emergent adverse events in the general ward is rare, mainly occurring in preoperative low-risk patients and after a postoperative cardiac arrest. High complication rates and low in-hospital survival require further investigations to identify patients at risk for such a complication, optimize resources, enhance intervention, and improve outcomes.
摘要：
目的：心脏切开术后的体外生命支持（ECLS）插管可能发生在一般的术后病房中。其特征的报道和调查很少。这项研究调查了在普通术后心脏病房接受ECLS插管的成年患者的特征和结果。
方法：心脏手术后体外生命支持（PELS）是回顾性的（2000-2020），多中心（34个中心），观察性研究包括因心脏切开术后休克需要ECLS的成年患者。这项PELS子分析分析了患者的特征，住院结果，以及普通病房接受静脉-动脉ECLS插管的患者的长期生存率，并进一步比较住院幸存者和非幸存者。
结果：PELS研究包括2058例患者，其中39例（1.9%）在普通病房插管。大多数患者接受了孤立的冠状动脉旁路移植术（CABG，n=15，38.5%）或孤立的非CABG操作（n=20，51.3%）。开始ECLS的主要指征包括心脏骤停（n=17，44.7%）和心源性休克（n=14，35.9%）。ECLS插管在手术后4(2-7)天的中位时间后发生。大多数患者病程并发急性肾损伤（n=23，59%），心律失常（n=19，48.7%），术后出血（n=20，51.3%）。住院死亡率为84.6%（n=33），其中持续性心力衰竭（n=11，28.2%）是最常见的死亡原因。在住院幸存者和非幸存者之间没有观察到特殊的差异。
结论：本研究表明，普通病房中由于心脏切开术后紧急不良事件引起的ECLS插管很少见，主要发生在术前低风险患者和术后心脏骤停后。高并发症发生率和低住院生存率需要进一步调查，以确定有这种并发症风险的患者。优化资源,加强干预,并改善结果。
方法：心脏手术后体外生命支持（PELS）是回顾性的（2000-2020），多中心（34个中心），观察性研究包括因心脏切开术后休克需要ECLS的成年患者。这项PELS子分析分析了患者的特征，住院结果，以及普通病房接受静脉-动脉ECLS插管的患者的长期生存率，并进一步比较住院幸存者和非幸存者。
结果：PELS研究包括2058例患者，其中39例（1.9%）在普通病房插管。大多数患者接受了孤立的冠状动脉旁路移植术（CABG，n=15，38.5%）或孤立的非CABG操作（n=20，51.3%）。开始ECLS的主要指征包括心脏骤停（n=17，44.7%）和心源性休克（n=14，35.9%）。ECLS插管在手术后4(2-7)天的中位时间后发生。大多数患者病程并发急性肾损伤（n=23，59%），心律失常（n=19，48.7%），术后出血（n=20，51.3%）。住院死亡率为84.6%（n=33），其中持续性心力衰竭（n=11，28.2%）是最常见的死亡原因。在住院幸存者和非幸存者之间没有观察到特殊的差异。
结论：本研究表明，普通病房中由于心脏切开术后紧急不良事件引起的ECLS插管很少见，主要发生在术前低风险患者和术后心脏骤停后。高并发症发生率和低住院生存率需要进一步调查，以确定有这种并发症风险的患者。优化资源,加强干预,并改善结果。
