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.
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。