Strategies for Weaning of Circulatory Support in Patients with Postcardiotomy Syndrome

Objectives: The use of venoarterial extracorporeal membrane oxygenation (va-ECMO) is therapy of choice in patients with postcardiotomy syndrome after cardiac surgery. After recovery of left ventricular function, several strategies for va-ECMO weaning have been proposed. In this study we evaluate determinants for survival after va-ECMO weaning in patients with postcardiotomy syndrome at our medical center.

Methods: Retrospective analyses of all patients in need of postoperative va-ECMO due to postcardiotomy syndrome between 2011 and 2015 at our medical center were included. All patients >18 years at time of operation were included. Patients undergoing heart- and heart–lung transplantation or implantation of left ventricular assist device were excluded from this study.

Result: During the study period, 171 patients could be included. Mean age was 65 ± 11 years, and 46 (26.9%) patients were female. Mean ECMO therapy duration was 6 ± 4 days. Preoperative ECMO was done in 20 (11.7%) patients, and 82 (47.9%) patients were cannulated intraoperatively and 69 (40.4%) patients postoperatively. Peripheral cannulation was done in 142 (83.0%) patients; 18 (10.5%) patients were centrally cannulated. In the remaining 11 (6.4%) patients, a combination was used. Distal leg perfusion was done in 132 (88.6%) patients. When compared survivor versus nonsurvivor population, significantly lower dosage of vasoactive substances was seen in the survival population at the start of va-ECMO weaning. Second, the survival population was significantly less sedated; 21.5% of patients had no sedation in the survival group compared with 4.7% of the nonsurvival population.

Conclusion: Our study shows significant reduction in mortality due to reduction of vasoactive substances prior to ECMO weaning in postcardiotomy patients. Furthermore, prolonged postoperative sedation contributes to poor outcome in patients on va-ECMO due to postcardiotomy syndrome.

Publication History

Article published online:
19 February 2021