Cannulation Strategies for Postcardiotomy Extracorporeal Life Support (PC-ECLS) and Their Impact on Postoperative Survival: A Single-Center's Experience

Background: The use of postcardiotomy extracorporeal life support (PC-ECLS) has become increasingly common in recent years. Yet intra-hospital mortality remains high. In addition to the indication, a key surgical decision is the choice of the cannulation strategy to be used. Accordingly, the question arises as to which cannulation strategies are currently used and whether there is an advantage of one procedure.

Method: In this retrospective analysis, we included 56 patients from the Department of Cardiothoracic Surgery at Augsburg University Hospital who required extracorporeal life support after cardiotomy (PC-ECLS) between 01/2020 and 07/2021. The indication was set due to intra- or postoperative cardiogenic shock or cardiac arrest. We evaluated clinical, operative and ECLS management data, as well as clinical outcome.

Results: Within our patient collective, there was a significant difference in gender distribution (men: n = 43 [76.8%]; women: n = 13 [23.2%], p ≤ 0.001). The mean age was 64.9 years (± 10.1 years). Procedures performed before ECLS were isolated coronary artery bypass grafting (CABG) (n = 16 [28.6%]), isolated valve surgery (n = 10 [17.9%]), combined CABG and valve surgery (n = 8 [14.3%]), isolated surgery for acute type A aortic dissection (ATAAD) (n = 7 [12.5%]), or other surgery (n = 15 [26.8%]). ECLS was established either via central cannulation using vascular prosthesis at the ascending aorta (n = 27 [48.2%]) or peripheral cannulation mostly via the common femoral artery and vein (n = 29 [51.8%]). The mean duration of ECLS was 6.1 days (± 4.4 days), with no significant difference between central and peripheral cannulation. Intra-hospital mortality after postcardiotomy ECLS was 60.7%, again with no significant difference between cannulation strategies.

Conclusion: Postcardiotomy extracorporeal life support remains an ultima ratio for the treatment of intra- or postoperative cardiogenic shock or cardiac arrest with continued high intra-hospital mortality. The cannulation strategy used depends largely on the clinical situation, surgical procedure, and comorbidities of the patient. Intraoperative central cannulation with antegrade perfusion of the entire circuit showed no significant advantage over peripheral cannulation in our patient population. Further in-depth studies of PC-ECLS, including postoperative complications, comorbidities, and long-term follow-up, are needed to clarify which cannulation strategy should be used in which patient.

Publikationsverlauf

Artikel online veröffentlicht:
03. Februar 2022