The following is a summary of “Characteristics and Outcomes of Prolonged Venoarterial Extracorporeal Membrane Oxygenation After Cardiac Surgery: The Post-Cardiotomy Extracorporeal Life Support (PELS-1) Cohort Study,” published in the June 2024 issue of Critical Care by Bunge et al.
Post-cardiotomy (PC) extracorporeal membrane oxygenation (ECMO) support typically lasts less than a week, but the effectiveness of extended use remains unclear due to conflicting study results.
Researchers conducted a retrospective study analyzing the association between PC-ECMO duration and patient characteristics, as well as short- and long-term outcomes, with an understanding of the impact of prolonged support exceeding 7 days.
They involved adults aged 18 and above who received ECMO support following cardiac surgery across 34 centers in 16 countries (January 2000 to December 2020).
The result showed that patient characteristics, in-hospital, and post-discharge outcomes were assessed based on ECMO duration, specifically on patients requiring ECMO support for more than 7 days. With 2021 patients, ECMO durations ranged from 0–3 days (n = 649 [32.1%]), 4–7 days (n = 776 [38.3%]), 8–10 days (n = 263 [13.0%]), to greater than 10 days (n = 333 [16.5%]). While no significant differences were observed in preoperative and procedural characteristics across ECMO duration groups, longer ECMO support was linked to heightened complications, including bleeding, acute kidney injury (AKI), arrhythmias, and sepsis. Notably, hospital mortality exhibited a U-shaped curve, with the lowest rate occurring in patients with ECMO duration of 4–7 days (n = 394, 50.8%) and the highest among patients requiring ECMO support for over 10 days (n = 242, 72.7%). Post-discharge survival rates did not significantly differ between ECMO duration groups. Furthermore, among patients with ECMO duration surpassing 7 days, factors such as age, comorbidities, valvular diseases, and the complexity of procedures emerged as predictors of nonsurvival.
Investigators concluded that prolonged use of extended 30% PC-ECMO (>7 days) increased in-hospital mortality, particularly for patients with complex procedures or complications, but long-term outcomes were similar to patients with shorter support.
Source: journals.lww.com/ccmjournal/fulltext/9900/characteristics_and_outcomes_of_prolonged.344.aspx
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