Post-Cardiotomy Extracorporeal Membrane Oxygenator: No Longer a Bridge
to No Where?
Background Post-Cardiotomy ECMO (PC-ECMO) represents a unique subset of
critically ill patients, with a paucity of data regarding long-term
survival, and characteristics correlated with short and long-term
outcomes. We present a retrospective cohort PC patients supported with
ECMO at a single institution, with outcomes at 1 and 3-year follow-up.
Methods Data was collected retrospectively for all patients requiring
ECMO within 72 hours of index cardiac operation, excluding assist
devices and heart transplantation. Operative data, frozen mediastinum
status, cannulation site, postoperative hemorrhage, and timing of
cannulation (immediate versus delayed) were all collected and examined.
Primary outcomes were ability to wean from ECMO, hospital survival, and
long-term survival. Results 33 patients required PC ECMO, representing a
total of 179 days of ECMO support. Overall survival data were: ability
to wean 61%, hospital survival 55%, one month survival 45%. The
estimated 12 and 36 month survival for all PC ECMO patients was 40% and
33% respectively. Twelve and 36 month survival for all hospital
survivors was 66% and 60% respectively. Operative times, type of
operation performed, open chest status, reoperation for hemorrhage and
cannulation location (central/peripheral) were all compared. There were
no statistically significant relationships of these variables short or
long-term survival. Conclusions Overall 12 month survival for PC-ECMO
patients was 40%, and was 33% at 36 months. For hospital survivors, 1
year survival was 66%, and was 60% at 36 months. These data support
PC-ECMO as a reasonable salvage strategy, with mid-term survival
comparable to other surgically treated diseases.