An audit of extracorporeal membrane oxygenation outcomes in patients with low cardiac output syndrome at Charlotte Maxeke Johannesburg Academic Hospital, South Africa
DOI:
https://doi.org/10.7196/Keywords:
ECMO, Low cardiac output syndrome, post cardiotomyAbstract
Background. Extracorporeal membrane oxygenation (ECMO) is a means of supporting an inefficient cardiorespiratory system, refractory to medical treatment, with a mechanical device. Low cardiac output syndrome (LCOS) is a frequent problem after cardiopulmonary bypass. Globally, centres have investigated outcomes of ECMO and have documented associated preoperative, intraoperative and postoperative predictive factors. Our centre has used ECMO since the mid-1990s, but there has been no study investigating the outcomes.
Objectives. To evaluate 30-day survival and associated predictive factors among patients with LCOS in whom ECMO was used during or after open-heart surgery.
Methods. The study was a retrospective review of clinical records of adult patients in whom ECMO was used during or within 72 hours after open-heart surgery from November 2016 until the end of December 2022. Data were collected using the RedCap (Research Electronic Data Capture) online database manager at the University of the Witwatersrand and entered into a Microsoft Excel spreadsheet. For descriptive analysis, continuous data were analysed using a one-way analysis of variance. The association between patient factors and outcomes was analysed using Fisher’s exact test. Statistical analysis was conducted using Stata.
Results. ECMO was used in 4.6% (n=60) of 1 311 patients who underwent heart surgery during the study period, of whom 38 met the study selection criteria; of these, 6 (15.8%) survived to discharge. Of the patients who survived, 5 were black females in the working age group. All the patients who died (n=32/38; 84.2%) did so within 30 days. All the patients experienced morbidity while on ECMO. All the surviving patients survived for >30 days and were discharged from hospital.
Conclusion. Our ECMO survival rate following open heart surgery (~16%) is low compared with other better-established centres. Various factors were associated with the poor outcomes.
References
1. Weisse AB. Cardiac surgery: A century of progress. Texas Heart Inst J 2011;38(5):486-490.
2. LomivorotovVV,EfremovSM,KirovMY,FominskiyEV,KaraskovAM.Low-cardiac-outputsyndromeafter cardiac surgery. J Cardiothorac Vasc Anesth 2017;31(1):291-308. https://doi.org/10.1053/j.jvca.2016.05.029 3. Monaco F, di Prima AL, Kim JH, et al. Management of challenging cardiopulmonary bypass separation.
J Cardiothorac Vasc Anesth 2020;34(6):1622-1635. https://doi.org/10.1053/j.jvca.2020.02.038
4. Makdisi G, Wang IW. Extra corporeal membrane oxygenation (ECMO) review of a lifesaving
technology. J Thorac Dis 2015;7(7):E166-E176. https://doi.org/10.3978/j.issn.2072-1439.2015.07.17
5. Bartlett RH. John H Gibbon Jr Lecture. Extracorporeal life support: Gibbon fulfilled. J Am Coll Surg
2014;218(3):317-327. https://doi.org/10.1016/j.jamcollsurg.2013.12.002
6. Squiers JJ, Lima B, DiMaio JM. Contemporary extracorporeal membrane oxygenation therapy in
adults: Fundamental principles and systematic review of the evidence. J Thorac Cardiovasc Surg
2016;152(1):20-32. https://doi.org/10.1016/j.jtcvs.2016.02.067
7. Guglin M, Zucker MJ, Bazan VM, et al. Venoarterial ECMO for adults: JACC Scientific Expert Panel.
J Am Coll Cardiol 2019;73(6):698-716. https://doi.org/10.1016/j.jacc.2018.11.038
8. Meuwese CL, Ramjankhan FZ, Braithwaite SA, et al. Extracorporeal life support in cardiogenic shock: Indications and management in current practice. Neth Heart J 2018;26(2):58-66. https://doi.
org/10.1007/s12471-018-1073-99. Brewer JM, Tran A, Yu J, et al. ECMO after cardiac surgery: A single-center study on survival and optimizing outcomes. J Cardiothorac Surg 2021;16(1):264. https://doi.org/10.1186/s13019-021-01638-0
10. Kumar TKS, Zurakowski D, Dalton H, et al. Extracorporeal membrane oxygenation in postcardiotomy
patients: Factors influencing outcome. J Thorac Cardiovasc Surg 2010;140(2):330-336.e2. https://doi.
org/10.1016/j.jtcvs.2010.02.034
11. Raffa GM, Kowalewski M, Brodie D, et al. Meta-analysis of peripheral or central extracorporeal membrane oxygenation in postcardiotomy and non-postcardiotomy shock. Ann Thorac Surg 2019;107(1):311-321. https://doi.org/10.1016/j.athoracsur.2018.05.063
12. Meani P, Matteucci M, Jiritano F, et al. Long-term survival and major outcomes in post-cardiotomy extracorporeal membrane oxygenation for adult patients in cardiogenic shock. Ann Cardiothorac Surg 2019;8(1):116-122. https://doi.org/10.21037/acs.2018.12.04
13. Hsu PS, Chen JL, Hong GJ, et al. Extracorporeal membrane oxygenation for refractory cardiogenic shock after cardiac surgery: Predictors of early mortality and outcome from 51 adult patients. Eur J Cardiothorac Surg 2010;37(2):328-333. https://doi.org/10.1016/j.ejcts.2009.07.033
14. Whitman GJR. Extracorporeal membrane oxygenation for the treatment of postcardiotomy shock. J Thorac Cardiovasc Surg 2017;153(1):95-101. https://doi.org/10.1016/j.jtcvs.2016.08.024
15. Murphy S. Extracorporeal membrane oxygenation therapy in intensive care units in South African state hospitals: A normative study. S Afr J Bioethics Law 2021;14(2):67-71. https://doi.org/10.7196/ SAJBL.2021.v1421.750
16. Richards GA, Joubert I. Extracorporeal membrane oxygenation: Position statement. South Afr J Crit Care 2013;29(1):7-9. https://doi.org/10.7196/SAJCC.161
17. Saxena P, Neal J, Joyce LD, et al. Extracorporeal membrane oxygenation support in postcardiotomy elderly patients: The Mayo Clinic experience. Ann Thoracic Surg 2015;99(6):2053-2060. https://doi. org/10.1016/j.athoracsur.2014.11.075
18. Rastan AJ, Dege A, Mohr M, et al. Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. J Thorac Cardiovasc Surg 2010;139(2):302-311. https://doi.org/10.1016/j.jtcvs.2009.10.043
19. Napp LC, Kuhn C, Hoeper MH, et al. Cannulation strategies for percutaneous extracorporeal membrane oxygenation in adults. Clin Res Cardiol 2016;105(4):283-296. https://doi.org/10.1007/s00392-015-0941-1 20. Pavlushkov E, Berman M, Valchanov K. Cannulation techniques for extracorporeal life support. Ann
Transl Med 2017;5(4):70. https://doi.org/10.21037/atm.2016.11.47
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