Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
Crit Care Resusc. 2017 Oct;19(Suppl 1):53-61.
The use of post-cardiotomy extracorporeal life support (PC-ECLS) has increased worldwide over the past years but a concurrent decrease in survival to hospital discharge has also been observed. We analysed use and outcome of PC-ECLS at the Maastricht University Medical Center.
A retrospective study of a single-centre PC-ECLS cohort. Patient characteristics and in-hospital outcomes were evaluated.
Patients who underwent PC-ECLS due to intra- or peri-operative cardiogenic shock or cardiac arrest were included. Descriptive statistics were analysed and frequency analysis and testing of group differences were performed.
Eighty-six patients who received PC-ECLS between October 2007 and June 2017 were included. The mean age of the population was 65 years (range, 31-86 years), and 65% were men.
Survival rates were calculated and PC-ECLS management data and complications were assessed.
Pre-ECLS procedures were isolated coronary artery bypass grafting (CABG) (22%), isolated valve surgery (16%), thoracic aorta surgery (4%), a combination of CABG and valve surgery (21%) or other surgery (24%). PC-ECLS was achieved via central cannulation in 17%, peripheral cannulation in 65%, or by a combination in 17%. The median duration of PC-ECLS was 5.0 days (IQR, 6.0 days). Weaning was achieved in 49% of patients, and 37% survived to discharge. Post-operative bleeding (overall rate, 42%) showed a trend towards a reduced rate over more recent years.
Our experience confirms an increased use of PC-ECLS during the last 10 years and shows that, by carefully addressing patient management and complications, survival rat e may be satisfactory, and improved outcome may be achieved in such a challenging ECLS setting.
近年来，全世界使用体外心肺复苏（ECLS）的病例数量有所增加，但同时观察到患者出院存活率有所下降。本研究分析了马斯特里赫特大学医学中心使用体外心肺复苏的情况和结果。
回顾性分析单中心体外心肺复苏患者队列。评估患者特征和院内转归。
纳入因术中或围手术期心源性休克或心脏骤停而接受体外心肺复苏的患者。分析描述性统计数据，并进行频率分析和组间差异检验。
2007 年 10 月至 2017 年 6 月期间，86 例患者接受了体外心肺复苏。患者平均年龄为 65 岁（范围 31-86 岁），65%为男性。
计算生存率，评估体外心肺复苏管理数据和并发症。
体外心肺复苏前手术为单纯冠状动脉旁路移植术（CABG）（22%）、单纯瓣膜手术（16%）、胸主动脉手术（4%）、CABG 联合瓣膜手术（21%）或其他手术（24%）。体外心肺复苏通过中心插管（17%）、外周插管（65%）或两者联合（17%）实现。体外心肺复苏中位持续时间为 5.0 天（IQR，6.0 天）。49%的患者成功撤机，37%的患者存活至出院。术后出血（总体发生率为 42%）近年来呈下降趋势。
我们的经验证实，在过去 10 年中，体外心肺复苏的使用有所增加，并且通过仔细处理患者管理和并发症，可以获得令人满意的存活率，在这种具有挑战性的体外心肺复苏环境下可能实现更好的结果。
