Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.
Department of Clinical Studies, University Medical Center Regensburg, Regensburg, Germany.
Thorac Cardiovasc Surg. 2021 Apr;69(3):271-278. doi: 10.1055/s-0040-1714746. Epub 2020 Sep 4.
Weaning failure from cardiopulmonary bypass, postoperative low cardiac output (LCO), and cardiopulmonary resuscitation (CPR) are common scenarios preceding extracorporeal life support (ECLS) implantation after cardiac surgery. The impact of these scenarios on short- and long-term outcome are not well described.
Between March 2006 and December 2018, 261 patients received ECLS support after cardiac surgery. Data of patients with weaning failure (NW), postoperative LCO, and CPR leading to ECLS implantation were retrospectively analyzed regarding outcome. Risk factors for outcome after postcardiotomy ECLS were assessed by uni- or multivariate regression analysis.
Median duration of extracorporeal support was 5.5 ± 8.5 days. Overall mortality on ECLS was 39.1%. Scenario analysis revealed weaning failure from cardiopulmonary bypass in 40.6%, postoperative LCO in 24.5%, and postoperative CPR in 34.9% leading to initiation of ECLS. Most common cause of death was refractory LCO (25.3%). Overall follow-up survival was 23.7%. Survival after weaning and during follow-up in all subgroups was 9.2% (CPR), 5.0% (LCO), and 9.6% (NW), respectively. Uni- or multivariate regression analysis revealed age, aortic surgery, and vasopressor medication level on day 1 as risk for death on support, as well as postoperative renal failure, and body mass index (BMI) as risk factors for death during follow-up.
Mortality after postcardiotomy ECLS is high. Overall, outcome after CPR, NW, weaning failure and LCO is comparable. Postoperative resuscitation does not negatively affect outcome after postcardiotomy ECLS. Neurological status of ECLS survivors is good.
心肺转流术后脱机失败、术后低心输出量（LCO）和心肺复苏（CPR）是心脏手术后体外生命支持（ECLS）植入前常见的情况。这些情况对短期和长期结果的影响尚未得到很好的描述。
2006 年 3 月至 2018 年 12 月，261 例心脏手术后患者接受 ECLS 支持。回顾性分析心肺转流术后脱机失败（NW）、术后 LCO 和 CPR 导致 ECLS 植入的患者的结局数据。采用单变量或多变量回归分析评估体外循环后 ECLS 结局的危险因素。
体外循环支持的中位时间为 5.5±8.5 天。ECLS 上的总体死亡率为 39.1%。情景分析显示，心肺转流术脱机失败占 40.6%，术后 LCO 占 24.5%，术后 CPR 占 34.9%，导致 ECLS 启动。最常见的死亡原因是难治性 LCO（25.3%）。总体随访生存率为 23.7%。所有亚组的脱机和随访期间的生存率分别为 9.2%（CPR）、5.0%（LCO）和 9.6%（NW）。单变量或多变量回归分析显示，年龄、主动脉手术和第 1 天的血管加压药物水平是支持死亡率的危险因素，术后肾功能衰竭和体重指数（BMI）是随访死亡率的危险因素。
心脏手术后 ECLS 的死亡率很高。总体而言，CPR、NW、脱机失败和 LCO 的预后相当。心肺复苏后不会对心脏手术后 ECLS 的预后产生负面影响。ECLS 幸存者的神经状态良好。
