Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany.
Department of Thoracic Surgery, Evangelical Hospital Herne, Herne, Germany.
Artif Organs. 2022 Jun;46(6):1158-1164. doi: 10.1111/aor.14166. Epub 2022 Jan 20.
Extracorporeal membrane oxygenation or extracorporeal life support (ECLS) in patients after cardiac surgery and postcardiotomy cardiogenic shock (PCS) is known to be associated with high mortality. Especially in patients after coronary artery bypass grafting (CABG) and PCS, ECLS is frequently established. The aim of this analysis was to evaluate factors associated with in-hospital mortality in patients treated with ECLS due to PCS after CABG.
Between August 2006 and January 2017, 92 consecutive patients with V-A ECLS due to PCS after isolated CABG were identified and included in this retrospective analysis. Patients were divided into survivors (S) and non-survivors (NS) and analyzed with risk factors of in-hospital mortality.
In-hospital mortality added up to 61 patients (66%). Non-survivors were significantly older (60 ± 812 (S) vs. 67 ± 10 (NS); p = 0.013). Bilateral internal mammary artery graft was significantly more frequently used in S (23% (S) vs. 2% (NS); p = 0.001). After 24 h of ECLS support, median lactate levels were significantly higher in NS (1.9 (1.3; 3.5) mmol/L (S) vs. 3.5 (2.1; 6.3) mmol/L (NS); p = 0.001). NS suffered more often acute kidney injury requiring dialysis (42% (S) vs. 74% (NS); p = 0.002).
Mortality in patients with refractory PCS after CABG and consecutive ECLS support remains high. Failing end-organ recovery under ECLS despite optimized concomitant medical therapy is an indicator of adverse outcomes in this specific patient cohort. Moreover, total-arterial revascularization might be beneficial for cardiac recovery in patients suffering PCS after CABG and following ECLS.
体外膜氧合或体外生命支持（ECLS）在心脏手术后和心脏手术后心源性休克（PCS）患者中与高死亡率相关。特别是在冠状动脉旁路移植术（CABG）和 PCS 后患者中，经常建立 ECLS。本分析的目的是评估因 CABG 后 PCS 而接受 ECLS 治疗的患者与院内死亡率相关的因素。
在 2006 年 8 月至 2017 年 1 月期间，确定了 92 例因孤立性 CABG 后 PCS 而接受 V-A ECLS 的连续患者，并将其纳入本回顾性分析。患者分为存活者（S）和非存活者（NS），并分析了与院内死亡率相关的危险因素。
院内死亡率为 61 例（66%）。非存活者年龄明显较大（60±812[S]与 67±10[NS]；p=0.013）。双侧内乳动脉移植物在 S 中更频繁使用（23%[S]与 2%[NS]；p=0.001）。在 ECLS 支持 24 小时后，NS 的中位乳酸水平明显较高（1.9[1.3；3.5]mmol/L[S]与 3.5[2.1；6.3]mmol/L[NS]；p=0.001）。NS 更常发生需要透析的急性肾损伤（42%[S]与 74%[NS]；p=0.002）。
CABG 后难治性 PCS 患者接受连续 ECLS 支持的死亡率仍然很高。在优化伴随的药物治疗后，ECLS 下终末器官恢复失败是该特定患者人群不良结局的指标。此外，全动脉血运重建可能有利于 CABG 后并发 ECLS 治疗的 PCS 患者的心脏恢复。
