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THE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery


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The Journal of Cardiovascular Surgery 2018 Apr 03

DOI: 10.23736/S0021-9509.18.10283-7

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Further options and survival results after failure following ECLS implantation

Leopold RUPPRECHT, Daniele CAMBONI, Alois PHILIPP, Dirk LUNZ, Thomas MÜLLER, Christof SCHMID , Andreas KEYSER

Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany


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BACKGROUND: A retrospective study was designed to analyze the outcome of patients with extracorporeal life support (ECLS) who needed a consecutive cardiac or pulmonary support system.
METHODS: From 2006 to 2016, 93 out of 587 patients with their age ranging from 2.4 to 77.3 years required an exchange of an ECLS by another mechanical support system. Sixty- one patients were inhospital cases, 39 patients were referred with ECLS from other institutions by ambulance car (n=15) or helicopter (n=24). Sixty-five patients came from internal medicine wards, of which 38 patients had CPR, whereas 24 patients suffered post- cardiotomy failure with CPR in 11 cases. Ten patients were referred from other hospitals for failure to wean from ECLS.
RESULTS: Leading symptoms were continuing cardiac failure in 43 patients (46%) and ongoing respiratory failure after cardiac recovery in 50 patients (54%). Patients with cardiac failure underwent implantation of a ventricular assist device (n=36) or remained on long-term ECLS (n=7) until a donor organ for heart transplantation was available (mean waiting time 43 days). Respiratory failure was treated by veno-venous ECMO (n=34) or vav-ECMO (n=16). Overall inhouse survival was 50.5 % (n=47). Only 22.6 % of patients (n=21) died during ongoing support. In contrast, 26.9 % of patients (n=25) deceased 35+/-51 days after weaning from vv- or vav-ECMO. Major reasons of death were multi-organ failure in 16 patients, cerebral hypoxia in 12 patients, sepsis in 10 patients, and intractable ow output in 5 patients.
CONCLUSIONS: Despite a switch from ECLS to another mechanical support system, survival remains limited as irreversible multi-organ failure and sepsis still jeopardize the patients’ life.


KEY WORDS: Heart failure - ECLS - ECMO - Resuscitation - LVAD

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Publication History

Article first published online: April 3, 2018
Manuscript accepted: April 3, 2018
Manuscript revised: February 22, 2018
Manuscript received: October 19, 2017

Cite this article as

Rupprecht L, Camboni D, Philipp A, Lunz D, Müller T, Schmid C et al. Further options and survival results after failure following ECLS implantation. J Cardiovasc Surg 2018 Apr 03. DOI: 10.23736/S0021-9509.18.10283-7

Corresponding author e-mail

christof.schmid@ukr.de