Risk factors associated with adverse outcome following extracorporeal life support: analysis from 360 consecutive patients.
OBJECTIVE
Risk factors for adverse outcome after extracorporeal life support (ECLS) are yet to be defined. For this purpose, we reviewed our institutional data from more than a decade, focusing on patients with ECLS.


METHODS
Between December 2001 and June 2013, 360 consecutive cardiac surgical patients received ECLS for post-cardiotomy cardiogenic shock, with high mortality risk despite optimal conventional therapy. Patient demographics, clinical characteristics, ECLS-related morbidity, as well as in-hospital and long-term mortality were analysed. Multivariate logistic regression analysis was performed to identify independent predictors of adverse outcome (failed ECLS weaning, in-hospital mortality).


RESULTS
The mean age was 62±17 years, 76% were male and the mean preoperative ejection fraction was 35±16%. ECLS was established through peripheral (90%) or central thoracic cannulation. The mean duration of ECLS was 7±1 days. Intra-aortic balloon pumps were implanted in 22% of the patients. ECLS weaning was successful in 58% and 30% could be discharged from hospital. The main cause of death was sepsis (69%). Overall, major cerebrovascular events occurred in 12% (bleeding 3%, embolic 9%), limb ischaemia in 13%, gastrointestinal complications in 16% and renal replacement therapy in 61%. Independent risk factors for adverse outcome were prior cardiorespiratory resuscitation (OR: 4.1, 95%CI: 0.34-4.21, p=0.04), pH <7.1 (OR: 2.8, 95%CI: 0.45-3.28, p=0.01), serum lactate >120 mg/dL (OR: 2.6, 95%CI: 0.75-2.96, p< 0.01), norepinephrine dosage >0.5 µg/kg/min (OR: 2.4, 95%CI: 0.35-2.92, p=0.02) and age >75 years (OR: 2.0, 95%CI: 0.41-2.88, p=0.02). Kaplan Meier estimates for long-term survival were 26±3% at one year and 22±2% at five years.


CONCLUSION
ECLS therapy offers one-year survival to one quarter of patients with an otherwise fatal prognosis. Procedural mortality is low and morbidity at the implantation site typically moderate. Thus, prolonged metabolic deterioration in combination with high-dose vasopressor support prior to ECLS therapy should be avoided, particularly in younger patients.
['Papadopoulos|N|N|', 'Marinos|S|S|', 'El-Sayed Ahmad|A|A|', 'Keller|H|H|', 'Meybohm|P|P|', 'Zacharowski|K|K|', 'Moritz|A|A|', 'Zierer|A|A|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D018572:Disease-Free Survival D005112:Extracorporeal Circulation D005260:Female D005500:Follow-Up Studies D017052:Hospital Mortality D006801:Humans D006863:Hydrogen-Ion Concentration D019344:Lactic Acid D008297:Male D008875:Middle Aged D011183:Postoperative Complications D012189:Retrospective Studies D012307:Risk Factors D013318:Stroke Volume D015996:Survival Rate
extracorporeal life support post-cardiotomy cardiogenic shock adult cardiac surgery intensive care unit mechanical circulatory support