OBJECTIVES: Post-cardiotomy extracorporeal life support (ECLS) cannulation might occur in a general post-operative ward due to emergent conditions. Its characteristics have been poorly reported and investigated This study investigates the characteristics and outcomes of adult patients receiving ECLS cannulation in a general post-operative cardiac ward. METHODS: The Post-cardiotomy Extracorporeal Life Support (PELS) is a retrospective (2000-2020), multicenter (34 centers), observational study including adult patients who required ECLS for post-cardiotomy shock. This PELS sub-analysis analyzed patients´ characteristics, in-hospital outcomes, and long-term survival in patients cannulated for veno-arterial ECLS in the general ward, and further compared in-hospital survivors and non-survivors. RESULTS: The PELS study included 2058 patients of whom 39 (1.9%) were cannulated in the general ward. Most patients underwent isolated coronary bypass grafting (CABG, n = 15, 38.5%) or isolated non-CABG operations (n = 20, 51.3%). The main indications to initiate ECLS included cardiac arrest (n = 17, 44.7%) and cardiogenic shock (n = 14, 35.9%). ECLS cannulation occurred after a median time of 4 (2-7) days post-operatively. Most patients' courses were complicated by acute kidney injury (n = 23, 59%), arrhythmias (n = 19, 48.7%), and postoperative bleeding (n = 20, 51.3%). In-hospital mortality was 84.6% (n = 33) with persistent heart failure (n = 11, 28.2%) as the most common cause of death. No peculiar differences were observed between in-hospital survivors and nonsurvivors. CONCLUSIONS: This study demonstrates that ECLS cannulation due to post-cardiotomy emergent adverse events in the general ward is rare, mainly occurring in preoperative low-risk patients and after a postoperative cardiac arrest. High complication rates and low in-hospital survival require further investigations to identify patients at risk for such a complication, optimize resources, enhance intervention, and improve outcomes.

2nd Department of Cardiovascular Surgery Cardiovascular Medicine General Teaching Hospital Prague Czech Republic

Adult Intensive Care Service The Prince Charles Hospital Brisbane Queensland Australia

Cardiac Surgery Unit IRCCS Humanitas Research Hospital Rozzano Italy

Cardiac Thoracic and Vascular Department Niguarda Hospital Milan Italy

Cardiothoracic Intensive Care Unit National University Hospital Singapore Singapore

Center for Cardiac Intensive Care Beijing Institute of Heart Lung and Blood Vessels Diseases Beijing Anzhen Hospital Beijing China

Clinic of Internal Medicine Department of Cardiac Surgery University of Szeged Szeged Hungary

Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione Palermo Italy

Department of Anesthesiology Centre of Anesthesia Intensive Care and Pain management Vilnius University Hospital Santariskiu Klinikos Vilnius Lithuania

Department of Cardiac Surgery Heinrich Heine University Duesseldorf Germany

Department of Cardiac Surgery Leipzig Heart Center Leipzig Germany

Department of Cardiac Surgery Louis Pradel Cardiologic Hospital Lyon France

Department of Cardiac Surgery Ospedale del Cuore Fondazione Toscana G Monasterio Massa Italy

Department of Cardiac Surgery University Hospitals Leuven Leuven Belgium

Department of Cardio Thoracic Surgery University Hospital Henri Mondor Créteil France

Department of Cardiology Fundación Cardiovascular de Colombia Bucaramanga Colombia

Department of Cardiothoracic Surgery University Medical Center Regensburg Regensburg Germany

Department of Cardiovascular Surgery Ziekenhuis Oost Limburg Genk Belgium

Department of Intensive Care Adults and Department of Cardiology Erasmus MC Rotterdam The Netherlands

Department of Intensive Care Medicine Center of Applied Medical Research St Vincent's Hospital Darlinghurst New South Wales Australia

Department of Medicine and Surgery Cardiac Surgery Clinic San Gerardo Hospital Monza Italy

Department of Medicine and Surgery University of Parma Parma Italy

Department of Thoracic and Cardiovascular Surgery Korea University Anam Hospital Seoul South Korea

Departments of Medicine and Surgery University of Maryland Baltimore Maryland USA

Division of Cardiac Surgery Cardiothoracic Department University Hospital of Udine Udine Italy

Division of Cardiac Surgery IRCCS Azienda Ospedaliero Universitaria di Bologna Bologna Italy

Division of Cardiac Surgery Johns Hopkins Hospital Baltimore Maryland USA

Division of Cardiac Surgery Medical University of Vienna Vienna Austria

Division of Cardiac Surgery Memorial Healthcare System Hollywood Florida USA

Division of Cardiothoracic and Vascular Surgery Pontchaillou University Hospital Rennes France

Division of Cardiovascular and Thoracic Surgery Department of Surgery Siriraj Hospital Bangkok Thailand

ECLS Unit Departamento de Anestesia Clínica Las Condes Santiago Chile

Intensive Care Unit The Alfred Hospital Melbourne Victoria Australia

Maastricht University Medical Center Cardio Thoracic Surgery Department and Cardiovascular Research Institute Maastricht Maastricht The Netherlands

Memorial Cardiac and Vascular Institute Indiana University Methodist Hospital Indianapolis Indiana USA

SOD Cardiochirurgia Ospedali Riuniti 'Umberto 1 Lancisi Salesi' Ancona Italy

See more in PubMed

Lorusso R, Whitman G, Milojevic M, Raffa G, McMullan DM, Boeken U, et al. 2020 EACTS/ELSO/STS/AATS expert consensus on post‐cardiotomy extracorporeal life support in adult patients. J Thorac Cardiovasc Surg. 2021;161(4):1287–1331.

Mariani S, Wang IW, van Bussel BCT, Heuts S, Wiedemann D, Saeed D, et al. The importance of timing in postcardiotomy venoarterial extracorporeal membrane oxygenation: a descriptive multicenter observational study. J Thorac Cardiovasc Surg. 2023;166:1670–1682.e33.

Abrams D, MacLaren G, Lorusso R, Price S, Yannopoulos D, Vercaemst L, et al. Extracorporeal cardiopulmonary resuscitation in adults: evidence and implications. Intensive Care Med. 2022;48(1):1–15.

Brand J, McDonald A, Dunning J. Management of cardiac arrest following cardiac surgery. BJA Educ. 2018;18(1):16–22.

Dunning J, Fabbri A, Kolh PH, Levine A, Lockowandt U, Mackay J, et al. Guideline for resuscitation in cardiac arrest after cardiac surgery. Eur J Cardiothorac Surg. 2009;36(1):3–28.

Richardson ASC, Tonna JE, Nanjayya V, Nixon P, Abrams DC, Raman L, et al. Extracorporeal cardiopulmonary resuscitation in adults. Interim guideline consensus Statement from the extracorporeal life support organization. ASAIO J. 2021;67(3):221–228.

Tonna JE, Selzman CH, Girotra S, Presson AP, Thiagarajan RR, Becker LB, et al. Resuscitation using ECPR during in‐hospital cardiac arrest (RESCUE‐IHCA) mortality prediction score and external validation. J Am Coll Cardiol Intv. 2022;15(3):237–247.

Mariani S, Heuts S, van Bussel BCT, Di Mauro M, Wiedemann D, Saeed D, et al. Patient and management variables associated with survival after postcardiotomy extracorporeal membrane oxygenation in adults: the PELS‐1 multicenter cohort study. J Am Heart Assoc. 2023;12(14):e029609.

Mariani S, Schaefer AK, van Bussel BCT, Di Mauro M, Conci L, Szalkiewicz P, et al. On‐support and post‐weaning mortality in post‐cardiotomy extracorporeal membrane oxygenation. Ann Thorac Surg. 2023;116:1079–1089.

Heuts S, Mariani S, van Bussel BCT, Boeken U, Samalavicius R, Bounader K, et al. The relation between obesity and mortality in postcardiotomy venoarterial membrane oxygenation. Ann Thorac Surg. 2023;116(1):147–154.

Silverborn M, Nielsen S, Karlsson M. The performance of EuroSCORE II in CABG patients in relation to sex, age, and surgical risk: a nationwide study in 14,118 patients. J Cardiothorac Surg. 2023;18(1):40.

Society of Thoracic Surgeons Task Force on Resuscitation After Cardiac Surgery. The Society of Thoracic Surgeons expert consensus for the resuscitation of patients who arrest after cardiac surgery. Ann Thorac Surg. 2017;103(3):1005–1020.

Tonna JE, Selzman CH, Girotra S, Presson AP, Thiagarajan RR, Becker LB, et al. Patient and institutional characteristics influence the decision to use extracorporeal cardiopulmonary resuscitation for in‐hospital cardiac arrest. J Am Heart Assoc. 2020;9(9):e015522.

Biancari F, Dalen M, Fiore A, Ruggieri VG, Saeed D, Jonsson K, et al. Multicenter study on postcardiotomy venoarterial extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg. 2020;159(5):1844–1854 e6.

Kowalewski M, Zieliński K, Brodie D, MacLaren G, Whitman G, Raffa GM, et al. Venoarterial extracorporeal membrane oxygenation for postcardiotomy shock‐analysis of the extracorporeal life support organization registry. Crit Care Med. 2021;49(7):1107–1117.

McCarthy FH, McDermott KM, Kini V, Gutsche JT, Wald JW, Xie D, et al. Trends in U.S. extracorporeal membrane oxygenation use and outcomes: 2002‐2012. Semin Thorac Cardiovasc Surg. 2015;27(2):81–88.

Saxena P, Neal J, Joyce LD, Greason KL, Schaff HV, Guru P, et al. Extracorporeal membrane oxygenation support in postcardiotomy elderly patients: the Mayo Clinic experience. Ann Thorac Surg. 2015;99(6):2053–2060.

Schaefer AK, Riebandt J, Bernardi MH, Distelmaier K, Goliasch G, Zimpfer D, et al. Fate of patients weaned from post‐cardiotomy extracorporeal life support. Eur J Cardiothorac Surg. 2022;61(5):1178–1185.

Schaefer AK, Latus M, Riebandt J, Goliasch G, Bernardi MH, Laufer G, et al. Bleeding and thrombotic events in post‐cardiotomy extracorporeal life support. Eur J Cardiothorac Surg. 2023;63(4). doi:10.1093/ejcts/ezad072