Abstract
<h3>Purpose</h3> The use of extracorporeal life support (ECLS) has increased worldwide over the past years due to improved technology, ease of management, growing familiarity with its capability and decreased costs. We analysed use and outcomes of ECLS at our Centre. <h3>Methods</h3> A retrospective cohort study of adults treated with ECLS for cardiogenic shock between January 2015 and April 2021 in a large London teaching hospital. We investigated patient characteristics, indications, and management to determine factors affecting outcomes. <h3>Results</h3> 95 patients underwent VA-ECLS of whom 46 were post-cardiotomy (PC) VA-ECLS patients. The mean age of the total cohort of patients was 52.3 years (range, 17-79 years), and 66.3% were male. Indications for ECLS included post-cardiotomy (PC) in 46/95 (48.4%), (post MI in 15/95 (15.8%), myocarditis in 13/95 (13.7%), and other in 21/95 (22.1%). The median duration of ECLS support was 5 days (range (0 - 30 days), and 37/95 (38.9%) of patients survived to discharge. Pre-ECLS procedures in PC patients in cardiogenic shock were isolated CABG in 4/46 (8.70%), isolated valve surgery in 20/46 (43.5%), thoracic aorta surgery in 13/46 (28.3%), CABG + valve in 6/46 (13.0%) or other surgery in 3/46 (6.52%). 16/46 (34.8%) were redo procedures; 24/46 (52.2%) were elective, 11/46 (23.9%) were urgent and 11/46 (23.9%) were emergency procedures. The mean age of this subset was 55.5 years (range 19 -79 years), 28/46 (60.9%) were males and 6/46 (8.7%) had pre-existing CKD. The mean EUROSCORE-II was 16.75. The median duration of ECLS support was 5 days (range 0-24 days) and 11/46 (23.9%) survived to discharge. Survival in PC patients (23.9%)) was significantly worse than in non-cardiotomy patients (26/49 (53.1%); p=0.0036). <h3>Conclusion</h3> Our experience confirms satisfactory survival rates may be achieved in such a challenging ECLS setting. PC patients had lower survival rates. Strategies to improve the selection and outcomes of PC-ECLS patients are needed. Nevertheless, PC-ECLS remains a valuable resource for temporary cardiocirculatory and respiratory support in patients who would otherwise most likely die.
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