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2020 EACTS/ELSO/STS/AATS expert consensus on post-cardiotomy extracorporeal life support in adult patients

Published:October 07, 2020DOI:https://doi.org/10.1016/j.jtcvs.2020.09.045

      Abstract

      Post-cardiotomy extracorporeal life support (PC-ECLS) in adult patients has been used only rarely but recent data have shown a remarkable increase in its use, almost certainly due to improved technology, ease of management, growing familiarity with its capability and decreased costs. Trends in worldwide in-hospital survival, however, rather than improving, have shown a decline in some experiences, likely due to increased use in more complex, critically ill patients rather than to suboptimal management. Nevertheless, PC-ECLS is proving to be a valuable resource for temporary cardiocirculatory and respiratory support in patients who would otherwise most likely die. Because a comprehensive review of PC-ECLS might be of use for the practitioner, and possibly improve patient management in this setting, the authors have attempted to create a concise, comprehensive and relevant analysis of all aspects related to PC-ECLS, with a particular emphasis on indications, technique, management, and avoidance of complications, appraisal of new approaches and ethics, education, and training.

      Key Words

      Abbreviations and Acronyms:

      ACT (activated clotting time), aPTT (activated partial thromboplastin time), ARDS (acute respiratory distress syndrome), AT (antithrombin), CABG (coronary artery bypass grafting), CO (cardiac output), CO2 (carbon dioxide), CPB (cardiopulmonary bypass), DTIs (direct thrombin inhibitors), EACTS (European Association for Cardio-Thoracic Surgery), ECLS (extracorporeal life support), ECMO (extracorporeal membrane oxygenation), ECPR (extracorporeal cardiopulmonary resuscitation), ELSO (Extracorporeal Life Support Organization), HIT (heparin-induced thrombocytopenia), HTx (heart transplant), IABP (intra-aortic balloon pump), ICU (intensive care unit), LCO (low cardiac output), LT-MCS (long-term mechanical circulatory support), LV (left ventricle), LVAD (left ventricular assist device), MCS (mechanical circulatory support), MI (Mmyocardial infarction), Oxy-RVAD (right ventricular assist device with oxygenator), PA (pulmonary artery), PC (post-cardiotomy), PCS (post-cardiotomy shock), PGD (primary graft dysfunction), RCT (randomized controlled trial), RRT (renal replacement therapy), RV (right ventricle), RVAD (right ventricular assist device), SAVE (Survival After Veno-arterial ECMO), ST-MCS (short-term mechanical circulatory support), STS (Society of Thoracic Surgeons), V-A (veno-arterial), V-V (veno-venous)
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      Linked Article

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        The Journal of Thoracic and Cardiovascular SurgeryVol. 161Issue 4
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          It is no secret that the use of extracorporeal life support (ECLS) has increased dramatically. According to the Extracorporeal Life Support Organization registry, 463 centers performed 15,875 ECLS runs in 2019 compared with 115 centers that performed 1743 ECLS runs in 2000.1 Several documents have been produced to guide the care of patients on ECLS on diverse topics from percutaneous mechanical circulatory support2 to extracorporeal cardiopulmonary resuscitation,3 blood transfusion,4 and most recently the Coronavirus Disease 2019 pandemic.
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      • Commentary: Toward achieving precision in the management of postcardiotomy failure
        The Journal of Thoracic and Cardiovascular SurgeryVol. 161Issue 4
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          As the field of mechanical circulatory support evolves, postcardiotomy extracorporeal life support (PC-ECLS) is being increasingly recognized as a potentially invaluable fallback to postoperative patients with refractory cardiovascular failure.1 By the very nature of the treatment, however, PC-ECLS lacks the evidence-based backing that has come to dictate care in much of the remainder of the cardiovascular surgery domain. Many times, PC-ECLS is the “last line of defense” for a postcardiotomy patient, and the nuances involved in determining whether, when, who, and how make decisions regarding PC-ECLS initiation, maintenance, and discontinuation anything but straightforward.
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