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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 07, 2020
Accepted:
April 21,
2020
Received in revised form:
April 3,
2020
Received:
October 16,
2019
Footnotes
EACTS/ELSO/STS/AATS Committee Reviewers: Rakesh Christopher Arora (Canada), Nick Freemantle (UK), Christoph Knosalla (Germany), Graeme Maclaren (Singapore), Evgenij V. Potapov (Germany), Christoph Schmid (Germany), Kiran Shekar (Australia), Scott Silvestri (USA), and Alexander Wahba (Norway).
Disclaimer 2020: The EACTS/ELSO/STS/AATS expert consensus represent the views of the EACTS, ELSO, STS, and AATS and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their dating. The EACTS, ELSO, STS, and AATS are not responsible in the event of any contradiction, discrepancy, and/or ambiguity between this document and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of health care or therapeutic strategies.
The EACTS, ELSO, STS, and AATS expert consensus does not, in any way whatsoever, override the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and, where appropriate and/or necessary, in consultation with that patient and the patient's care provider. Nor do the EACTS, ELSO, STS, and AATS expert consensus exempt health professionals from giving full and careful consideration to the relevant official, updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.
R. Lorusso, G. Whitman, and M. Milojevic contributed equally to this work.
The article has been co-published with permission in the The Journal of Thoracic and Cardiovascular Surgery, European Journal of Cardio-Thoracic Surgery, The Annals of Thoracic Surgery, and the ASAIO Journal. The articles are identical except for minor stylistic and spelling differences in keeping with each journal’s style. Either citation can be used when citing this article.
Identification
Copyright
in respect of <ce:italic>European Journal of Cardio-Thoracic Surgery</ce:italic> © European Association for Cardio-Thoracic Surgery 2020 published by Oxford University Press and in respect of <ce:italic>The Annals of Thoracic Surgery</ce:italic> © The Society of Thoracic Surgeons 2020, published by Elsevier Inc. and in respect of <ce:italic>The Journal of Thoracic and Cardiovascular Surgery,</ce:italic> © American Association for Thoracic Surgery 2020, published by Elsevier Inc. and in respect of <ce:italic>ASAIO Journal</ce:italic>, © American Society of Artificial Internal Organs 2020. All rights reserved.
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