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Post-Cardiotomy Extracorporeal Membrane Oxygenator: No Longer a Bridge to No Where?
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  • HelenMari Merritt Genore,
  • Michael Schwabe,
  • Abel Luksan,
  • Timothy Ryan,
  • Elizabeth Lyden,
  • Michael Moulton
HelenMari Merritt Genore
University of Nebraska Medical Center College of Medicine
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Michael Schwabe
University of Nebraska Medical Center College of Medicine
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Abel Luksan
Mary Lanning Memorial Hospital
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Timothy Ryan
University of Nebraska Medical Center College of Medicine
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Elizabeth Lyden
University of Nebraska Medical Center
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Michael Moulton
University of Nebraska Medical Center
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Abstract

Background Post-Cardiotomy ECMO (PC-ECMO) represents a unique subset of critically ill patients, with a paucity of data regarding long-term survival, and characteristics correlated with short and long-term outcomes. We present a retrospective cohort PC patients supported with ECMO at a single institution, with outcomes at 1 and 3-year follow-up. Methods Data was collected retrospectively for all patients requiring ECMO within 72 hours of index cardiac operation, excluding assist devices and heart transplantation. Operative data, frozen mediastinum status, cannulation site, postoperative hemorrhage, and timing of cannulation (immediate versus delayed) were all collected and examined. Primary outcomes were ability to wean from ECMO, hospital survival, and long-term survival. Results 33 patients required PC ECMO, representing a total of 179 days of ECMO support. Overall survival data were: ability to wean 61%, hospital survival 55%, one month survival 45%. The estimated 12 and 36 month survival for all PC ECMO patients was 40% and 33% respectively. Twelve and 36 month survival for all hospital survivors was 66% and 60% respectively Operative times, type of operation performed, open chest status, reoperation for hemorrhage and cannulation location (central/peripheral) were all compared. There were no statistically significant relationships of these variables short or long-term survival. Conclusions Overall 12 month survival for PC-ECMO patients was 40%, and was 33% at 36 months. For hospital survivors, 1 year survival was 66%, and was 60% at 36 months. These data support PC-ECMO as a reasonable salvage strategy, with mid-term survival comparable to other surgically treated diseases.

Peer review status:ACCEPTED

14 Apr 2020Submitted to Journal of Cardiac Surgery
16 Apr 2020Submission Checks Completed
16 Apr 2020Assigned to Editor
16 Apr 2020Reviewer(s) Assigned
24 Apr 2020Review(s) Completed, Editorial Evaluation Pending
24 Apr 2020Editorial Decision: Revise Major
18 May 20201st Revision Received
23 May 2020Submission Checks Completed
23 May 2020Assigned to Editor
23 May 2020Reviewer(s) Assigned
23 May 2020Review(s) Completed, Editorial Evaluation Pending
23 May 2020Editorial Decision: Accept