| Autor: |
Poschner T; Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria., Schaefer AK; Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria., Hutschala D; Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, 1090 Vienna, Austria., Goliasch G; Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria., Riebandt J; Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria., Distelmaier K; Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria., Bernardi MH; Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, 1090 Vienna, Austria., Andreas M; Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria., Brands R; Alloksys Life Sciences BV, 6708 PW Wageningen, The Netherlands.; Institute for Risk Assessment Sciences (IRAS), University of Utrecht, 3584 CM Utrecht, The Netherlands., Aref T; Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria., Laufer G; Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria., Wiedemann D; Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria. |
| Abstrakt: |
(1) Alkaline phosphatase (AP) is consumed during cardiopulmonary bypass (CPB). A high AP depletion leads to an impaired outcome after cardiac surgery. However, data is scarce on the postoperative course of AP under venoarterial ECMO (VA-ECMO) support. (2) A total of 239 patients with VA-ECMO support between 2000 and 2019 at the Department of Cardiac Surgery (Vienna General Hospital, Austria) were included in this retrospective analysis. Blood samples were collected at several timepoints (baseline, postoperative day (POD) 1-7, POD 14 and 30). Patients were categorized according to the relative AP drop (<60% vs. ≥60%) and ECMO duration (<5 days vs. ≥5 days). (3) Overall, 44.4% reached the baseline AP values within 5 days-this was only the case for 28.6% with a higher AP drop (compared to 62.7% with a lower drop; p = 0.000). A greater AP drop was associated with a significantly higher need for renal replacement therapy (40.9% vs. 61.9%; p = 0.002) and an impaired 1-year survival (51.4% vs. 66.0%; p = 0.031). (4) CPB exceeds the negative impact of VA-ECMO; still, ECMO seems to delay alkaline phosphatase recovery. A greater initial AP drop bears the risk of higher morbidity and mortality. |
