Heterogeneity in Clinical Practices for Post-Cardiotomy Extracorporeal Life Support: a Pilot Survey from the PELS-1 Multicenter Study.

Autor: Mariani S; Cardio-Thoracic Surgery Department, and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands., Bari G; Clinic of Internal Medicine, Department of Cardiac Surgery, University of Szeged, Szeged, Hungary., Ravaux JM; Cardio-Thoracic Surgery Department, and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands., van Bussel BCT; Cardio-Thoracic Surgery Department, and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.; Department of Intensive Care Medicine, and Care and Public Health Research Institute, Maastricht, The Netherlands., De Piero ME; Cardio-Thoracic Surgery Department, and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands., Schaefer AK; Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria., Jawad K; Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany., Pozzi M; Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital, Lyon, France., Loforte A; Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.; University of Turin, Department of Surgical Sciences, Turin, Italy., Kalampokas N; Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany., Jankuviene A; II Department of Anesthesiology, Centre of Anesthesia, Intensive Care and Pain management, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania., Flecher E; Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France., Hou X; Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung, and Blood Vessels Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China., Bunge JJH; Department of Intensive Care Adults, and Department of cardiology, Erasmus MC, Rotterdam, The Netherlands., Sriranjan K; Department of Intensive Care Medicine, Center of Applied Medical Research, St Vincent's Hospital, Darlinghurst, NSW, Australia., Salazar L; Department of Cardiology, Fundación Cardiovascular de Colombia, Bucaramanga, Colombia., Meyns B; Department of Cardiac Surgery, University Hospitals Leuven and Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium., Mazzeffi MA; Departments of Medicine and Surgery, University of Maryland, Baltimore, USA., Matteucci S; SOD Cardiochirurgia Ospedali Riuniti 'Umberto I - Lancisi - Salesi' Università Politecnica delle Marche, Ancona, Italy., Sponga S; Division of Cardiac Surgery, Cardiothoracic Department, University Hospital of Udine, Udine, Italy., Ramanathan K; Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, Singapore., Costetti A; Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, Niguarda Hospital, Milan, Italy., Formica F; Department of Medicine and Surgery, Cardiac Surgery Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; Department of Medicine and Surgery, University of Parma, Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy., Sakiyalak P; Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand., Fiore A; Department of Cardio-Thoracic Surgery, University Hospital Henri-Mondor, Créteil, Paris, France., Schmid C; Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany., Raffa GM; Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy., Castillo R; ECLS Unit, Departamento de Anestesia, Clínica Las Condes, Las Condes, Santiago, Chile., Wang IW; Division of Cardiac Surgery, Memorial Healthcare System, Hollywood, FL, USA., Jung JS; Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine, Seoul, South Korea., Grus T; 2nd Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic., Pellegrino V; Intensive Care Unit, The Alfred Hospital, Melbourne, VIC, Australia., Bianchi G; Ospedale del Cuore Fondazione Toscana 'G. Monasterio', Massa, Italy., Pettinari M; Department of Cardiovascular Surgery, Ziekenhuis Oost-, Limburg, Genk, Belgium., Barbone A; Cardiac Surgery Unit, IRCCS Humanitas Research Hospital -, Rozzano(MI), Italy., Garcia JP; IU Health Advanced Heart & Lung Care, Indiana University Methodist Hospital, Indianapolis, IN, USA., Kowalewski M; Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland., Shekar K; Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia., Whitman G; Cardiac Intensive Care Unit, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Jazyk: angličtina
Zdroj: Artificial organs [Artif Organs] 2023 Jun 23. Date of Electronic Publication: 2023 Jun 23.
DOI: 10.1111/aor.14601
Abstrakt: Background: High-quality evidence for post-cardiotomy extracorporeal life support (PC-ECLS) management is lacking. This study investigated the real-world PC-ECLS clinical practices.
Methods: This cross-sectional, multi-institutional, international pilot survey explored center organization, anticoagulation management, left ventricular unloading, distal limb perfusion, PC-ECLS monitoring and transfusions practices. Twenty-nine questions were distributed among 34 hospitals participating in the Post-cardiotomy Extra-Corporeal Life Support Study.
Results: Of the 32 centers [16 low-volume (50%); 16 high-volume (50%)] that responded, 16 (50%) had dedicated ECLS specialists. Twenty-six centers (81.3%) reported using additional mechanical circulatory supports. Anticoagulation practices were highly heterogeneous: 24 hospitals (75%) reported using patient's bleeding status as a guide, without a specific threshold in 54.2% of cases. Transfusion targets ranged 7-10 g/dL. Most centers used cardiac venting on a case-by-case basis (78.1%) and regular distal limb perfusion (84.4%). Nineteen (54.9%) centers reported dedicated monitoring protocols including daily echocardiography (87.5%), Swan-Ganz catheterization (40.6%), cerebral near-infrared spectroscopy (53.1%) and multimodal assessment of limb ischemia. Inspection of the circuit (71.9%), oxygenator pressure drop (68.8%), plasma free hemoglobin (75%), d-dimer (59.4%), lactate dehydrogenase (56.3%) and fibrinogen (46.9%) are used to diagnose hemolysis and thrombosis.
Conclusions: This study shows remarkable heterogeneity in clinical practices for PC-ECLS management. More standardized protocols and better implementation of available evidence are recommended.
(This article is protected by copyright. All rights reserved.)
Databáze: MEDLINE
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