; Bari, Gabor
; Ravaux, Justine M.
; van Bussel, Bas C. T. ; De Piero, Maria Elena
; Schaefer, Ann‐Kristin ; Jawad, Khalil ; Pozzi, Matteo ; Loforte, Antonio
; Kalampokas, Nikolaos ; Jankuviene, Agne ; Flecher, Erwan ; Hou, Xiaotong ; Bunge, Jeroen J. H. ; Sriranjan, Kogulan ; Salazar, Leonardo ; Meyns, Bart ; Mazzeffi, Michael A. ; Matteucci, Sacha ; Sponga, Sandro ; Ramanathan, Kollengode ; Costetti, Alessandro ; Formica, Francesco ; Sakiyalak, Pranya ; Fiore, Antonio
; Schmid, Chistof ; Raffa, Giuseppe Maria ; Castillo, Roberto ; Wang, I‐wen ; Jung, Jae‐Seung
; Grus, Tomas ; Pellegrino, Vin ; Bianchi, Giacomo ; Pettinari, Matteo ; Barbone, Alessandro
; Garcia, José P. ; Kowalewski, Mariusz ; Shekar, Kiran ; Whitman, Glenn ; Lorusso, Roberto | Dokumentenart: | Artikel | ||||
|---|---|---|---|---|---|
| Titel eines Journals oder einer Zeitschrift: | Artificial Organs | ||||
| Verlag: | WILEY | ||||
| Ort der Veröffentlichung: | HOBOKEN | ||||
| Band: | 47 | ||||
| Nummer des Zeitschriftenheftes oder des Kapitels: | 10 | ||||
| Seitenbereich: | S. 1641-1653 | ||||
| Datum: | 2023 | ||||
| Institutionen: | Medizin > Lehrstuhl für Herz-, Thorax- und herznahe Gefäßchirurgie | ||||
| Identifikationsnummer: |
| ||||
| Stichwörter / Keywords: | MEMBRANE-OXYGENATION; CASE VOLUME; ADULT; FAILURE; ORGANIZATION; OUTCOMES; cardiac surgery; clinical practices; extracorporeal life support; heart failure; post-cardiotomy shock; survey | ||||
| Dewey-Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin | ||||
| Status: | Veröffentlicht | ||||
| Begutachtet: | Ja, diese Version wurde begutachtet | ||||
| An der Universität Regensburg entstanden: | Ja | ||||
| Dokumenten-ID: | 76304 |
Zusammenfassung
Background: High-quality evidence for post-cardiotomy extracorporeal life support (PC-ECLS) management is lacking. This study investigated 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 ...

Zusammenfassung
Background: High-quality evidence for post-cardiotomy extracorporeal life support (PC-ECLS) management is lacking. This study investigated 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 transfusion 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 patients bleeding status as a guide, without a specific threshold in 54.2% of cases. Transfusion targets ranged from 7 to 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 the available evidence are recommended.
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