Mariani, Silvia and Bari, Gabor and Ravaux, Justine M. and van Bussel, Bas C. T. and De Piero, Maria Elena and Schaefer, Ann-Kristin and Jawad, Khalil and Pozzi, Matteo and Loforte, Antonio and Kalampokas, Nikolaos and Jankuviene, Agne and Flecher, Erwan and Hou, Xiaotong and Bunge, Jeroen J. H. and Sriranjan, Kogulan and Salazar, Leonardo and Meyns, Bart and Mazzeffi, Michael A. and Matteucci, Sacha and Sponga, Sandro and Ramanathan, Kollengode and Costetti, Alessandro and Formica, Francesco and Sakiyalak, Pranya and Fiore, Antonio and Schmid, Chistof and Raffa, Giuseppe Maria and Castillo, Roberto and Wang, I-wen and Jung, Jae-Seung and Grus, Tomas and Pellegrino, Vin and Bianchi, Giacomo and Pettinari, Matteo and Barbone, Alessandro and Garcia, Jose P. and Kowalewski, Mariusz and Shekar, Kiran and Whitman, Glenn and Lorusso, Roberto (2023) Heterogeneity in clinical practices for post-cardiotomy extracorporeal life support: A pilot survey from the PELS-1 multicenter study. ARTIFICIAL ORGANS, 47 (10). pp. 1641-1653. ISSN 0160-564X, 1525-1594
Full text not available from this repository. (Request a copy)Abstract
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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | MEMBRANE-OXYGENATION; CASE VOLUME; ADULT; FAILURE; ORGANIZATION; OUTCOMES; cardiac surgery; clinical practices; extracorporeal life support; heart failure; post-cardiotomy shock; survey |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Herz-, Thorax- und herznahe Gefäßchirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 30 Jan 2024 07:04 |
| Last Modified: | 30 Jan 2024 07:04 |
| URI: | https://pred.uni-regensburg.de/id/eprint/60978 |
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