TY - JOUR
T1 - Heterogeneity in clinical practices for post-cardiotomy extracorporeal life support
T2 - A pilot survey from the PELS-1 multicenter study
AU - Mariani, Silvia
AU - Bari, Gabor
AU - the PELS-1 Investigators
AU - Ravaux, Justine M.
AU - van Bussel, Bas C.T.
AU - De Piero, Maria Elena
AU - Schaefer, Ann Kristin
AU - Jawad, Khalil
AU - Pozzi, Matteo
AU - Loforte, Antonio
AU - Kalampokas, Nikolaos
AU - Jankuviene, Agne
AU - Flecher, Erwan
AU - Hou, Xiaotong
AU - Bunge, Jeroen J.H.
AU - Sriranjan, Kogulan
AU - Salazar, Leonardo
AU - Meyns, Bart
AU - Mazzeffi, Michael A.
AU - Matteucci, Sacha
AU - Sponga, Sandro
AU - Ramanathan, Kollengode
AU - Costetti, Alessandro
AU - Formica, Francesco
AU - Sakiyalak, Pranya
AU - Fiore, Antonio
AU - Schmid, Chistof
AU - Raffa, Giuseppe Maria
AU - Castillo, Roberto
AU - Wang, I. wen
AU - Jung, Jae Seung
AU - Grus, Tomas
AU - Pellegrino, Vin
AU - Bianchi, Giacomo
AU - Pettinari, Matteo
AU - Barbone, Alessandro
AU - Garcia, José P.
AU - Kowalewski, Mariusz
AU - Shekar, Kiran
AU - Whitman, Glenn
AU - Lorusso, Roberto
AU - Heuts, Samuel
AU - Wiedemann, Dominik
AU - Conci, Luca
AU - Szalkiewicz, Philipp
AU - Saeed, Diyar
AU - Lehmann, Sven
AU - Obadia, Jean Francois
AU - Boeken, Udo
AU - Samalavicius, Robertas
AU - Miranda, Dinis Dos Reis
N1 - Publisher Copyright:
© 2023 The Authors. Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.
PY - 2023/10
Y1 - 2023/10
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85164770533&partnerID=8YFLogxK
U2 - 10.1111/aor.14601
DO - 10.1111/aor.14601
M3 - Article
C2 - 37351569
AN - SCOPUS:85164770533
SN - 0160-564X
VL - 47
SP - 1641
EP - 1653
JO - Artificial Organs
JF - Artificial Organs
IS - 10
ER -