Heterogeneity in clinical practices for post-cardiotomy extracorporeal life support: A pilot survey from the PELS-1 multicenter study

Silvia Mariani*, Gabor Bari, the PELS-1 Investigators, Justine M. Ravaux, Bas C.T. van Bussel, Maria Elena De Piero, Ann Kristin Schaefer, Khalil Jawad, Matteo Pozzi, Antonio Loforte, Nikolaos Kalampokas, Agne Jankuviene, Erwan Flecher, Xiaotong Hou, Jeroen J.H. Bunge, Kogulan Sriranjan, Leonardo Salazar, Bart Meyns, Michael A. Mazzeffi, Sacha MatteucciSandro Sponga, Kollengode Ramanathan, Alessandro Costetti, Francesco Formica, Pranya Sakiyalak, Antonio Fiore, Chistof Schmid, Giuseppe Maria Raffa, Roberto Castillo, I. wen Wang, Jae Seung Jung, Tomas Grus, Vin Pellegrino, Giacomo Bianchi, Matteo Pettinari, Alessandro Barbone, José P. Garcia, Mariusz Kowalewski, Kiran Shekar, Glenn Whitman, Roberto Lorusso

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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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.

Original languageEnglish
Pages (from-to)1641-1653
Number of pages13
JournalArtificial Organs
Volume47
Issue number10
Early online date23 Jun 2023
DOIs
Publication statusPublished - Oct 2023

Bibliographical note

Publisher Copyright:
© 2023 The Authors. Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.

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