title: Outcomes of extracorporeal life support for low cardiac output syndrome after major cardiac surgery.
abstract: OBJECTIVE
  Extracorporeal life support (ECLS) is a widely accepted modality for the treatment of postoperative low cardiac output syndrome (LCOS) after major cardiac surgery by providing temporary circulatory support for the stunned myocardium. We sought to identify the factors that affect outcomes of ECLS for postoperative LCOS.
  
  
  METHODS
  From 2005 to 2011, of a total of 9267 adult patients underwent major cardiac surgery, 93 patients (aged, 60.6 ± 13.8 years; 47 women) underwent ECLS to treat postoperative LCOS.
  
  
  RESULTS
  Thirty-nine (41.9%) patients were weaned off ECLS successfully, and 1 patient underwent heart transplantation. A final total of 23 patients (24.3%), including 1 heart transplantation recipient, survived until the end of the follow-up period (median, 611 days; range, 125-2247 days). On logistic regression analysis, old age (P = .001), a high blood lactate level before ECLS initiation (P < .001), cardiopulmonary bypass weaning failure after surgery (P < .001), and postoperative bleeding (P = .012) were independent factors associated with mortality. In contrast, administration of anticoagulant nafamostat mesilate (P = .040) was found to be associated with improved outcomes of ECLS. When the predictive value of pre-ECLS blood lactate level for mortality was assessed using the receiver operating characteristic curve, the greatest accuracy was obtained at the cutoff value of 7.9 mmol/L, with 63% sensitivity and 68% specificity.
  
  
  CONCLUSIONS
  High lactate level before ECLS is an independent predictor of mortality after ECLS, necessitating earlier ECLS implementations before profound lactic acidosis develops. Moreover, nafamostat mesilate should be considered as alternative to heparin to reduce the risk of bleeding in these high-risk patients.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Sung Jun
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Electronic address: jbkim1975@amc.seoul.kr.
authors.forename: Joon Bum
authors.initials: JB
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Sung-Ho
authors.initials: SH
authors.lastname: Jung
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Suk Jung
authors.initials: SJ
authors.lastname: Choo
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Cheol Hyun
authors.initials: CH
authors.lastname: Chung
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects; D019540:Area Under Curve; D001550:Benzamidines; D015415:Biomarkers / Q000097:blood; D002303:Cardiac Output, Low / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D005112:Extracorporeal Circulation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006146:Guanidines / Q000627:therapeutic use; D016027:Heart Transplantation; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012372:ROC Curve; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D001550:Benzamidines; D015415:Biomarkers; D006146:Guanidines; D019344:Lactic Acid; D006493:Heparin; C032855:nafamostat