title: Risk factors associated with adverse outcome following extracorporeal life support: analysis from 360 consecutive patients.
abstract: OBJECTIVE
  Risk factors for adverse outcome after extracorporeal life support (ECLS) are yet to be defined. For this purpose, we reviewed our institutional data from more than a decade, focusing on patients with ECLS.
  
  
  METHODS
  Between December 2001 and June 2013, 360 consecutive cardiac surgical patients received ECLS for post-cardiotomy cardiogenic shock, with high mortality risk despite optimal conventional therapy. Patient demographics, clinical characteristics, ECLS-related morbidity, as well as in-hospital and long-term mortality were analysed. Multivariate logistic regression analysis was performed to identify independent predictors of adverse outcome (failed ECLS weaning, in-hospital mortality).
  
  
  RESULTS
  The mean age was 62±17 years, 76% were male and the mean preoperative ejection fraction was 35±16%. ECLS was established through peripheral (90%) or central thoracic cannulation. The mean duration of ECLS was 7±1 days. Intra-aortic balloon pumps were implanted in 22% of the patients. ECLS weaning was successful in 58% and 30% could be discharged from hospital. The main cause of death was sepsis (69%). Overall, major cerebrovascular events occurred in 12% (bleeding 3%, embolic 9%), limb ischaemia in 13%, gastrointestinal complications in 16% and renal replacement therapy in 61%. Independent risk factors for adverse outcome were prior cardiorespiratory resuscitation (OR: 4.1, 95%CI: 0.34-4.21, p=0.04), pH <7.1 (OR: 2.8, 95%CI: 0.45-3.28, p=0.01), serum lactate >120 mg/dL (OR: 2.6, 95%CI: 0.75-2.96, p< 0.01), norepinephrine dosage >0.5 µg/kg/min (OR: 2.4, 95%CI: 0.35-2.92, p=0.02) and age >75 years (OR: 2.0, 95%CI: 0.41-2.88, p=0.02). Kaplan Meier estimates for long-term survival were 26±3% at one year and 22±2% at five years.
  
  
  CONCLUSIONS
  ECLS therapy offers one-year survival to one quarter of patients with an otherwise fatal prognosis. Procedural mortality is low and morbidity at the implantation site typically moderate. Thus, prolonged metabolic deterioration in combination with high-dose vasopressor support prior to ECLS therapy should be avoided, particularly in younger patients.
authors: Division of Thoracic and Cardiovascular Surgery, University Frankfurt/Main, Germany nestoras.papadopoulos@kgu.de.
authors: N
authors: N
authors: Papadopoulos
authors: Division of Thoracic and Cardiovascular Surgery, University Frankfurt/Main, Germany.
authors: S
authors: S
authors: Marinos
authors: Division of Thoracic and Cardiovascular Surgery, University Frankfurt/Main, Germany.
authors: A
authors: A
authors: El-Sayed Ahmad
authors: Division of Thoracic and Cardiovascular Surgery, University Frankfurt/Main, Germany.
authors: H
authors: H
authors: Keller
authors: Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt/Main, Germany.
authors: P
authors: P
authors: Meybohm
authors: Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt/Main, Germany.
authors: K
authors: K
authors: Zacharowski
authors: Division of Thoracic and Cardiovascular Surgery, University Frankfurt/Main, Germany.
authors: A
authors: A
authors: Moritz
authors: Division of Thoracic and Cardiovascular Surgery, University Frankfurt/Main, Germany.
authors: A
authors: A
authors: Zierer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005112:Extracorporeal Circulation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D006863:Hydrogen-Ion Concentration; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000401:mortality* / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D015996:Survival Rate
chemical_list: D019344:Lactic Acid
keywords: adult cardiac surgery; extracorporeal life support; intensive care unit; mechanical circulatory support; post-cardiotomy cardiogenic shock