Risk Factors Of Extracorporeal Life Support After Cardiac Transplantation

Objective:Extracorporeal life support(ECLS)which including Extracorporeal membrane oxygenation(ECMO)and Intra-aortic balloon pump(IABP)has been used after conventional cardiac surgery successfully.To retrospectively review the clinical data of patients receiving ECLS in Fuwai Hospital and assess the factors associated with the decision of patients who had undergone ECLS.Methods:The clinical data of 469 adult patients(from 13 to 67 years old)undergoing cardiac transplantation admitted to Fuwai Hospital from April 2005 to July 2016 were retrospectively analyzed.Demographic characteristics,diagnosis,extracorporeal circulation process,ECMO and/or IABP related data,including indication,duration of ECMO and/or IABP,clinical parameters after ECLS,outcomes and complications.The patients were divided into support group and non-support group according to the ECLS use,the former was divided into ECMO group,IABP group and combined group according to the support choices.The risk factors of ECLS support after cardiac transplantation were analyzed by logistic regression.Results:There were 54 patients(11.5%)received ECLS support after transplantation surgeries,among them,25 patients(5.3%)received only ECMO support,while 15 patients(3.2%)received only IABP,14 patients(3.0%)received both.Compared with non-support patients,the support patients had higher pulmonary arterial systolic pressure(p=0.021),longer ischemia time(p=0.02)and extracorporeal circulation time(p<0.01).Besides,most of these patients were male(p=0.032)and had received ECLS before surgeries(p<0.01).The logistic regression revealed that the pulmonary hypertension(OR 1.027,95%CI 1.004-1.050,p=0.019),extracorporeal circulation time(OR 1.032,95%CI 1.023-1.040,p<0.01),received ECLS before surgeries(OR 33.646,95%CI 10.935-103.532,p<0.01)were risk factors about ECLS.The risk factors of ECMO support were pulmonary arterial systolic pressure(OR 1.036,95%CI 1.004-1.069,P=0.026),extracorporeal circulation time(OR 1.033,95%CI 1.023-1.044,P<0.01)and received ECLS before surgeries(OR 0.078,95%CI 0.014-0.439,P=0.004).For IABP support,the risk factors were donor age(OR 1.101,95%CI 1.011-1.198,P=0.026)and ECLS before surgeries(OR 0.015,95%CI 0.004-0.056,P<0.01).The extracorporeal circulation time(OR 1.046,95%CI 1.029-1.064,P<0.01)was the risk factor for combined ECMO and IABP support.Among the 54 support patients,39 patients(72.2%)survived and discharged.Conclusions:ECLS can provide effective auxiliary support in patients with respiratory and circulatory failure after cardiac transplantation surgery,the choice of ECMO is more than IABP.Pulmonary hypertension of receiver and donor age are respective predictors of ECMO and IABP implementation after surgery.Thus choosing optimal donor,controlling cardiac function and reduce extracorporeal circulation time may help reduce the risk of cardiac dysfunction after surgery,if happen,timely ECMO and/or IABP support according to patients illness are the keys to the recovery of patients.