Heterogeneity in clinical practices for post-cardiotomy extracorporeal life support: A pilot survey from the PELS-1 multicenter study
Issued Date
2023-01-01
Resource Type
ISSN
0160564X
eISSN
15251594
Scopus ID
2-s2.0-85164770533
Pubmed ID
37351569
Journal Title
Artificial Organs
Rights Holder(s)
SCOPUS
Bibliographic Citation
Artificial Organs (2023)
Suggested Citation
Mariani S., Bari G., Ravaux J.M., van Bussel B.C.T., De Piero M.E., Schaefer A.K., Jawad K., Pozzi M., Loforte A., Kalampokas N., Jankuviene A., Flecher E., Hou X., Bunge J.J.H., Sriranjan K., Salazar L., Meyns B., Mazzeffi M.A., Matteucci S., Sponga S., Ramanathan K., Costetti A., Formica F., Sakiyalak P., Fiore A., Schmid C., Raffa G.M., Castillo R., Wang I.w., Jung J.S., Grus T., Pellegrino V., Bianchi G., Pettinari M., Barbone A., Garcia J.P., Kowalewski M., Shekar K., Whitman G., Lorusso R. Heterogeneity in clinical practices for post-cardiotomy extracorporeal life support: A pilot survey from the PELS-1 multicenter study. Artificial Organs (2023). doi:10.1111/aor.14601 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/88036
Title
Heterogeneity in clinical practices for post-cardiotomy extracorporeal life support: A pilot survey from the PELS-1 multicenter study
Author(s)
Mariani S.
Bari G.
Ravaux J.M.
van Bussel B.C.T.
De Piero M.E.
Schaefer A.K.
Jawad K.
Pozzi M.
Loforte A.
Kalampokas N.
Jankuviene A.
Flecher E.
Hou X.
Bunge J.J.H.
Sriranjan K.
Salazar L.
Meyns B.
Mazzeffi M.A.
Matteucci S.
Sponga S.
Ramanathan K.
Costetti A.
Formica F.
Sakiyalak P.
Fiore A.
Schmid C.
Raffa G.M.
Castillo R.
Wang I.w.
Jung J.S.
Grus T.
Pellegrino V.
Bianchi G.
Pettinari M.
Barbone A.
Garcia J.P.
Kowalewski M.
Shekar K.
Whitman G.
Lorusso R.
Bari G.
Ravaux J.M.
van Bussel B.C.T.
De Piero M.E.
Schaefer A.K.
Jawad K.
Pozzi M.
Loforte A.
Kalampokas N.
Jankuviene A.
Flecher E.
Hou X.
Bunge J.J.H.
Sriranjan K.
Salazar L.
Meyns B.
Mazzeffi M.A.
Matteucci S.
Sponga S.
Ramanathan K.
Costetti A.
Formica F.
Sakiyalak P.
Fiore A.
Schmid C.
Raffa G.M.
Castillo R.
Wang I.w.
Jung J.S.
Grus T.
Pellegrino V.
Bianchi G.
Pettinari M.
Barbone A.
Garcia J.P.
Kowalewski M.
Shekar K.
Whitman G.
Lorusso R.
Author's Affiliation
Siriraj Hospital
Departement Cardiovasculaire Wetenschappen
Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione
National University Health System
Heinrich-Heine-Universität Düsseldorf Medizinische Fakultät
Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona
Centralny Szpital Kliniczny MSWiA w Warszawie
Fundación Cardiovascular de Colombia
Beijing Anzhen Hospital, Capital Medical University
CARIM School for Cardiovascular Disease
Ziekenhuis Oost-Limburg
Vilniaus Universitetas
Všeobecná Fakultní Nemocnice v Praze
Erasmus MC
KU Leuven– University Hospital Leuven
Korea University College of Medicine
Szegedi Tudományegyetem (SZTE)
Hôpital Pontchaillou
St. Vincent's Hospital Sydney
Humanitas Research Hospital
Indiana University-Purdue University Indianapolis
IRCCS Azienda Ospedaliero-Universitaria di Bologna
Hôpital Henri Mondor
Herzzentrum Leipzig
Klinikum der Universität Regensburg und Medizinische Fakultät
Clinica Las Condes
Asst Grande Ospedale Metropolitano Niguarda
Policlinico Universitario, Udine
University of Maryland, Baltimore (UMB)
Università degli Studi di Milano-Bicocca
Università degli Studi di Torino
Medizinische Universität Wien
The Alfred
Azienda Ospedaliero-Universitaria di Parma
Memorial Healthcare System
Università di Parma
The Prince Charles Hospital
The Johns Hopkins Hospital
Ospedale del Cuore Fondazione Toscana “G. Monasterio”
Louis Pradel Cardiologic Hospital
Departement Cardiovasculaire Wetenschappen
Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione
National University Health System
Heinrich-Heine-Universität Düsseldorf Medizinische Fakultät
Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona
Centralny Szpital Kliniczny MSWiA w Warszawie
Fundación Cardiovascular de Colombia
Beijing Anzhen Hospital, Capital Medical University
CARIM School for Cardiovascular Disease
Ziekenhuis Oost-Limburg
Vilniaus Universitetas
Všeobecná Fakultní Nemocnice v Praze
Erasmus MC
KU Leuven– University Hospital Leuven
Korea University College of Medicine
Szegedi Tudományegyetem (SZTE)
Hôpital Pontchaillou
St. Vincent's Hospital Sydney
Humanitas Research Hospital
Indiana University-Purdue University Indianapolis
IRCCS Azienda Ospedaliero-Universitaria di Bologna
Hôpital Henri Mondor
Herzzentrum Leipzig
Klinikum der Universität Regensburg und Medizinische Fakultät
Clinica Las Condes
Asst Grande Ospedale Metropolitano Niguarda
Policlinico Universitario, Udine
University of Maryland, Baltimore (UMB)
Università degli Studi di Milano-Bicocca
Università degli Studi di Torino
Medizinische Universität Wien
The Alfred
Azienda Ospedaliero-Universitaria di Parma
Memorial Healthcare System
Università di Parma
The Prince Charles Hospital
The Johns Hopkins Hospital
Ospedale del Cuore Fondazione Toscana “G. Monasterio”
Louis Pradel Cardiologic Hospital
Other Contributor(s)
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.