Analysis Of Physical Complications Associated With Veno-arterial Extracorporeal Membrane Oxygenation After Cardiac Surgery

Objective:This retrospective study analyzed the occurrence of physical complications in adult patients who received VA-ECMO support after cardiac surgery at the Second Hospital of Jilin University.Early clinical outcomes were evaluated,risk factors affecting patient prognosis were analyzed,and lessons learned were provided to reduce physical complications and improve the success rate of VA-ECMO treatment.Methods:This study collected clinical data from adult patients who received VA-ECMO supportive therapy after cardiac surgery at the Second Hospital of Jilin University during a five-year period from 01/01/2017 to 12/31/2021.The author recorded the patient’s gender,age,BMI,underlying disease,disease type,duration of surgery,duration of extracorporeal circulation,duration of VA-ECMO support,duration of ventilator-assisted ventilation,duration of ICU stay,duration of hospitalization,and physical complications,and created a database.The patients were divided into survival and death groups according to their length of stay.Logistic regression was used to analyze the independent risk factors for death in patients on VA-ECMO support.Results:During this five-year period,94 adult patients received VA-ECMO support after cardiac surgery at our institution.Of these,59 were male and 35 were female,aged(58.3±12.1)years.Hypertension was the main underlying disease,with a prevalence of 44.7%.Major diseases included coronary heart disease,valvular disease and aortic dissection,with prevalence rates of 46.8%,18.1% and 27.7%,respectively.The operative time was(513±178)minutes.The extracorporeal circulation time was(160±110)minutes.The median duration of VA-ECMO support was 184 hours(132,354).The median duration of ventilator-assisted ventilation was 124 hours(70,183).The duration of ICU stay was(323±71)hours and the duration of hospitalization was(701±451)hours.Age and ventilation time were lower in the survival group than in the death group,and hospital stay was higher than in the death group,with statistical difference between the two groups(P<0.05).74(78.7%)of 94 patients were successfully weaned from VA-ECMO,54(57.4%)recovered and were discharged,and 40 died because they were unable to wean from VA-ECMO or abandon treatment.80 patients developed physical complications associated with VA-ECMO,including 34(36.2%)bleeding,59(62.8%)infections,50(53.2%)acute kidney injury,32(34.0%)liver function abnormalities,36(38.3%)hyperbilirubinemia,2(2.1%)hemolysis,2(2.1%)neurological complications and2(2.1%)distal limb ischemia.Univariate analysis showed that acute kidney injury,hyperbilirubinemia and abnormal liver function were significant factors affecting mortality in adult patients treated with VA-ECMO after cardiac surgery.Logistic regression analysis showed that only acute kidney injury was an independent risk factor.Conclusion:1.The main physical complications in adult patients treated with VA-ECMO after cardiac surgery are infections,followed by acute kidney injury,hyperbilirubinemia,bleeding,and liver function abnormalities.2.Acute kidney injury,hyperbilirubinemia and liver function abnormalities are important factors affecting mortality in adult patients treated with VA-ECMO after cardiac surgery,with acute kidney injury being an independent risk factor.