초록접수 현황
| 16F-049 | 구연 발표 |
The Outcome of Extracorporeal Life Support after General Thoracic Surgery: Timing of Application
Heemoon Lee¹, Yang Hyun Cho¹, Hyoung Woo Chang², Ji-Hyuk Yang¹, Jong Ho Cho¹, Kiick Sung¹, Young Tak Lee¹
¹Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, ²Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Gyeonggi-do, Korea
Background : Extracorporeal life support (ECLS) is widely used in refractory cardiac or pulmonary failure. Since complications of general thoracic surgery (GTS) frequently involve the heart or lungs, ECLS can be a useful option. Therefore, we reviewed our experience in ECLS after GTS.
Methods : There were 17,185 adult GTS procedures between 2005 and 2013 at our institution; resection of the lung (n=10,434, 60.7%), esophagus (n=1,847, 10.7%), and other procedures (n=4,904, 28.5%). Among them, 30 (0.2%) patients were supported by ECLS postoperatively.
Results : The median age was 65 years (range: 24-81). The primary operations were lobectomy (n=14, 46.7%), pneumonectomy (n=10, 33.3%), bilobectomy (n=5, 16.7%), and esophageal surgery (n=1, 3.3%). Initially, the mode of ECLS was veno-veno (VV) type in 21 patients (70.0%) and veno-arterial (VA) type in 9 patients (30.0%). There were 12 (40.0%) weaning successes and 7 (23.3%) survival discharges. Multivariate analysis revealed that a longer surgery-to-ECLS time was a risk factor of hospital mortality (OR=1.765, CI=1.030-3.026, p=0.039). The best cut-off point of surgery-to-ECLS time to predict hospital mortality by the ROC curve was 2 days. (AUC, 0.919; 95% CI=0.821-0.999, p=0.001). Hospital mortality was significantly higher in the patient group with surgery-to-ECLS time > 2days (28.6% in the surgery-to-ECLS time≤2days and 91.3% in the surgery-to-ECLS time > 2days, p=0.003, Fig. 1).
Conclusion : ECLS after GTS can be a viable option as a rescue therapy. Both late presentation of complications and delayed application of ECLS are predictors of death.
Methods : There were 17,185 adult GTS procedures between 2005 and 2013 at our institution; resection of the lung (n=10,434, 60.7%), esophagus (n=1,847, 10.7%), and other procedures (n=4,904, 28.5%). Among them, 30 (0.2%) patients were supported by ECLS postoperatively.
Results : The median age was 65 years (range: 24-81). The primary operations were lobectomy (n=14, 46.7%), pneumonectomy (n=10, 33.3%), bilobectomy (n=5, 16.7%), and esophageal surgery (n=1, 3.3%). Initially, the mode of ECLS was veno-veno (VV) type in 21 patients (70.0%) and veno-arterial (VA) type in 9 patients (30.0%). There were 12 (40.0%) weaning successes and 7 (23.3%) survival discharges. Multivariate analysis revealed that a longer surgery-to-ECLS time was a risk factor of hospital mortality (OR=1.765, CI=1.030-3.026, p=0.039). The best cut-off point of surgery-to-ECLS time to predict hospital mortality by the ROC curve was 2 days. (AUC, 0.919; 95% CI=0.821-0.999, p=0.001). Hospital mortality was significantly higher in the patient group with surgery-to-ECLS time > 2days (28.6% in the surgery-to-ECLS time≤2days and 91.3% in the surgery-to-ECLS time > 2days, p=0.003, Fig. 1).
Conclusion : ECLS after GTS can be a viable option as a rescue therapy. Both late presentation of complications and delayed application of ECLS are predictors of death.
책임저자: Ji-Hyuk Yang
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
발표자: Heemoon Lee, E-mail : rhythmists@gmail.com