Abdominal Surgery Needs Extracorporeal Life Support as a Final Back-up

Abstract Background: There are very limited published data regarding the experience of extracorporeal membrane oxygenation (ECMO) after abdominal surgery. Our objective was to examine the clinical application and outcome of ECMO in patients deteriorating early after abdominal surgery. Methods: Between 1998 and 2018, patients who had ECMO implantation within 30 days after abdominal surgery were enrolled. Clinical outcomes, patient demographics, ECMO types and indications, laboratory findings and other relevant aspects of their medical histories were reviewed. Results: Sixteen patients aged between 20 and 77 years were enrolled, including 11 patients who underwent elective surgery and 5 who underwent emergency laparotomies. Six veno-arterial ECMO (VA-ECMO) and 10 veno-venous ECMO (VV-ECMO) devices were implanted for refractory hypotension or acute respiratory distress syndrome (ARDS) based on the clinical discretion of the attending physician. After timely diagnosis of the aetiology underlying the deterioration, 4 additional salvage interventions were allowed under ECMO support. Three VA-ECMO and 5 VV-ECMO patients were successfully weaned, while 5 patients (31.25%) survived to hospital discharge without significant sequelae. Patients who survived to discharge had a significant inotropic dose taper on day two after ECMO implantation (59.4 versus 1.3 mcg/kg/min, p = 0.0487). ECMO-related complications included 3 implantation wound haematomas, limb ischaemia requiring wound debridement and reperfusion catheter insertion. There was no intra-abdominal bleeding or major thromboembolic event in our series. Conclusions: ECMO gave surgeons additional chances to treat reversible cause of sudden patient collapse after the timely diagnosis of the cause. No patients in our cohort encountered serious ECMO-related complications. Our study demonstrated that ECMO may be used as a final back-up for sudden deterioration after abdominal surgery.