Heterogeneity in clinical practices for post‐cardiotomy extracorporeal life support: A pilot survey from the PELS‐1 multicenter study

Abstract

AbstractBackgroundHigh‐quality evidence for post‐cardiotomy extracorporeal life support (PC‐ECLS) management is lacking. This study investigated real‐world PC‐ECLS clinical practices.MethodsThis 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.ResultsOf 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.ConclusionsThis study shows remarkable heterogeneity in clinical practices for PC‐ECLS management. More standardized protocols and better implementation of the available evidence are recommended.