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Emergency Abdominal Surgery Outcomes of Critically Ill Patients on Extracorporeal Membrane Oxygenation: A Case-Matched Study with a Propensity Score Analysis

  • Anna Taieb
  • Florence Jeune
  • Said Lebbah
  • Matthieu Schmidt
  • Romain Deransy
  • Jean-Christophe Vaillant
  • Charles-Edouard Luyt
  • Christophe TrésalletEmail author
  • Alain Combes
  • Nicolas Bréchot
Original Scientific Report
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Abstract

Background

Extracorporeal membrane oxygenation (ECMO) induces coagulation disorders increasing the risk of bleeding during invasive procedures. We aimed to describe the outcomes of critically ill ECMO patients undergoing emergency abdominal surgery compared to non-ECMO patients.

Study design

This is a retrospective case-matched single-center study with propensity score analysis in a tertiary ICU. All patients who underwent abdominal surgery were included.

Results

From 2006 to 2014, 77 patients admitted in our ICU underwent emergency abdominal surgery, 35 were on ECMO. Surgery indications were comparable for ECMO and non-ECMO patients: mostly intestinal ischemia (42%) and cholecystectomy (25%). Postoperative bleeding was significantly more frequent in ECMO group versus non-ECMO: 77% versus 40% transfused, with medians of 13 (6–22) versus 3 (0–5) packed red blood cell; 9 (3–17) versus 0 (0–4) fresh frozen plasma and 12 (3–22) versus 0 (0–8) platelet units (p < 0.001 for all items). Reintervention for hemorrhage was required in 20% versus 2%, respectively, p = 0.02. At multivariable analysis, ECMO was strongly associated with bleeding (OR, 5.6 [95% CI, 2.0–15.4]; p = 0.001). ICU mortality was higher for ECMO-treated patients (69% vs. 33%; p = 0.003), but perioperative mortality remained comparable between groups (11% vs. 12%, NS). Propensity score-matched analysis confirmed more frequent and severe bleeding in ECMO patients.

Conclusions

Abdominal surgery procedures on ECMO-treated patients are associated with a higher risk of hemorrhage compared to non-ECMO ICU patients. Further studies are needed to optimize ECMO patient management during such interventions.

Abbreviations

ARDS

Acute respiratory distress syndrome

ECMO

Extracorporeal membrane oxygenation

PRBCs

Packed red blood cell units

SAPS

Simplified Acute Physiology Score

SOFA

Sepsis-related organ failure assessment

VA-ECMO

Venoarterial-extracorporeal membrane oxygenation

VV-ECMO

Venovenous-extracorporeal membrane oxygenation

Notes

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Supplementary material

268_2019_4930_MOESM1_ESM.pdf (314 kb)
Supplementary material 1 (PDF 313 kb)

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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Anna Taieb
    • 1
  • Florence Jeune
    • 2
  • Said Lebbah
    • 3
  • Matthieu Schmidt
    • 4
    • 5
  • Romain Deransy
    • 6
  • Jean-Christophe Vaillant
    • 2
  • Charles-Edouard Luyt
    • 4
    • 5
  • Christophe Trésallet
    • 1
    • 7
    Email author
  • Alain Combes
    • 4
    • 5
  • Nicolas Bréchot
    • 4
    • 8
  1. 1.Department of Digestive and Endocrine Surgery, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de ParisSorbonne University (Paris 6)ParisFrance
  2. 2.Department of Digestive and Hepato-Pancreato-Biliary Surgery, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de ParisSorbonne University (Paris 6)ParisFrance
  3. 3.Clinical Research Department, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de ParisSorbonne University (Paris 6)ParisFrance
  4. 4.Medical–Surgical ICU, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de ParisSorbonne University (Paris 6)ParisFrance
  5. 5.INSERM, UMRS_1166-iCANInstitute of Cardiometabolism and NutritionParisFrance
  6. 6.Department of Anesthesiology and Critical Care, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de ParisSorbonne University (Paris 6)ParisFrance
  7. 7.INSERM-CNRS U 678- laboratoire d’imagerie Biomédicale (LIB), Departement of General, Visceral and Endocrine Surgery, Groupe Hospitalier Pitié–SalpêtrièreSorbonne University (Paris 6)Paris Cedex 13France
  8. 8.INSERM U1050, Centre Interdisciplinaire de Recherche en BiologieCollege de FranceParisFrance

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