C McCann1, K Adams2, A Schizas3, M George4, N A Barrett5, D L A Wyncoll6, L Camporota7. 1. Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. Electronic address: claire.mccann@doctors.org.uk. 2. Department of Colorectal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. Electronic address: katieadams1@nhs.net. 3. Department of Colorectal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. Electronic address: alexis.schizas@gstt.nhs.uk. 4. Department of Colorectal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. Electronic address: mark.george@gstt.nhs.uk. 5. Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human & Applied Physiological Sciences, King's College London, London, United Kingdom. Electronic address: nicolas.barrett@gstt.nhs.uk. 6. Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. Electronic address: duncan.wyncoll@gstt.nhs.uk. 7. Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human & Applied Physiological Sciences, King's College London, London, United Kingdom. Electronic address: luigi.camporota@gstt.nhs.uk.
Abstract
PURPOSE: There is a paucity of literature to support undertaking emergency laparotomy when indicated in patients supported on ECMO. Our study aims to identify the prevalence, outcomes and complications of this high risk surgery at a large ECMO centre. MATERIALS AND METHODS: A single centre, retrospective, observational cohort study of 355 patients admitted to a university teaching hospital Severe Respiratory Failure service between December 2011 and January 2017. RESULTS: The prevalence of emergency laparotomy in patients on ECMO was 3.7%. These patients had significantly higher SOFA and APACHE II scores compared to similar patients not requiring laparotomy. There was no difference in the duration of ECMO or intensive care unit (ICU) stay post decannulation between the two groups. 31% of laparotomy patients survived to hospital discharge. Major haemorrhage was uncommon, however emergency change of ECMO oxygenator was commonly required. CONCLUSION: Survival to hospital discharge is possible following emergency laparotomy on ECMO, however the mortality is higher than for those patients not requiring laparotomy, this likely reflects the severity of underlying organ failure rather than the surgery itself. Our service's collocation with a general surgical service has made this development in care possible. ECMO service planning should consider general surgical provision. Crown
PURPOSE: There is a paucity of literature to support undertaking emergency laparotomy when indicated in patients supported on ECMO. Our study aims to identify the prevalence, outcomes and complications of this high risk surgery at a large ECMO centre. MATERIALS AND METHODS: A single centre, retrospective, observational cohort study of 355 patients admitted to a university teaching hospital Severe Respiratory Failure service between December 2011 and January 2017. RESULTS: The prevalence of emergency laparotomy in patients on ECMO was 3.7%. These patients had significantly higher SOFA and APACHE II scores compared to similar patients not requiring laparotomy. There was no difference in the duration of ECMO or intensive care unit (ICU) stay post decannulation between the two groups. 31% of laparotomy patients survived to hospital discharge. Major haemorrhage was uncommon, however emergency change of ECMO oxygenator was commonly required. CONCLUSION: Survival to hospital discharge is possible following emergency laparotomy on ECMO, however the mortality is higher than for those patients not requiring laparotomy, this likely reflects the severity of underlying organ failure rather than the surgery itself. Our service's collocation with a general surgical service has made this development in care possible. ECMO service planning should consider general surgical provision. Crown