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Sepsis in postcardiotomy cardiogenic shock patients supported with veno-arterial extracorporeal membrane oxygenation.

BACKGROUND: Sepsis could affect the outcomes of patients with postcardiotomy cardiogenic shock supported with extracorporeal membrane oxygenation (ECMO). Our objectives were to characterize sepsis patients with ECMO support for postcardiotomy cardiogenic shock and assess its predictors and effect on patients' outcomes.

METHODS: This retrospective study included 103 patients with ECMO for postcardiotomy cardiogenic shock from 2009 to 2020. Patients were divided according to the occurrence and timing of sepsis into three groups. Group 1 included patients with no sepsis ( n  = 67), Group 2 included patients with ECMO-related sepsis ( n  = 10), and Group 3 included patients with non-ECMO-related sepsis ( n  = 26).

RESULTS: Lactate level before ECMO was highest in the ECMO-associated sepsis group (Group 1 and 2 p  = 0.003 and Group 2 and 3 p  = 0.003). Dialysis and gastrointestinal bleeding were highest in ECMO-associated sepsis ( p  = 0.03 and 0.04, respectively). Blood transfusion was higher in ECMO-associated sepsis than in patients with no sepsis ( p  = 0.01). Mortality was nonsignificantly higher in patients with ECMO-associated sepsis. High BMI (OR: 1.11; p  = 0.004), preoperative dialysis (OR: 7.35; p  = 0.02), preoperative IABP (OR: 9.9.61; p  = 0.01) and CABG (OR: 6.29; p  = 0.01) were significantly associated with sepsis. Older age (OR: 1.08; p = 0.004), lower BSA (OR: 0.004; p  = 0.003), peripheral cannulation (OR: 29.82; p  = 0.03), and high pre ECMO lactate level (OR: 1.24; p  = 0.001) were associated with increased mortality. Sepsis did not predict mortality (OR: 1.83; p  = 0.21).

CONCLUSIONS: Sepsis is a dreaded complication in patients with postcardiotomy cardiogenic shock, especially ECMO-associated sepsis. Preoperative risk factors could predict postoperative sepsis in ECMO patients.

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