Outcomes of emergency laparotomy in patients on extracorporeal membrane oxygenation for severe respiratory failure: A retrospective, observational cohort study

• Published in: Journal of critical care 2019-10, Vol.53, p.253-257
• Main Authors: McCann, C., Adams, K., Schizas, A., George, M., Barrett, N.A., Wyncoll, D.L.A., Camporota, L.
• Format: Article
• Language: English
• Subjects: Abdomen; Archives & records; Blood; Cohort analysis; Critical care; Emergency laparotomy; Extracorporeal membrane oxygenation; General surgery; Independent sample; Medical imaging; Mortality; Observational studies; Ostomy; Patients; Pneumonia; Respiratory distress syndrome; Respiratory failure; Sepsis; Severe respiratory failure; Surgery; Swine flu
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2019.06.021

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. 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. 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. 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. •Acute abdominal pathology requiring laparotomy is not rare in the ECMO population.•Those patients with more organ failure are more likely to need laparotomy.•Ceasing heparin and using procoagulants may limit incidence of major haemorrhage.•There is a common requirement for emergency ECMO oxygenator change postoperatively.•One third of patients who underwent laparotomy on ECMO were discharged home.