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The Need for Emergency Laparotomy With Open Abdomen Therapy in the Course of ECMO—A Retrospective Analysis of Course and Outcome

Background: Abdominal compartment syndrome (ACS) can occur in patients placed on extra corporeal membrane oxygenation (ECMO). This implies the necessity of decompressive laparotomy followed by an open abdomen (OA) to prevent complications such as multi-organ-failure or death. Methods: We searched fo...

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Autores principales: Schulz, Sissy-A., Schaefer, Simone, Richards, Dana C., Karagiannidis, Christian, Thomaidis, Panagiotis, Heiss, Markus M., Bulian, Dirk R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7498926/
https://www.ncbi.nlm.nih.gov/pubmed/33102513
http://dx.doi.org/10.3389/fsurg.2020.00063
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author Schulz, Sissy-A.
Schaefer, Simone
Richards, Dana C.
Karagiannidis, Christian
Thomaidis, Panagiotis
Heiss, Markus M.
Bulian, Dirk R.
author_facet Schulz, Sissy-A.
Schaefer, Simone
Richards, Dana C.
Karagiannidis, Christian
Thomaidis, Panagiotis
Heiss, Markus M.
Bulian, Dirk R.
author_sort Schulz, Sissy-A.
collection PubMed
description Background: Abdominal compartment syndrome (ACS) can occur in patients placed on extra corporeal membrane oxygenation (ECMO). This implies the necessity of decompressive laparotomy followed by an open abdomen (OA) to prevent complications such as multi-organ-failure or death. Methods: We searched for ECMO patients in our hospital database between July 2015 and April 2020 and selected those with an emergency laparotomy and OA therapy. Of these, we analyzed only patients who were treated with an OA after establishing the ECMO regarding patient-related parameters like sex, age, height, weight, and indications for ECMO as well as outcome parameters like complete fascial closure rate, mortality, length of stay in intensive care unit (ICU), length and kind of OA therapy, number of surgical procedures, dressing changes concerning negative pressure wound therapy (NPWT), and number of surgical revisions. Results: In eight out of 421 patients (1.9%), a laparostoma had to be created during ECMO support. For temporary closure, either NPWT, abdominal packing, or both were used. The median length of OA therapy was 17 days, and the median length of stay in ICU was 42 days in total. The median number of surgical procedures and NPWT dressing changes was seven. In three of the eight patients, a surgical revision was necessary. The total mortality rate was 50%. In 75%, the fascia could be closed. Two patients died before final closure. In all deceased patients, an abdominal packing was necessary during the course of treatment; in the survivors, only once. No enteroatmospheric fistula or abscesses occurred. Conclusions: ACS in patients placed on ECMO is a very rare condition with a considerable mortality rate but high secondary closure rate of the fascia. A necessary abdominal packing due to a severe bleeding seems to be a risk factor with a potentially fatal outcome.
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spelling pubmed-74989262020-10-22 The Need for Emergency Laparotomy With Open Abdomen Therapy in the Course of ECMO—A Retrospective Analysis of Course and Outcome Schulz, Sissy-A. Schaefer, Simone Richards, Dana C. Karagiannidis, Christian Thomaidis, Panagiotis Heiss, Markus M. Bulian, Dirk R. Front Surg Surgery Background: Abdominal compartment syndrome (ACS) can occur in patients placed on extra corporeal membrane oxygenation (ECMO). This implies the necessity of decompressive laparotomy followed by an open abdomen (OA) to prevent complications such as multi-organ-failure or death. Methods: We searched for ECMO patients in our hospital database between July 2015 and April 2020 and selected those with an emergency laparotomy and OA therapy. Of these, we analyzed only patients who were treated with an OA after establishing the ECMO regarding patient-related parameters like sex, age, height, weight, and indications for ECMO as well as outcome parameters like complete fascial closure rate, mortality, length of stay in intensive care unit (ICU), length and kind of OA therapy, number of surgical procedures, dressing changes concerning negative pressure wound therapy (NPWT), and number of surgical revisions. Results: In eight out of 421 patients (1.9%), a laparostoma had to be created during ECMO support. For temporary closure, either NPWT, abdominal packing, or both were used. The median length of OA therapy was 17 days, and the median length of stay in ICU was 42 days in total. The median number of surgical procedures and NPWT dressing changes was seven. In three of the eight patients, a surgical revision was necessary. The total mortality rate was 50%. In 75%, the fascia could be closed. Two patients died before final closure. In all deceased patients, an abdominal packing was necessary during the course of treatment; in the survivors, only once. No enteroatmospheric fistula or abscesses occurred. Conclusions: ACS in patients placed on ECMO is a very rare condition with a considerable mortality rate but high secondary closure rate of the fascia. A necessary abdominal packing due to a severe bleeding seems to be a risk factor with a potentially fatal outcome. Frontiers Media S.A. 2020-09-04 /pmc/articles/PMC7498926/ /pubmed/33102513 http://dx.doi.org/10.3389/fsurg.2020.00063 Text en Copyright © 2020 Schulz, Schaefer, Richards, Karagiannidis, Thomaidis, Heiss and Bulian. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Surgery
Schulz, Sissy-A.
Schaefer, Simone
Richards, Dana C.
Karagiannidis, Christian
Thomaidis, Panagiotis
Heiss, Markus M.
Bulian, Dirk R.
The Need for Emergency Laparotomy With Open Abdomen Therapy in the Course of ECMO—A Retrospective Analysis of Course and Outcome
title The Need for Emergency Laparotomy With Open Abdomen Therapy in the Course of ECMO—A Retrospective Analysis of Course and Outcome
title_full The Need for Emergency Laparotomy With Open Abdomen Therapy in the Course of ECMO—A Retrospective Analysis of Course and Outcome
title_fullStr The Need for Emergency Laparotomy With Open Abdomen Therapy in the Course of ECMO—A Retrospective Analysis of Course and Outcome
title_full_unstemmed The Need for Emergency Laparotomy With Open Abdomen Therapy in the Course of ECMO—A Retrospective Analysis of Course and Outcome
title_short The Need for Emergency Laparotomy With Open Abdomen Therapy in the Course of ECMO—A Retrospective Analysis of Course and Outcome
title_sort need for emergency laparotomy with open abdomen therapy in the course of ecmo—a retrospective analysis of course and outcome
topic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7498926/
https://www.ncbi.nlm.nih.gov/pubmed/33102513
http://dx.doi.org/10.3389/fsurg.2020.00063
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