(225) Outcomes of Patients Undergoing Emergency Laparotomy on ECMO: A Retrospective, Observational Study

Introduction: Patients supported with extracorporeal membrane oxygenation (ECMO) are some of the most critically ill patients who are at increased risk of intra-abdominal complications necessitating emergency laparotomy (EL). There is paucity of data regarding the outcomes in patients undergo EL while receiving ECMO support.

Methods: This was a retrospective observational study conducted on all the patients who received ECMO support between January 1st, 2018 and to June 30th, 2023. SOFA score within 24 h postadmission to ICU, ECMO duration, ICU length of stay, type of surgery, duration on mechanical ventilation, length of hospitalization and mortality were recorded. Initial SOFA score, mortality and post and pre surgical complications were calculated and correlated with mortality and duration of stay in ICU.

Results: Forty patients (out of 220 patients who received ECMO – 18.2%) underwent EL while on ECMO during the study period. A total of 30 % of the patients were on venovenous (VV) ECMO with the remaining 70 % on venoarterial (VA) ECMO during the surgery. Bowel ischemia was the most common pathology (50%) followed by intra-abdominal hemorrhage (28%). The mortality rate was 77.5%, re-exploratory laparotomy was seen in 82.5 % of patients and post-operative AKI incidence was 59.4%. The mean duration of stay in the ICU of the survivors was 61.1 days with average duration on ECMO at 24.44 days whereas the average length of stay in ICU and ECMO support for non-survivors stood at 84.1 days and 42.70 days respectively. The period of invasive mechanical ventilation among survivors was 21.5 days and non-survivors at 33.6 days. The maximum SOFA score in survivors (4.75 ± 2.50) was significantly lower than nonsurvivor (8.9 ± 3.70).

Conclusions: Requirement for EL amongst patients on ECMO is high – more so in the VAECMO population compared to those supported with VVECMO. Bowel ischemia and intra-abdominal bleed are more common pathologies necessitating surgical intervention. Non-survivors following the surgery are likely to be more critically ill at admission, have longer duration of ECMO support, ICU stay and mechanical ventilator support.