title: When to discontinue extracorporeal membrane oxygenation for postcardiotomy support.
abstract: BACKGROUND
  Extracorporeal membrane oxygenation (ECMO) has demonstrated limited success in adult postcardiotomy shock. The goal of this study was to determine when to discontinue ECMO for postcardiotomy support.
  
  
  METHODS
  During a 7-year period ECMO was used in 51 postcardiotomy patients, of whom 16 (31%) weaned and 8 (16%) survived.
  
  
  RESULTS
  Patients in the heart transplant group were more likely to wean compared with patients in the non-heart transplant group (p = 0.03). Patients aged greater than 65 years (p = 0.04) or with ejection fractions of less than 30% after 48 hours of ECMO (p < 0.001) were less likely to wean. Time on ECMO was significantly longer for survivors in the heart transplant group (101.3 +/- 7.5 hours) compared with survivors in the non-heart transplant group (28.3 +/- 11.9 hours, p < 0.001).
  
  
  CONCLUSIONS
  After 48 to 72 hours, consideration should be given to discontinuing ECMO, either by moving to an implantable ventricular assist device or by withdrawal of support, except in those patients with heart transplants. In the latter, both severe postoperative pulmonary hypertension and reperfusion injury may take as long as 120 hours to reverse.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Fiser
authors.forename: C G
authors.initials: CG
authors.lastname: Tribble
authors.forename: A K
authors.initials: AK
authors.lastname: Kaza
authors.forename: S M
authors.initials: SM
authors.lastname: Long
authors.forename: R K
authors.initials: RK
authors.lastname: Zacour
authors.forename: J A
authors.initials: JA
authors.lastname: Kern
authors.forename: I L
authors.initials: IL
authors.lastname: Kron
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D006976:Hypertension, Pulmonary / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000628:therapy; D013997:Time Factors