Application of "double bridge mechanical" resuscitation for profound cardiogenic shock leading to cardiac transplantation.
BACKGROUND
In patients with acute profound cardiogenic circulatory failure unresponsive to conventional resuscitation, we instituted immediate aggressive application of extracorporeal membrane oxygenation (ECMO) to restore circulatory stability. Long-term hemodynamic support was accomplished with an early "bridge" to ventricular assist device (VAD) before definitive treatment with cardiac transplantation.


METHODS
A respective review of ECMO and VAD data registries was instituted.


RESULTS
From May 1996 to July 2000, 23 patients were placed on ECMO support for profound cardiogenic circulatory failure. Eleven patients (47%) were withdrawn from support due to severe neurologic injury or multisystem organ failure. Three patients (13%) were weaned off ECMO with good outcome. Nine patients (39%) were transferred to a VAD. Two patients expired while on VAD support, and 7 of the VAD-supported patients (78%) survived to transplantation. Overall survival was 43%.


CONCLUSIONS
Emergent ECMO support is a salvage approach for cardiac resuscitation once conventional measures have failed. In neurologically intact patients, the early transfer to a VAD quickly stabilizes hemodynamics, avoids complications, and is essential for long-term circulatory support before definitive treatment with cardiac transplantation.
Bowen
F W
FW
Department of Surgery, School of Medicine, University of Pennsylvania, Philadelphia, USA.
Carboni
A F
AF
O'Hara
M L
ML
Pochettino
A
A
Rosengard
B R
BR
Morris
R J
RJ
Gorman
R C
RC
Gorman
J H
JH
Acker
M A
MA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D012042:Registries; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome