Five-year results of 219 consecutive patients treated with extracorporeal membrane oxygenation for refractory postoperative cardiogenic shock.
BACKGROUND
Postcardiotomy cardiogenic shock occurs in approximately 1% of patients. We prospectively evaluated the early and long-term outcome as well as predictors of survival when using temporary extracorporeal membrane oxygenation (ECMO) support.


METHODS
During 5 years 219 of 18150 patients (1.2%) undergoing cardiac surgery (coronary artery bypass grafting, n = 119; aortic valve replacement, n = 24; coronary artery bypass grafting and aortic valve replacement, n = 21; coronary artery bypass grafting and mitral valve replacement, n = 11; other procedures, n = 44) required temporary postoperative ECMO support. The ECMO implantation was performed through the femoral vessels or through the right atrium and ascending aorta. Additional intraaortic balloon counterpulsation was employed in 144 patients to improve coronary blood flow.


RESULTS
Mean duration of ECMO support was 2.8 +/- 2.2 days. One hundred thirty-four patients (60%) were successfully weaned from ECMO. Of these, 52 patients (24%) were discharged from the hospital after 29.9 +/- 24 days. The main cause of death was myocardial failure. Five-year follow-up is 96% complete; 37 patients (74%) were alive with reasonable exercise capacity.


CONCLUSIONS
Extracorporeal membrane oxygenation is an acceptable technique for short-term treatment of refractory postoperative low cardiac output. It can save the lives of a group of very high risk patients.
Doll
Nicolas
N
Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany. dolln@medizin.uni-leipzig.de
Kiaii
Bob
B
Borger
Michael
M
Bucerius
Jan
J
Krämer
Klaus
K
Schmitt
Dierk V
DV
Walther
Thomas
T
Mohr
Friedrich W
FW
D000368:Aged; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies; D012770:Shock, Cardiogenic / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors