title: Five-year results of 219 consecutive patients treated with extracorporeal membrane oxygenation for refractory postoperative cardiogenic shock.
abstract: 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.
authors.affiliation: Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany. dolln@medizin.uni-leipzig.de
authors.forename: Nicolas
authors.initials: N
authors.lastname: Doll
authors.forename: Bob
authors.initials: B
authors.lastname: Kiaii
authors.forename: Michael
authors.initials: M
authors.lastname: Borger
authors.forename: Jan
authors.initials: J
authors.lastname: Bucerius
authors.forename: Klaus
authors.initials: K
authors.lastname: Krämer
authors.forename: Dierk V
authors.initials: DV
authors.lastname: Schmitt
authors.forename: Thomas
authors.initials: T
authors.lastname: Walther
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
mesh_terms: 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