Temporary extracorporeal membrane oxygenation in patients with refractory postoperative cardiogenic shock--a single center experience.
BACKGROUND
Approximately 1% of patients require temporary circulatory support due to refractory cardiogenic shock following cardiac surgery. Such patients are at very high risk for subsequent morbidity and mortality. We evaluated the results of temporary extracorporeal membrane oxygenation (ECMO) support in patients with postcardiotomy cardiogenic shock.


METHODS
From November 1997 to February 2000, 7900 patients underwent cardiac surgery in our institution. Ninety-five patients (1.2%) (CABG, n = 63; AVR, n = 16; CABG and AVR, n = 8; other procedures, n = 8) required temporary postoperative ECMO support. ECMO implantation was performed via the femoral vessels or via the right atrium and ascending aorta. Intraaortic balloon counterpulsation was employed in all patients.


RESULTS
Mean duration of ECMO support was 2.8 +/- 2.1 days. Forty-five patients (47%) were successfully weaned from ECMO. Of these, 28 patients were discharged from hospital 35.8 +/- 20.8 days post-ECMO support. Overall hospital mortality for all ECMO patients was considerable at 71%. Mortality rate in the combined CABG and AVR group was 100% (P < 0.05 versus the other surgical groups). ECMO support was complicated by renal failure in 64% of patients, bleeding requiring mediastinal reexploration in 62%, ischemia of the lower limbs in 16%, cerebral edema in 6%, and cerebral hemorrhage in 3%.


CONCLUSIONS
ECMO is a suitable technique for short-term treatment of refractory postoperative low cardiac output. Mortality rates are comparable to other cardiac assist devices, with approximately 30% of patients able to be discharged from hospital.
Doll
Nicolas
N
Department of Cardiac Surgery, Heart Center, University of Leipzig, Strumpellstrasse 39, 04289 Leipzig, Germany. dolln@medizin.uni-leipzig.de
Fabricius
Alexander
A
Borger
Michael A
MA
Bucerius
Jan
J
Doll
Susanne
S
Krämer
Klaus
K
Ullmann
Chris
C
Schmitt
Dirk V
DV
Walther
Thomas
T
Falk
Volkmar
V
Mohr
Friedrich W
FW
D000368:Aged; D002303:Cardiac Output, Low / Q000628:therapy; D001026:Coronary Artery Bypass; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006440:Hemofiltration; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D012770:Shock, Cardiogenic / Q000628:therapy*