Venoarterial extracorporeal membrane oxygenation for treatment of cardiogenic shock: clinical experiences in 45 adult patients.
OBJECTIVE
Venoarterial extracorporeal membrane oxygenation is an established treatment option in patients with cardiogenic shock. This report reviews our 3-year experience with this support system with respect to early and midterm outcome, as well as predictors of survival.


METHODS
From January 2003 until November 2006, 45 (0.8%) of 5750 patients undergoing cardiac surgery procedures required the following: temporary extracorporeal membrane oxygenation support coronary artery bypass grafting, n = 20; implantation of a left ventricular assist device, n = 5; heart transplantation, n = 1; heart and lung transplantation, n = 1; coronary artery bypass grafting plus repair of postinfarction ventricular septal defect, n = 3; coronary artery bypass grafting plus mitral valve repair, n = 5; aortic valve replacement, n = 2; coronary artery bypass grafting plus aortic valve replacement, n = 3; and other procedures, n = 5. Extracorporeal membrane oxygenation implantation was performed through the femoral vessels or axillary artery or through the right atrium and ascending aorta. Additional intra-aortic balloon pumps were used in 30 patients.


RESULTS
Average patient age was 60.1 +/- 13.6 years. There were 35 male patients. Average duration of extracorporeal membrane oxygenation was 6.4 +/- 4.5 days. Twenty-five patients could be successfully weaned from extracorporeal membrane oxygenation. The 30-day mortality was 53% (24/45 patients). The in-hospital mortality was 71% (32/45 patients). Thirteen (29%) patients could be successfully discharged. After a follow-up period of up to 3 years, 10 (22%) patients were still alive.


CONCLUSIONS
Extracorporeal membrane oxygenation offers sufficient cardiopulmonary support in adults with similar hospital and midterm survival rates to those of other mechanical support systems. Early indication, alternative peripheral cannulation techniques, and reduced anticoagulation to avoid perioperative bleeding could improve our results with increasing experience.
Bakhtiary
Farhad
F
Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt/Main, Germany. farhad@bakhtiary.de
Keller
Harald
H
Dogan
Selami
S
Dzemali
Omer
O
Oezaslan
Feyzan
F
Meininger
Dirk
D
Ackermann
Hanns
H
Zwissler
Bernhard
B
Kleine
Peter
P
Moritz
Anton
A
D000367:Age Factors; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D002423:Cause of Death; D015331:Cohort Studies; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome