Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock.
OBJECTIVE
To assess the outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation (ECMO) for refractory cardiogenic shock.


METHODS
Refractory cardiogenic shock is almost always lethal without emergency circulatory support, e.g., ECMO. ECMO-associated morbidity and mortality plead for identification of early predictors of its failure, and detailed analyses of short- and long-term outcomes to refine patient selection and improve results. Outcomes of 81 patients given ECMO support for medical (n = 55), postcardiotomy (n = 16), or posttransplantation (n = 10) cardiogenic shock were evaluated.


RESULTS
Thirty-four (42%) patients survived to hospital discharge; 57% suffered > or = 1 major ECMO-related complications. Independent predictors of intensive care unit death were: device insertion under cardiac massage (odds ratio [OR] = 20.68), 24 hr urine output < 500 mL (OR = 6.52), prothrombin activity < 50% (OR = 3.93), and female sex (OR = 3.89); myocarditides were associated with better outcomes (OR = .13). Sequelae and health-related quality-of-life were evaluated for 28 long-term survivors (median follow-up, 11 months), whose mean Short-Form 36 scores were significantly lower than matched healthy controls for physical role, general health, and social functioning, but higher than those reported for patients on chronic hemodialysis, with advanced heart failure, or after recovery from acute respiratory distress syndrome.


CONCLUSIONS
ECMO support can rescue 40% of otherwise fatal cardiogenic shock patients but its initiation under cardiac massage or after renal or hepatic failure carried higher risks of intensive care unit death, while fulminant myocarditis had a better prognosis. Despite satisfactory mental health and vitality, long-term survivors' persistent physical and social problems might benefit from tailored medical or psychosocial interventions.
Combes
Alain
A
Service de Réanimation Médicale, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris 6, Paris, France. alain.combes@psl.aphp.fr
Leprince
Pascal
P
Luyt
Charles-Edouard
CE
Bonnet
Nicolas
N
Trouillet
Jean-Louis
JL
Léger
Philippe
P
Pavie
Alain
A
Chastre
Jean
J
D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012770:Shock, Cardiogenic / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome