title: Extracorporeal membrane oxygenation in 108 patients with low cardiac output – a single-center experience.
abstract: BACKGROUND
  For short-term ventricular and pulmonary support the extracorporeal membrane oxygenation (ECMO) system using the Bio-Medicus centrifugal pump (Medtronic®, Minneapolis, MN, USA) was applied in 108 patients with cardiac low-output.
  
  
  METHODS
  From December 1996 to July 2006 the ECMO was implanted in 108 patients (73 adult, mean age: 49.3±18.0 yrs and 35 children, mean age: 1.3 ± 2.7 yrs) with mostly postcardiotomy cardiac low output. The surgical procedures included congenital heart surgery (n=35), heart transplantation (HTx) (n=21), coronary artery bypass operation (CABG) and/or valvular operation (n=33), other operations (n=6) and 13 patients with ECMO support for bridge to recovery.
  
  
  RESULTS
  The mean supporting time was 5.1±5.6 days. Overall, 30-day-survival was 40.2%. Best survival rates were seen after congenital heart surgery (24/35, 65.7%) and after HTx (9/21, 42.9%); the worst rates were in the group of CABG and/or valvular operations (5/33, 15.2%), only ECMO support (3/13, 23.1%) and other operations (1/6, 16.7%). Fifty-four patients died while supported by ECMO, 15 were weaned from ECMO but died in hospital, 39 patients were weaned and survived. Causes of death were multi-organ failure (40.6%), bleeding (23.2%), persistent cardiac low output (21.7%), thrombembolic events (8.7%), and graft failure (5.8%). Markers for adverse outcome were identified as older age, high body weight, increased AST/GOT levels, and lower thrombocyte count in adults; and as higher levels of serum creatinine in pediatric patients.
  
  
  CONCLUSIONS
  ECMO support showed best results in pediatric patients after congenital heart surgery and in patients after HTx in contrast to multimorbid, older patients with often irreversible myocardial damage.
authors.affiliation: Department of Cardiac Surgery, Grosshadern University Hospital, Ludwig-Maximilians-University (LMU) Munich - Germany. abeiras@med.uni-muenchen.de
authors.forename: Andres
authors.initials: A
authors.lastname: Beiras-Fernandez
authors.forename: Marcus-André
authors.initials: MA
authors.lastname: Deutsch
authors.forename: Sandra
authors.initials: S
authors.lastname: Kainzinger
authors.forename: Ingo
authors.initials: I
authors.lastname: Kaczmarek
authors.forename: Ralf
authors.initials: R
authors.lastname: Sodian
authors.forename: Peter
authors.initials: P
authors.lastname: Ueberfuhr
authors.forename: Bruno
authors.initials: B
authors.lastname: Meiser
authors.forename: Michael
authors.initials: M
authors.lastname: Schmoeckel
authors.forename: Bruno
authors.initials: B
authors.lastname: Reichart
authors.forename: Paolo
authors.initials: P
authors.lastname: Brenner
mesh_terms: D000328:Adult; D001672:Biocompatible Materials; D002302:Cardiac Output; D002303:Cardiac Output, Low / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D005858:Germany; D006353:Heart-Assist Devices; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials