title: Peripheral extracorporeal membrane oxygenation system as salvage treatment of patients with refractory cardiogenic shock: preliminary outcome evaluation.
abstract: The novel Permanent Life Support (PLS; Maquet, Jostra Medizintechnik AG, Hirrlingen, Germany) as peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) support system has been investigated as treatment for patients with refractory cardiogenic shock (CS). Between January 2007 and July 2011, 73 consecutive adult patients were supported on peripheral PLS ECMO system at our institution (55 men; age 60.3 ± 11.6 years, range: 23-84 years). Indications for support were failure to wean from cardiopulmonary bypass in the setting of postcardiotomy (n = 50) and primary donor graft failure (n = 8), post-acute myocardial infarction CS (n = 12), and CS on chronic heart failure (n = 3). Mean support time was 10.9 ± 7.6 days (range: 2-34 days). Overall, 26 (35.6%) patients died on ECMO. Among survivors on ECMO, 44 (60.2%) patients were successfully weaned from support, and three (4.1%) were switched to a mid-long-term ventricular assist device. Thirty-three (45.2%) were successfully discharged. The following variables were significantly different if survivors and nonsurvivors on ECMO were compared: age (P = 0.04), female gender (P < 0.01), cardiopulmonary resuscitation before ECMO (P < 0.01), lactate level before ECMO (P = 0.01), number of platelets, fresh frozen plasma units, and packed red blood cells (PRBCs) transfused during ECMO support (P = 0.03, P = 0.02, and P < 0.01), blood lactate level (P = 0.01), and creatine kinase isoenzyme MB (CK-MB) relative index 72 h after ECMO initiation (P < 0.001), and multiple organ failure on ECMO (P < 0.01). Stepwise logistic regression identified blood lactate level and CK-MB relative index at 72 h after ECMO initiation, and number of PRBCs transfused on ECMO as significant predictors of mortality on ECMO (P = 0.011, odds ratio [OR] = 2.48; 95% confidence interval [CI] = 1.11-3.12; P = 0.012, OR = 2.81, 95% CI = 1.026-2.531; and P = 0.012, OR = 1.94, 95% CI = 1.02-5.21; respectively). Patients with an initial poor hemodynamic status could benefit by rapid peripheral installation of PLS ECMO. The blood lactate level, CK-MB relative index, and PRBCs transfused should be strictly monitored during ECMO support.
authors.affiliation: Department of Cardiac Surgery and Transplantation, San Camillo Hospital, Piazza C. Forlanini no. 1, Rome, Italy. antonioloforte@yahoo.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Loforte
authors.forename: Andrea
authors.initials: A
authors.lastname: Montalto
authors.forename: Federico
authors.initials: F
authors.lastname: Ranocchi
authors.forename: Paola Lilla
authors.initials: PL
authors.lastname: Della Monica
authors.forename: Giovanni
authors.initials: G
authors.lastname: Casali
authors.forename: Angela
authors.initials: A
authors.lastname: Lappa
authors.forename: Antonio
authors.initials: A
authors.lastname: Menichetti
authors.forename: Carlo
authors.initials: C
authors.lastname: Contento
authors.forename: Francesco
authors.initials: F
authors.lastname: Musumeci
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D052279:Creatine Kinase, MB Form / Q000097:blood; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation*; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D012770:Shock, Cardiogenic / Q000097:blood / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019344:Lactic Acid; D052279:Creatine Kinase, MB Form