title: Salvage peripheral extracorporeal membrane oxygenation using Cobe Revolution(®) centrifugal pump as a bridge to decision for acute refractory cardiogenic shock.
abstract: OBJECTIVE
  Acute refractory cardiogenic shock with early multisystem organ failure has a poor outcome without mechanical circulatory support. We review our experience with emergent peripheral cardiopulmonary support as a bridge to decision in these patients.
  
  
  METHODS
  A retrospective review from January 2009 through December 2010 was conducted of 26 consecutive adult patients at a single institution with acute refractory cardiogenic shock who underwent salvage peripheral cardiopulmonary support.
  
  
  RESULTS
  There were 18 men and 8 women with a mean age of 54 years (range 18 to 76). Indications for support: acute myocardial infarction (n = 16), decompensated chronic heart failure (n = 2), refractory arrhythmic arrest (n = 3), acute valvular pathology (n = 4), and unknown (n = 1). Patients with primary postcardiotomy shock were excluded. Median duration of support was 3 days (range 1 to 14). Decisions included: withdraw of support (n = 4), recovery (n = 5), and bridge to a procedure (n = 17). The procedures were percutaneous coronary intervention (n = 4), left ventricular assist device (n = 9), heart transplantation (n = 1), and miscellaneous cardiac surgery (n = 3). Overall survival to discharge was 65%. In the recovery and bridge to a procedure group, 78% were discharged from the hospital and survival at three months was 72%.
  
  
  CONCLUSIONS
  Salvage peripheral cardiopulmonary support is a useful tool to rapidly stabilize acute refractory cardiogenic shock permitting an assessment of neurologic and end-organ viability.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA. rmoraca@wpahs.org
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Moraca
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Wanamaker
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Bailey
authors.forename: Walter E
authors.initials: WE
authors.lastname: McGregor
authors.forename: Srinivas
authors.initials: S
authors.lastname: Murali
authors.forename: Raymond
authors.initials: R
authors.lastname: Benza
authors.forename: George
authors.initials: G
authors.lastname: Sokos
authors.forename: George J
authors.initials: GJ
authors.lastname: Magovern
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D003661:Decision Support Techniques; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010107:Oxygenators, Membrane; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult