title: End-organ recovery is key to success for extracorporeal membrane oxygenation as a bridge to implantable left ventricular assist device.
abstract: Preexisting organ dysfunctions are known factors of death after placement of implantable mechanical circulatory support (MCS). Extracorporeal membrane oxygenation (ECMO) may able to stabilize organ function in patients with cardiogenic shock before MCS implantation. Between 2008 and 2012, 17 patients with cardiogenic shock were supported with ECMO before implantable MCS placement. Patient's end-organ functions were assessed by metabolic, cardiac, hepatic, renal, and respiratory parameters. Survival data after MCS implantations were analyzed for overall survival to discharge, complications, and breakpoint in days on ECMO to survival. Before MCS implantation, lactate, hepatic, and renal functions were improved and pulmonary edema was resolved. The interval between ECMO initiation and MCS placement was 12.1 ± 7.9 days. Overall survival rate to discharge after left ventricular assist device/total artificial heart placement was 76%. The survival of patients transitioned from ECMO to MCS within 14 days was 92% and was significantly better than the survival of patients from ECMO to MCS supported longer than 14 days, 25%, p < 0.05. ECMO support can immediately stabilize organ dysfunction in patients with cardiogenic shock. After improvement of organ function, MCS implantation should be done without delay, since the patients supported for longer than 14 days with ECMO had inferior survival compared to national data.
authors.affiliation: From the *Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania; †Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania. Currently, Division of Cardiothoracic Surgery, Inova Health System, Falls Church, Virginia; and ‡Heart and Vascular Institute, Penn State Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Joel B
authors.initials: JB
authors.lastname: Durinka
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Bogar
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hirose
authors.forename: Chris
authors.initials: C
authors.lastname: Brehm
authors.forename: Michael M
authors.initials: MM
authors.lastname: Koerner
authors.forename: Walter E
authors.initials: WE
authors.lastname: Pae
authors.forename: Aly
authors.initials: A
authors.lastname: El-Banayosy
authors.forename: Edward R
authors.initials: ER
authors.lastname: Stephenson
authors.forename: Nicholas C
authors.initials: NC
authors.lastname: Cavarocchi
mesh_terms: D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D012770:Shock, Cardiogenic / Q000401:mortality* / Q000601:surgery*