title: Outcomes after transfer to a tertiary center for postcardiotomy cardiopulmonary failure.
abstract: BACKGROUND
  Postcardiotomy shock affects 0.5% to 6% of cardiac operations and is associated with a high mortality. Many of these patients had their procedures performed at lower-volume cardiac surgery centers with limited resources. The objective of this study was to determine the outcomes in patients in postcardiotomy shock who were transferred to a tertiary care center for escalated care.
  
  
  METHODS
  We performed a retrospective review of 104 postcardiotomy shock patients transferred to our institution between 2004 and 2012. Univariable and multivariable analyses were performed to determine predictors of in-hospital and overall survival.
  
  
  RESULTS
  Seventy-eight percent of patients were receiving temporary mechanical support. The in-hospital mortality in our series was 46%. Multivariable predictors of in-hospital mortality included higher initial creatinine level on arrival and a history of known heart failure. Multivariable predictors of overall mortality included higher initial creatinine and lactate levels, lower initial ejection fraction, and a history of heart failure and hypertension. The Kaplan-Meier estimation of 5-year survival was 39% in all patients and 72% in patients who survived to hospital discharge.
  
  
  CONCLUSIONS
  Patients with postcardiotomy cardiac failure transported to a tertiary care center for advanced cardiac support had a nearly 50% survival, with excellent long-term survival of those discharged alive. Preservation of end-organ function, often with mechanical support, can improve survival.
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Teman
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: David S
authors.initials: DS
authors.lastname: Demos
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Reames
authors.affiliation: Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Francis D
authors.initials: FD
authors.lastname: Pagani
authors.affiliation: Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, Michigan. Electronic address: haft@med.umich.edu.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Haft
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000601:surgery*; D010360:Patient Transfer; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality*; D015996:Survival Rate / Q000639:trends; D062606:Tertiary Care Centers; D016896:Treatment Outcome