title: [Extracorporeal membrane oxygenation for the treatment of refractory cardiogenic shock in adults: strategies, results, and predictors of mortality].
abstract: BACKGROUND
  The RotaFlow (Maquet, Jostra Medizintechnik AG, Hirrlingen, Germany) and Levitronix CentriMag (Levitronix LCC, Waltham, MA, USA) veno-arterial extracorporeal membrane oxygenation (ECMO) support systems have been investigated as treatment for refractory cardiogenic shock.
  
  
  METHODS
  Between 2004 and 2012, 119 consecutive adult patients were supported on RotaFlow (n=104) or CentriMag (n=15) ECMO at our Institution (79 men; mean age 57.3 ± 12.5 years, range 19-78 years). Indications for support were: failure to wean from cardiopulmonary bypass in the setting of postcardiotomy (n=47) and primary graft failure (n=26); post-acute myocardial infarction cardiogenic shock (n=11); acute myocarditis (n=3), and cardiogenic shock on chronic heart failure (n=32).
  
  
  RESULTS
  A central ECMO setting was established in 64 (53.7%) patients while peripherally in 55 (46.2%). Overall mean support time was 10.9 ± 8.7 days (range 1-43 days). Forty-two (35.2%) patients died on ECMO. Overall success rate, in terms of survival on ECMO (n=77), weaning from mechanical support (n=51; 42.8%) and bridge to heart transplantation (n=26; 21.8%), was 64.7%. Sixty-eight (57.1%) patients were successfully discharged. Stepwise logistic regression identified blood lactate levels and creatine kinase-MB relative index at 72h after ECMO initiation, and number of packed red blood cells (PRBCs) transfused on ECMO as significant predictors of mortality. Central ECMO population had a higher rate of continuous veno-venous hemofiltration need and bleeding events compared with the peripheral setting.
  
  
  CONCLUSIONS
  ECMO support provides encouraging results in different subsets of patients in cardiogenic shock. Blood lactate levels, creatine kinase-MB relative index and PRBCs transfused should be strictly monitored during veno-arterial ECMO running. Type of ECMO implantation, if peripheral or central, should be decided according to the specific patient subset.
authors.forename: Antonio
authors.initials: A
authors.lastname: Loforte
authors.forename: Emanuele
authors.initials: E
authors.lastname: Pilato
authors.forename: Sofia
authors.initials: S
authors.lastname: Martin Suarez
authors.forename: Gianluca
authors.initials: G
authors.lastname: Folesani
authors.forename: Giuliano
authors.initials: G
authors.lastname: Jafrancesco
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Castrovinci
authors.forename: Mariano
authors.initials: M
authors.lastname: Cefarelli
authors.forename: Luciano
authors.initials: L
authors.lastname: Potena
authors.forename: Gaia
authors.initials: G
authors.lastname: Magnani
authors.forename: Francesco
authors.initials: F
authors.lastname: Grigioni
authors.forename: Fabio
authors.initials: F
authors.lastname: Caramelli
authors.forename: Guido
authors.initials: G
authors.lastname: Frascaroli
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Bartolomeo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Marinelli
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003402:Creatine Kinase / Q000097:blood; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012770:Shock, Cardiogenic / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D019344:Lactic Acid; D003402:Creatine Kinase