title: Contemporary Outcomes of Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock at a Large Tertiary Care Center.
abstract: Refractory cardiogenic shock (RCS) is associated with significant morbidity and mortality, and current mainstays of medical therapy appear inadequate. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) represents an increasingly accepted therapy for RCS. Demographics, past medical history, preoperative characteristics, outcomes, and adverse events were collected for consecutive patients who received VA-ECMO support for RCS at our institution from March 2007 to December 2013. One hundred and seventy-nine patients with a mean age of 56.9 ± 16.1 years were included. Etiologies of RCS included postcardiotomy shock in 70 patients (39%), acute myocardial infarction in 46 patients (26%), primary graft failure in 17 patients (10%), and acute decompensated heart failure in 24 patients (13%). Mean arterial pressure before VA-ECMO support was 59.4 ± 22.8 mm Hg and 30.7% (n = 55) were undergoing active cardiopulmonary resuscitation at the time of cannulation. Overall, 38.6% of patients (n = 69) survived to discharge and 44.7% of patients (n = 80) survived to 30 days. Myocardial recovery was achieved in 79.7% of survivors (n = 55) and 39.1% were transitioned to a more durable device. Univariate analysis identified age (p = 0.002) and etiology of RCS (p = 0.041) as the most significant predictors of in-hospital mortality. Venoarterial extracorporeal membrane oxygenation for RCS appears successful as salvage therapy. Age and etiology should be considered when evaluating patients for VA-ECMO.
authors.affiliation: From the *Department of Surgery, Columbia University Medical Center, New York, New York; and †Department of Medicine, Columbia University Medical Center, New York, New York.
authors.forename: Lauren
authors.initials: L
authors.lastname: Truby
authors.forename: Lily
authors.initials: L
authors.lastname: Mundy
authors.forename: Bindu
authors.initials: B
authors.lastname: Kalesan
authors.forename: Ajay
authors.initials: A
authors.lastname: Kirtane
authors.forename: Paolo C
authors.initials: PC
authors.lastname: Colombo
authors.forename: Koji
authors.initials: K
authors.lastname: Takeda
authors.forename: Shinichi
authors.initials: S
authors.lastname: Fukuhara
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
mesh_terms: D000368:Aged; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D062606:Tertiary Care Centers; D016896:Treatment Outcome