title: Clinical Features and outcomes in adults with cardiogenic shock supported by extracorporeal membrane oxygenation.
abstract: Extracorporeal membrane oxygenation (ECMO) is an increasingly used supportive measure for patients with refractory cardiogenic shock (CS). Despite its increasing use, there remain minimal data regarding which patients with refractory CS are most likely to benefit from ECMO. We retrospectively studied all patients (n = 123) who underwent initiation of ECMO for CS from February 2009 to September 2014 at a single center. Baseline patient characteristics, including demographics, co-morbid illness, cause of CS, available laboratory values, and patient outcomes were analyzed. Overall, 69 patients (56%) were weaned from ECMO, with 48 patients (39%) surviving to discharge. Survivors were younger (50 vs 60 years; p ≤0.0001), had a lower rate of previous smoking (27 vs 56%; p = 0.01) and chronic kidney disease (2% vs 13%; p = 0.03), and had lower lactate measured soon after ECMO initiation (3.1 vs 10.2 mmol/l; p = 0.01). Patients with pulmonary embolism (odds ratio 8.0, 95% confidence interval 2.00 to 31.99; p = 0.01) and acute cardiomyopathy (odds ratio 7.5, 95% confidence interval 1.69 to 33.27; p = 0.01) had a higher rate of survival than acute myocardial infarction, chronic cardiomyopathy, and miscellaneous etiologies compared to postcardiotomy CS as a referent. In conclusion, survival after ECMO initiation differs based on underlying cause of CS. Survival may be lower in older patients and those with early evidence of persistent hypoperfusion after initiation of ECMO for CS.
authors.affiliation: Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Brett J
authors.initials: BJ
authors.lastname: Carroll
authors.affiliation: Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Ravi V
authors.initials: RV
authors.lastname: Shah
authors.affiliation: Division of Cardiology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Venkatesh
authors.initials: V
authors.lastname: Murthy
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: McCullough
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Nosheen
authors.initials: N
authors.lastname: Reza
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Sunu S
authors.initials: SS
authors.lastname: Thomas
authors.affiliation: Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Tae H
authors.initials: TH
authors.lastname: Song
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Newton-Cheh
authors.affiliation: Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Janice M
authors.initials: JM
authors.lastname: Camuso
authors.affiliation: Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Thomas
authors.initials: T
authors.lastname: MacGillivray
authors.affiliation: Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Thoralf M
authors.initials: TM
authors.lastname: Sundt
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Semigran
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Lewis
authors.affiliation: Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Joshua N
authors.initials: JN
authors.lastname: Baker
authors.affiliation: Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: jgarcia@mgh.harvard.edu.
authors.forename: José P
authors.initials: JP
authors.lastname: Garcia
mesh_terms: D000328:Adult; D000368:Aged; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome