Cardiac arrest does not affect survival in post-operative cardiovascular surgery patients undergoing extracorporeal membrane oxygenation.
Veno-arterial extracorporeal membrane oxygenation (ECMO) is rapidly evolving as bailout option in patients with refractory cardiogenic shock after cardiovascular surgery (CV). Cardiac arrest represents a common and severe complication in the immediate post-operative phase. We therefore evaluated the impact of cardiac arrest at time of ECMO implantation on short- and long-term mortality in patients following CV surgery.



We included 385 patients undergoing veno-arterial extracorporeal membrane oxygenation therapy following CV surgery at a university-affiliated tertiary-care center into our single-center registry. Thirty patients underwent cardiopulmonary resuscitation (CPR) followed by immediate initiation of ECMO support. During a median follow-up time of 44 months (IQR 21-76 months), 68% of patients (n=262) died. We did not detect a significant impact of CPR during ECMO initiation on 30-day mortality (HR 1.04, 95%CI 0.89-1.83, P=0.86) as well as for long-term mortality (HR 1.01, 95%CI 0.63-1.61, P=0.97). Results were virtually unchanged for 30-day (HR 0.88, 95%CI 0.44-1.73, P=0.70) and long-term mortality (HR 0.93, 95%CI 0.54-1.60, P=0.79) after adjustment for age, sex, left ventricular ejection fraction, SAPS2 score, type of CV surgery, and year of study inclusion in order to unveil a potential negative confounding.



Cardiac arrest did not affect short-tem and long-term mortality in a large cohort of patients with therapy refractory cardiogenic shock undergoing ECMO support following CV surgery. Our results suggest that the decision to initiate ECMO support in this specific patient population should not be influenced by the occurrence of cardiac arrest.
Department of Internal Medicine II, Medical University of Vienna, Austria.
Klaus
K
Distelmaier
Department of Internal Medicine II, Medical University of Vienna, Austria.
Lore
L
Schrutka
Department of Internal Medicine II, Medical University of Vienna, Austria.
Christina
C
Binder
Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Austria.
Barbara
B
Steinlechner
Department of Internal Medicine II, Medical University of Vienna, Austria.
Gottfried
G
Heinz
Department of Internal Medicine II, Medical University of Vienna, Austria.
Irene M
IM
Lang
Section for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria.
Robin
R
Ristl
Department of Internal Medicine II, Medical University of Vienna, Austria.
Gerald
G
Maurer
University Hospital Krems, Department of Anaesthesia and Intensive Care Medicine, Karl Landsteiner University of Health Sciences, Austria.
Herbert
H
Koinig
Department of Cardiac Surgery, Medical University of Vienna, Austria.
Dominik
D
Wiedemann
Department of Anaesthesia and Intensive Care Medicine, Cleveland Clinic, Cleveland, United States.
Kurt
K
Rützler
Department of Internal Medicine II, Medical University of Vienna, Austria.
Alexander
A
Niessner
Department of Internal Medicine II, Medical University of Vienna, Austria. Electronic address: georg.goliasch@meduniwien.ac.at.
Georg
G
Goliasch
D000046:Academic Medical Centers; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D016022:Case-Control Studies; D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality*; D005260:Female; D006323:Heart Arrest / Q000150:complications* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011184:Postoperative Period; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality*; D000072878:Simplified Acute Physiology Score; D016896:Treatment Outcome
Cardiac arrest; Cardiovascular surgery; Extracorporeal membrane oxygenation; Outcome