A local network for extracorporeal membrane oxygenation in refractory cardiogenic shock.
BACKGROUND
Veno-arterial extracorporeal membrane oxygenation (VA ECMO) represents a therapeutic option in patients with refractory cardiogenic shock (RCS). This strategy is limited to a restricted number of centres with capabilities for implanting VA ECMO and management patients on this support. We report on the initial experience of our ECMO referral centre for patients with RCS.


METHODS
We retrospectively analysed our ECMO data registry for RCS of 14 patients treated with VA ECMO, consecutively admitted to our intensive cardiac care unit (ICCU), which is an ECMO referral centre.


RESULTS
Six patients (6/14, 42%) came from peripheral centres, four were transferred to our ICCU directly. During ICCU stay, four patients died (28.5%) due to multi-organ failure, seven showed a complete recovery while one underwent cardiac transplantation. The remaining two patients died while waiting for cardiac transplantation because of cerebral haemorrhage. The 30-day overall mortality rate was 42.8%, all survivors showed a good neurologic outcome.


CONCLUSIONS
In our series, the survival rate of RCS patients supported by VA ECMO is high (57%) and the transfer of RCS patients is feasible and safe. Our data support that a network for RCS is needed to transfer patients in well experienced centres even on ECMO support.
a Intensive Cardiac Care Unit, Azienda Ospedaliero-Universitaria Careggi , Florence , Italy.
Carlotta Sorini
CS
Dini
a Intensive Cardiac Care Unit, Azienda Ospedaliero-Universitaria Careggi , Florence , Italy.
Chiara
C
Lazzeri
a Intensive Cardiac Care Unit, Azienda Ospedaliero-Universitaria Careggi , Florence , Italy.
Marco
M
Chiostri
a Intensive Cardiac Care Unit, Azienda Ospedaliero-Universitaria Careggi , Florence , Italy.
Gian Franco
GF
Gensini
a Intensive Cardiac Care Unit, Azienda Ospedaliero-Universitaria Careggi , Florence , Italy.
Serafina
S
Valente
D000328:Adult; D000368:Aged; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
Refractory cardiogenic shock; extra-corporeal membrane oxygenation; network; prognosis