title: Mechanical support with venoarterial extracorporeal membrane oxygenation (ECMO-VA): Short-term and long-term prognosis after a successful weaning.
abstract: OBJECTIVE
  Extracorporeal membrane oxygenation (ECMO) affords mechanical circulatory assistance associated to high mortality. However, weaning from such mechanical support may not imply improved short- or long-term survival. This study describes the characteristics and evolution of patients with refractory cardiogenic shock (RCS) subjected to venoarterial ECMO (VA-ECMO) in a hospital with a heart transplant program.
  
  
  METHODS
  A single-center, retrospective cohort study was carried out.
  
  
  METHODS
  The cardiovascular ICU of a tertiary hospital.
  
  
  METHODS
  Forty-six patients consecutively subjected to VA-ECMO over 6 years.
  
  
  METHODS
  Hospital mortality after weaning from ECMO and overall survival (OS) were analyzed.
  
  
  RESULTS
  Fifteen patients (33%) died with VA-ECMO and 31 (67%) were weaned after 8 days of support (IQR: 5-15). Fourteen patients under went transplantation. Hospital mortality in these patients was 32% (10/31), and was associated to age (P=.001), SAPS II score (P=.009), cannulation bleeding (P=.01) and post-acute myocardial infarction RCS (P=.001). After a median follow-up of 27 months (IQR: 11-49), 91% of the patients discharged from hospital were still alive. Overall survival after weaning from assistance was associated to the type of cardiac disease (P=.002). Patients with RCS after acute myocardial infarction had a poorer prognosis.
  
  
  CONCLUSIONS
  In our experience, VA-ECMO can be used as mechanical assistance in the management of RCS. The technique is associated to high early mortality, though the long-term survival rate after hospital discharge is good.
authors.affiliation: UCI Cardiológica, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España. Electronic address: rennygg@hotmail.com.
authors.forename: R
authors.initials: R
authors.lastname: García-Gigorro
authors.affiliation: UCI Cardiológica, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: E
authors.initials: E
authors.lastname: Renes-Carreño
authors.affiliation: UCI Cardiológica, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: J L
authors.initials: JL
authors.lastname: Pérez-Vela
authors.affiliation: UCI Cardiológica, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: H
authors.initials: H
authors.lastname: Marín-Mateos
authors.affiliation: UCI Cardiológica, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: J
authors.initials: J
authors.lastname: Gutiérrez
authors.affiliation: UCI Cardiológica, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: M A
authors.initials: MA
authors.lastname: Corrés-Peiretti
authors.affiliation: Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: J F
authors.initials: JF
authors.lastname: Delgado
authors.affiliation: Servicio de Cirugía Cardíaca, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: E
authors.initials: E
authors.lastname: Pérez-de la Sota
authors.affiliation: Servicio de Cirugía Cardíaca, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: J M
authors.initials: JM
authors.lastname: Cortina-Romero
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: J C
authors.initials: JC
authors.lastname: Montejo-González
mesh_terms: D000328:Adult; D000368:Aged; D001925:Brain Damage, Chronic / Q000209:etiology; D015897:Comorbidity; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006470:Hemorrhage / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D015300:Ventilator Weaning
keywords: Acute cardiac care; Cardiovascular support; Cuidados cardiológicos agudos; Hospital mortality; Membrana de oxigenación extracorpórea veno-arterial; Mortalidad hospitalaria; Overall survival; Soporte cardiovascular; Supervivencia global; Venoarterial extracorporeal membrane oxygenation