Extracorporeal membrane oxygenation after cardiac surgery in 12 patients with cardiogenic shock

• Published in: Revista española de anestesiología y reanimación Vol. 58; no. 3; p. 156
• Main Authors: Moreno, I, Soria, A, López Gómez, A, Vicente, R, Porta, J, Vicente, J L, Barberá, M
• Format: Journal Article
• Language: Spanish
• Published: Spain 01.03.2011
• Subjects: Aged; Cardiac Surgical Procedures - adverse effects; Extracorporeal Membrane Oxygenation; Female; Humans; Male; Middle Aged; Retrospective Studies; Shock, Cardiogenic - etiology; Shock, Cardiogenic - therapy
• ISSN: 0034-9356
• DOI: 10.1016/S0034-9356(11)70023-8

Mortality is high when cardiogenic shock develops after cardiotomy, making it impossible to discontinue extracorporeal circulation and/or leading to low postoperative cardiac output that is refractory to treatment with vasoactive drugs or implantation of an intra-aortic balloon pump. Extracorporeal membrane oxygenation (ECMO) provides temporary assisted circulation, lending hemodynamic and respiratory support to the patient with cardiogenic shock in order to prevent multiple organ failure and death. For this retrospective study of cases in which ECMO was applied in our hospital's assisted circulation unit, we analyzed demographic data, indication, score on the European system for cardiac operative risk evaluation (Euroscore), duration of assistance, complications, and survival. In the first 3 years after the assisted circulation unit was established, during which 1375 cardiac interventions took place, ECMO was used postoperatively in 12 patients (0.87%). In 8 of the patients, assistance was provided during cardiac surgery following cardiotomy and in 4 transplant patients it was used following primary graft failure. The mean (SD) patient age was 56.8 (9.1) years. The Euroscore predicted 37.3% (16.7%) of the deaths. ECMO was used for a mean of 5.4 (2.5) days. The most frequent complications were bleeding in the surgical area, cardiac tamponade, and acute renal insufficiency. Overall in-hospital mortality was 50%, lower than rates reported in the literature. ECMO provided viable temporary support, maintaining adequate cardiac output while the patient's condition could be observed and heart function evaluated. Mortality was reduced.