Contemporary Outcomes of Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock at a Large Tertiary Care Center. Issue 4 (July 2015)

• Record Type: Journal Article
• Authors: Truby, Lauren; Mundy, Lily; Kalesan, Bindu; Kirtane, Ajay; Colombo, Paolo C.; Takeda, Koji; Fukuhara, Shinichi; Naka, Yoshifumi; Takayama, Hiroo
• Is Part Of: ASAIO journal. Volume 61:Issue 4(2015)
• Publication Date: 2015-07
• Subjects: mechanical circulatory support -- venoarterial extracorporeal membrane oxygenation -- heart failure; Artificial organs -- Periodicals; 617
• DOI: 10.1097/MAT.0000000000000225
• Languages: English
• ISSNs: 1058-2916

Abstract

Abstract : Refractory cardiogenic shock (RCS) is associated with significant morbidity and mortality, and current mainstays of medical therapy appear inadequate. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) represents an increasingly accepted therapy for RCS. Demographics, past medical history, preoperative characteristics, outcomes, and adverse events were collected for consecutive patients who received VA-ECMO support for RCS at our institution from March 2007 to December 2013. One hundred and seventy-nine patients with a mean age of 56.9 ± 16.1 years were included. Etiologies of RCS included postcardiotomy shock in 70 patients (39%), acute myocardial infarction in 46 patients (26%), primary graft failure in 17 patients (10%), and acute decompensated heart failure in 24 patients (13%). Mean arterial pressure before VA-ECMO support was 59.4 ± 22.8 mm Hg and 30.7% (n = 55) were undergoing active cardiopulmonary resuscitation at the time of cannulation. Overall, 38.6% of patients (n = 69) survived to discharge and 44.7% of patients (n = 80) survived to 30 days. Myocardial recovery was achieved in 79.7% of survivors (n = 55) and 39.1% were transitioned to a more durable device. Univariate analysis identified age ( p = 0.002) and etiology of RCS ( p = 0.041) as the most significant predictor s of in-hospital mortality. Venoarterial extracorporeal membrane oxygenation for RCS appears successful as salvage therapy. Age and etiology should be considered when evaluating patients for VA-ECMO.