Extracorporeal membrane oxygenation support for adult postcardiotomy cardiogenic shock

doi:10.1016/S0003-4975(01)03330-6

The Annals of Thoracic Surgery

Volume 73, Issue 2, February 2002, Pages 538-545

https://doi.org/10.1016/S0003-4975(01)03330-6 Get rights and content

Abstract

Background. Postcardiotomy cardiogenic shock occasionally develops in patients who have undergone cardiac procedures. We report our experience using extracorporeal membrane oxygenation (ECMO) in adult patients with postcardiotomy cardiogenic shock, and analyze the factors that affected outcomes for these ECMO patients.

Methods. We retrospectively reviewed the medical records of ECMO patients.

Results. From August 1994 to May 2000, 76 adult patients (48 men, 28 women; mean age, 56.8 ± 15.9 years) received ECMO support for postcardiotomy cardiogenic shock at the National Taiwan University Hospital. The mean ECMO blood flow was 2.53 ± 0.84 L/min. The cardiac operations included coronary artery bypass grafting (n = 37), coronary artery bypass grafting and valvular operation (n = 6), valvular operation alone (n = 14), heart transplantation (n = 12), correction of congenital heart defects (n = 3), implantation of a left ventricular assist device (n = 2), and aortic operations (n = 2). Fifty-four patients received ECMO support after intraaortic balloon pumping, but 22 patients directly received ECMO support. Two patients were bridged to heart transplantation and two bridged to ventricular assist devices. Thirty patients died on ECMO support. The causes of mortality included brain death (n = 3), refractory arrhythmia (n = 2), near motionless heart (n = 2), acute graft rejection (n = 1), primary graft failure (n = 1), uncontrolled bleeding (n = 5), and multiple organ failure (n = 16). Twenty-two patients were weaned off ECMO support but presented intrahospital mortality. The cause of mortality included brain death (n = 1), sudden death (n = 4), and multiple organ failure (n = 17). Twenty patients were weaned off ECMO support and survived to hospital discharge. During the follow-up of 33 ± 22 months, all were in New York Heart Association functional status I or II except two cases of late deaths. Among the ECMO-weaned patients, “dialysis for acute renal failure” was a significant factor in reducing the chance of survival.

Conclusions. The ECMO provided a satisfactory partial cardiopulmonary support to patients with postcardiotomy cardiogenic shock, and allowed time for clinicians to assess the patients and make appropriate decisions.

Section snippets

Patients and methods

The ECMO had been used as an MCS at the National Taiwan University Hospital since August 1994. Between August 1994 and May 2000, 2,912 adults (≥ 16 years old) underwent open heart operations at the hospital. The operations included coronary bypass grafting (CABG) (n = 1,318), heart valvular operations (n = 1,194), and other operations (n = 400, including correction of congenital heart disease, heart transplantation, and aortic operations). Beating heart CABG began at the hospital in February

Background data

Seventy-eight adult postcardiotomy patients received ECMO support in their early postoperative period. The indications were acute respiratory distress syndrome (n = 2) and cardiogenic shock (n = 76). Only the patients receiving ECMO support for PCS were included in this study. Their mean age was 56.8 ± 15.9 years. Forty-eight (63%) patients were men and 28 were women. Their operations included CABG (n = 37), CABG and valvular operations (n = 6), valvular operation only (n = 14), heart

Comment

When MCS was indicated, IABP was the first consideration because of its relative noninvasiveness. Intraaortic balloon pump decreases left ventricular afterload and augments the coronary arterial perfusion, and is particularly beneficial for heart failure from ischemic heart diseases. However, IABP cannot increase cardiac output much. Its effect is limited or not possible in patients with profound heart failure, tachyarrhythmia, small body weight, or right heart failure.

Successful use of

Acknowledgements

This study was supported by grant NSC 90–2314-B002–428 from National Science Council, Taiwan.

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Original article: cardiovascularExtracorporeal membrane oxygenation support for adult postcardiotomy cardiogenic shock

Abstract

Section snippets

Patients and methods

Background data

Comment

Acknowledgements

J Thorac Cardiovasc Surg

Ann Thorac Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

Original article: cardiovascular
Extracorporeal membrane oxygenation support for adult postcardiotomy cardiogenic shock