028 * EXTRACORPOREAL MEMBRANE OXYGENATION SYSTEM AS SALVAGE TREATMENT FOR PATIENTS WITH REFRACTORY CARDIOGENIC SHOCK

Abstract

Objectives: The RotaFlow (Maquet, Jostra Medizintechnik AG, Hirrlingen, Germany) and the Levitronix CentriMag (Levitronix LCC, Waltham, MA) as central or peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) support systems have been investigated as treatment for patients with refractory cardiogenic shock (CS). Methods: Between January 2007 and December 2012, 228 consecutive adult patients were supported on RotaFlow (n = 213) or CentriMag (n = 15) ECMO, at our institutions (155 men, age 58.3 ± 10.5, range 19-84 years). Indications for support were: failure to wean from cardiopulmonary bypass in the setting of postcardiotomy (n = 118) and primary donor graft failure (n = 37); post-acute myocardial infarction CS (n = 27); acute myocarditis (n = 6); and CS in chronic heart failure (n = 40). Results: A central ECMO setting was established in 102 (44.7%) patients and peripherally in 126 (55.2%). Overall mean support time was 10.9 ± 9.7 (range 1-34) days. Eighty-four (36.8%) patients died on ECMO. Overall success rate, in terms of survival on ECMO (n = 144), weaning from mechanical support (n = 107; 46.9%), bridge to long-term ventricular assist device (n = 6, 2.6%) and bridge to heart transplantation (n = 31, 13.5%), was 63.1%. One-hundred and twenty-two (53.5%) patients were successfully discharged. Stepwise logistic regression identified blood lactate level and CK-MB relative index at 72 h after ECMO initiation, and number of packed red blood cells (PRBCs) transfused on ECMO as significant predictors of mortality on ECMO (P = 0.010, odds ratio [OR] 2.94, 95% confidence interval [CI] 1.10-3.14; P = 0.010, OR 2.82, 95% CI 1.014-3.72; P = 0.011, OR = 2.69, 95% CI 1.06-4.16, respectively). No significant differences were seen by comparing RotaFlow and CentriMag populations in terms of device performance. Conclusions: Patients with a poor haemodynamic status may benefit from rapid central and peripheral insertion of ECMO. The blood lactate level, CK-MB relative index and PRBCs transfused should be strictly monitored during ECMO support.