Clinical experience with adults receiving extracorporeal membrane oxygenation for cardiogenic shock and quality of life in survivals

Abstract

To review the experience with extracorporeal membrane oxygenation (ECMO) in adult postcardiotomy cardiogenic shock and evaluate quality of life (QOL) in survivals. During 4 years 62 of 12, 644 patients (0.49%) undergoing cardiac surgery (valve procedures, n = 39; coronary artery bypass grafting, n = 13; coronary artery bypass grafting plus valve procedures, n = 4; heart transplantation, n = 4, and total aortic arch replacement, n = 2) required temporary postoperative ECMO support. At follow-up (mean 2.3 +/- 1.5 years, 100% complete), 32 were still alive and answered the Short-Form 36 Health Survey QOL questionnaire. Mean duration of ECMO support was 61 +/- 37 hors. Forty patients (64.5%) were successfully weaned from ECMO. Thirty-four patients (54.8%) were discharged from hospital after 44.3 +/- 17.6 days. The in-hospital mortality was 45.2%. The main cause of death was multiple organ failure. The postoperative peak lactate levels >or= 12 mmol/L before ECMO initiation was a risk factor of in-hospital death. Mean QOL scores between the ECMO survivors and other patients after cardiac surgery without ECMO support showed no significant difference, except that the vitality and mental health were significant lower in the ECMO survivors (P < 0.05). Both the ECMO survivors and the patients without ECMO support have significant lower QOL scores (except the vitality and mental health) relative to their respective Chinese population norms (P < 0.05). ECMO offers sufficient cardiopulmonary support in adults. Early indication, reduced complication could improve results with increasing experience. However, ECMO survivors had lower physical and mental health that need to be recovered.