Early and late outcome of 527 consecutive patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock (PCS)

Abstract

Aims: PCS occurs in 1–2% of cardiac surgery patients. Hospital and long-term results of 527 consecutive patients receiving ECMO implantation were evaluated. Methods: Between 05/96 and 05/08 527 of 40.538 pts (1.3%) undergoing cardiac surgery (37.1% elective, 24.4% urgent, 38.5 emergency) received perioperative ECMO support. Procedures were isolated CABG (32.6%), CABG+valve surgery (19.3%), valve surgery (38.1%), thoracic organ transplantation (6.4%) and others (3.8%). Fourty-four preoperative, 28 intraoperative and 42 postoperative risk factors were evaluated by uni- und multivariate logistic regression analysis to identify risk factors for early mortality. Cumulative survival was estimated by Kaplan-Meier analysis. Mean follow-up was 2.9y (0.1–11.4y). Results: Age was 61.3y, 73.0% were male, ejection fraction was 44.2±17.3%. ECMO implantation was performed through thoracic (56.7%) or extrathoracic (42.3%) cannulation using femoral or axillary arterial and femoral venous cannulation. Additional IABP support was employed in 74.3%. Mean drainage loss was 4.4 liter after 48h. 52.7% were successfully weaned from ECMO after mean 86h and 24.4% were discharged from hospital after 41±25d. Neurological complications occurred in 12.3%. Hospital mortality was 75.6%. Risk factors for hospital mortality were emergency indication, preoperative cardiogenic shock, EF 70y and diabetes were none. Cumulative survival was 20.2±2.9% after 6 months, 18.7±2.7% after one and 16.3±3.3% after five years. Conclusion: Temporary ECMO support it is an acceptable option for patients with PCS that otherwise would die. However due to high morbidity and mortality individual indication has to be made on the specific risk profile.