ECMO as a Bridge to Decision in “Crash an Burn” Patients: 8-Years Experience

Abstract

Purpose Treatment of refractory cardiogenic shock with VAD or transplantation is controversial. The aim of our study was to evaluate ECMO support as a bridge to decision in “crash and burn patients” through our 8-years experience. Methods and Materials From June 2003 to December 2011, 124 patients received an ECMO for refractory cardiogenic shock, 26 out-hospital cardiac arrests were excluded from our study. Median age was 43 years, range from 11 to 73 years. Primary diagnoses were postcardiotomy failure (29.6%), end stage heart failure (18.4%), acute ischemic cardiomyopathy (17.4%), primary graft failure (12.2%), myocarditis (5.1%) and others (17.3%). ECMO was used in in-hospital arrest in 37.8% of cases. Peripheral femoro-femoral ECMO was mainly implanted (79.6%), a “central ECMO” was used in 20 patients. Results The median duration of ECMO support was 4.5 days (12 hours to 82 days). Mortality while supported with ECMO was 50% (40 patients) with a median support time of 2 days. Weaning from ECMO was achieved through cardiac recovery (57.7%), heart transplantation (26.5%), VAD implantation (14.1%). Most of the patients were weaned between the 4th and the 11th days of support (87.5%). Survival was 82.7%, 61.5% and 71.4% in case of cardiac recovery, heart transplantation or VAD implantation respectively. Stroke and persistent renal function impairment were significant risk factors with OR: 4.940 [2.274– 10.732], p Conclusions ECMO brings promising results as a bridge to decision in end stage refractory cardiogenic shock patients. Persistent renal function failure while supported with ECMO was associated with poor outcome. Further studies are needed to build appropriate risks score to better determine issues for patients supported with ECMO.