Extracorporeal membrane oxygenation in refractory cardiogenic shock - the Leipzig ECMO registry

Abstract

Purpose: With mortality rates approaching 50%, prognosis of cardiogenic shock remains poor. According to current guidelines of the European Society of Cardiology, implantation of left ventricular assist devices such as extracorporeal membrane oxygenation (ECMO) may be considered to achieve hemodynamic stability in patients with refractory cardiogenic shock. However, data on clinical outcome in patients treated with ECMO in clinical routine are scarce. Here we report the in-hospital outcome and predictors for mortality in patients undergoing ECMO implantation due to refractory cardiogenic shock in a high volume tertiary care centre. Methods: Between 2008 and 2012, 85 patients with refractory cardiogenic shock underwent femoral percutaneous arteriovenous ECMO implantation performed by interventional cardiologists. A detailed set of clinical, therapeutic and laboratory parameters was assessed in all patients. Survival at hospital discharge was surveyed and independent predictors for mortality were identified. Results: Mean age was 60.6±14.4 years (range 23-84), 76.4% of all patients (n=65) were male and mean left ventricular ejection fraction was 28±17% (range 5-55). The majority of all patients underwent cardiopulmonary resuscitation prior to ECMO implantation (n=48, 56.4%). Indications for ECMO were cardiogenic shock complicated by acute coronary syndrome (n=54, 63.6%), acute non-ischemic heart failure (n=19, 22.4%), deterioration of valvular heart disease (n=9, 10.5%) and interventional complications during percutaneous coronary intervention (n=3, 3.5%). Mean ECMO support lasted 7.2±6.8 days (range 1-54). Despite initial successful ECMO weaning in 48 patients (56.4%), in-hospital mortality was 70.5% as only 25 patients were alive at discharge. Finally, age was identified as the only independent predictor for mortality (HR 1.04, 95% CI 1.01-1.08, p=0.02). No patient over the age of 75 years survived. Conclusion: Despite ECMO support, in-hospital mortality of patients with cardiogenic shock refractory to standard treatment remains high. However, especially in younger patients ECMO is a therapeutic option in this otherwise futile situation.