Extracorporeal Membrane Oxygenation Support System as Bridge to Solution in Refractory Cardiogenic Shock

Abstract

Purpose The RotaFlow (Maquet, Jostra Medizintechnik AG, Hirrlingen, Germany) and 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 and Materials Between January 2007 and October 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 years, 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 on chronic heart failure (n=40). Results A central ECMO setting was established in 102 (44.7%) patients while peripherally in 126 (55.2%). Overall mean support time was 10.9±9.7 days (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%. Hundred-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 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; and 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 hemodynamic status may benefit by 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.