Abstract
To compare the outcomes of patients with postcardiotomy shock treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) only compared with VA-ECMO and intra-aortic balloon pump (IABP). A retrospective multicenter registry study. At 19 cardiac surgery units. A total of 615 adult patients who required VA-ECMO from 2010 to 2018. The patients were divided into 2 groups depending on whether they received VA-ECMO only (ECMO only group) or VA-ECMO plus IABP (ECMO-IABP group). The overall series mean age was 63 ± 13 years, and 33% were female. The ECMO-only group included 499 patients, and 116 patients were in the ECMO-IABP group. Urgent and/or emergent procedures were more common in the ECMO-only group. Central cannulation was performed in 47% (n=54) in the ECMO-IABP group compared to 27% (n=132) in the ECMO-only group. In the ECMO-IABP group, 58% (n=67) were successfully weaned from ECMO, compared to 46% (n=231) in the ECMO-only group (p=0.026). However, in-hospital mortality was 63% in the ECMO-IABP group compared to 65% in the ECMO-only group (p=0.66). Among 114 propensity score-matched pairs, ECMO-IABP group had comparable weaning rates (57% v 53%, p=0.51) and in-hospital mortality (64% v 58%, p=0.78). This multicenter study showed that adjunctive IABP did not translate into better outcomes in patients treated with VA-ECMO for postcardiotomy shock.
Highlights
Postcardiotomy shock (PCS) is defined as low cardiac output following cardiac surgery and is associated with high mortality[1]
The present study did not find any association between concurrent intra-aortic balloon pump (IABP) use and short-term or longterm mortality of patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) therapy for postcardiotomy shock (PCS)
A meta-analysis including patients requiring VA-ECMO for mixed causes of cardiogenic shock showed no additional benefit of adjunctive IABP treatment.[6]
Summary
Postcardiotomy shock (PCS) is defined as low cardiac output following cardiac surgery and is associated with high mortality[1]. The treatment reduces right ventricular preload and afterload as well as left ventricular preload, by shunting blood from the right side of the heart to a major systemic artery[2]. A potential problem with VA-ECMO is retrograde flow of blood in the aorta, resulting in increased left ventricular afterload. Studies on adjunctive use of IABP with VAECMO have provided conflicting results on its efficacy[3,5,6,7]. Since PCS is uncommon, multicenter data is required to investigate the usefulness of adjunctive IABP with VAECMO in treating PCS.
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