Prolonged Veno-Arterial Bypass with membrane oxygenator for profound cardiogenic shock following cardiac surgery experience in 13 cases.

Abstract

As a mechanical cardiac support, prolonged (over 5 hrs) Veno Arterial Bypass (VAB) with membrane oxygenator was indicated to 13 patients who was profound cardiogenic shock following open heart surgery, among 1700 cases of cardiac surgery (0.8%). In 12 of 13 cases, cardiopulmonary bypass could not be weaned after intracardiac repair, despite maximal pharmacological management with or without IABP support. Another one case was intractable ventricular fibrillation in ICU, two days after operation. Six of 13 patients who were supported by prolonged VAB, survived and discharged from the hospital. In survivors, mean of VAB flow was 900 +/- 265 ml/min/m2, in died 7 cases, mean of VAB flow was 1450 +/- 550 ml/min/m2 (p less than 0.05). The longest duration of VAB in survivors was less than 28 hrs. Improvements of anticoagulation and VAB circuits make it safer to manage prolonged VAB. For profound cardiogenic shock, prolonged VAB is an easy and safe mechanical cardiac support not only in surgical cases but in internal medical cases.