Short term effect of extracorporeal membrane oxygenation and intra-aortic balloon pump for patients undergoing cardiac surgery complicated with cardiogenic shock

Abstract

Objective To investigate the short-term clinical effect of extracorporeal membrane oxygenation (ECMO) versus intra-aortic balloon pump (IABP) for patients with cardiogenic shock (CS) undergoing cardiac surgery. Methods The clinical data of 56 patients with CS after cardiac surgery admitted in Fuwai Hospital was analyzed retrospectively from January 2010 to December 2018. According to the treatment methods, the patients were divided into ECMO group (n=24) and IABP group (n=32). Baseline characteristics were compared between the two groups. Short-term prognosis, including medication treatment, use of temporary pacemaker, continuous renal replacement therapy and ventilation treatment, survival rates to hospital discharge and complications were compared. Univariate and multivariate logistic regression analysis was used to evaluate the risk factors for short-term mortality. Results Of the 56 patients, there were 31 males (55.4%), with a mean age of (51.2±5.3) years. There were significant differences in left ventricular end-diastolic diameter, end-systolic diameter, left ventricular ejection fraction, troponin levels, serum creatinine, urea nitrogen, B-type natriuretic peptide, lactic acid, norepinephrine, and adrenaline in ECMO and IABP groups (all P 0.05), but the invasive mechanical ventilation in the ECMO group was significantly used more frequently than that in the IABP group (53.0% vs. 20.8%, P<0.05). The mortality rate of the IABP group was lower than that of the ECMO group, but the difference was not significant (37.5% vs. 31.3%). The incidence of infection in the ECMO group was higher than that in the IABP group (P<0.05). Multivariate logistic regression analysis revealed that higher levels of B-type natriuretic peptide, lactic acid, and low level of central venous oxygen saturation were risk factors for poor prognosis. Conclusion Aggressive use of IABP or ECMO can provide effective circulation support for patients with CS after cardiac surgery. B-type natriuretic peptide, lactic acid, and central venous oxygen saturation were risk factors for poor prognosis. More high-quality randomized clinical studies are needed to confirm these findings. Key words: Shock, cardiogenic; Extracorporeal membrane oxygenation; Intra-aortic balloon pump; Prognosis