SHOULD ECMO BE ABANDONED FOR TREATMENT OF CARDIO-GENIC SHOCK IN ADULTS?

Abstract

Purpose: Despite advances in mechanical circulatory support, cardio-genic shock continues to have a high mortality. We reviewed our recent experience with pulsatile vs non-pulsatile temporary mechanical support. Method: From January 2001-December 2003, mechanical support for cardiogenic shock was instituted in 38 patients (mean age 52±12 years). Indications for mechanical support, complications, and overall survival were examined. Results: Centrifugal pump or ECMO were used in 22 patients (non-pulsatile- NP group). Abiomed was used in 13 and Thoratec in 3 patients (pulsatile- P group). Indications in the NP group were post-cardiotomy shock (PCS) in 1 7, myocardial infarction (MI) in 2, and post-cardiotomy right ventricular (RV) failure in 3. In the P group, 9 had the device placed for PCS, 3 for myocarditis, 1 after MI, and 3 for RV failure after LVAD. Overall, bleeding, limb ischemia, and multi-system organ failure (MSOF) were higher in NP group. In the NP group, 5 patients were weaned from the device and only 3 survived to discharge (14%). These survivors had NP support for isolated RV failure. In the P group, survivors to hospital discharge included 7 weaned and 3 transplanted patients (63'). Cause of death were arrhythmia in 1 after weaning, severe preoperative brain injury in 2, and MSOF in 1 patients. Conclusion: ECMO/centrifugal support has dismal results in the treatment of cardiogenic shock and its use should be discouraged. Survival may improve with pulsatile mechanical support. For refractory heart failure, chronic VAD or transplantation remains the only solution for survival.