HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Farhad Bakhtiary Selami Dogan Omer Dzemali Peter Kleine Anton Moritz Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bakhtiary, F. Articles by Moritz, A. Search for Related Content PubMed Articles by Bakhtiary, F. Articles by Moritz, A.

J Thorac Cardiovasc Surg 2008;135:382-388
© 2008 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Venoarterial extracorporeal membrane oxygenation for treatment of cardiogenic shock: Clinical experiences in 45 adult patients

^a Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt/Main, Germany
^b Department of Perfusion and Cardio-technique, Johann Wolfgang Goethe University Hospital, Frankfurt/Main, Germany
^c Department of Anaesthesiology, Intensive Care Medicine, and Pain Therapy, Johann Wolfgang Goethe University Hospital, Frankfurt/Main, Germany
^d Department of Biomedical Statistics, Johann Wolfgang Goethe University Hospital, Frankfurt/Main, Germany.

Received for publication January 31, 2007; revisions received May 13, 2007; accepted for publication August 9, 2007.

^_* Address for reprints: Farhad Bakhtiary, MD, Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Theodor Stern Kai 7, 60590 Frankfurt am Main, Germany (Email: farhad{at}bakhtiary.de).

Objective: Venoarterial extracorporeal membrane oxygenation is an established treatment option in patients with cardiogenic shock. This report reviews our 3-year experience with this support system with respect to early and midterm outcome, as well as predictors of survival.

Methods: From January 2003 until November 2006, 45 (0.8%) of 5750 patients undergoing cardiac surgery procedures required the following: temporary extracorporeal membrane oxygenation support coronary artery bypass grafting, n = 20; implantation of a left ventricular assist device, n = 5; heart transplantation, n = 1; heart and lung transplantation, n = 1; coronary artery bypass grafting plus repair of postinfarction ventricular septal defect, n = 3; coronary artery bypass grafting plus mitral valve repair, n = 5; aortic valve replacement, n = 2; coronary artery bypass grafting plus aortic valve replacement, n = 3; and other procedures, n = 5. Extracorporeal membrane oxygenation implantation was performed through the femoral vessels or axillary artery or through the right atrium and ascending aorta. Additional intra-aortic balloon pumps were used in 30 patients.

Results: Average patient age was 60.1 ± 13.6 years. There were 35 male patients. Average duration of extracorporeal membrane oxygenation was 6.4 ± 4.5 days. Twenty-five patients could be successfully weaned from extracorporeal membrane oxygenation. The 30-day mortality was 53% (24/45 patients). The in-hospital mortality was 71% (32/45 patients). Thirteen (29%) patients could be successfully discharged. After a follow-up period of up to 3 years, 10 (22%) patients were still alive.

Conclusions: Extracorporeal membrane oxygenation offers sufficient cardiopulmonary support in adults with similar hospital and midterm survival rates to those of other mechanical support systems. Early indication, alternative peripheral cannulation techniques, and reduced anticoagulation to avoid perioperative bleeding could improve our results with increasing experience.

This article has been cited by other articles:

				S. Allen, D. Holena, M. McCunn, B. Kohl, and B. Sarani A Review of the Fundamental Principles and Evidence Base in the Use of Extracorporeal Membrane Oxygenation (ECMO) in Critically Ill Adult Patients J Intensive Care Med, January 1, 2011; 26(1): 13 - 26. [Abstract] [PDF]

				C. F. Russo, A. Cannata, M. Lanfranconi, G. Bruschi, F. Milazzo, R. Paino, and L. Martinelli Veno-arterial extracorporeal membrane oxygenation using Levitronix centrifugal pump as bridge to decision for refractory cardiogenic shock J. Thorac. Cardiovasc. Surg., December 1, 2010; 140(6): 1416 - 1421. [Abstract] [Full Text] [PDF]

				F. Formica, L. Avalli, L. Colagrande, O. Ferro, G. Greco, E. Maggioni, and G. Paolini Extracorporeal membrane oxygenation to support adult patients with cardiac failure: predictive factors of 30-day mortality Interact CardioVasc Thorac Surg, May 1, 2010; 10(5): 721 - 726. [Abstract] [Full Text] [PDF]

				A. J. Rastan, A. Dege, M. Mohr, N. Doll, V. Falk, T. Walther, and F. W. Mohr Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. J. Thorac. Cardiovasc. Surg., February 1, 2010; 139(2): 302 - 311. [Abstract] [Full Text] [PDF]

				P.-S. Hsu, J.-L. Chen, G.-J. Hong, Y.-T. Tsai, C.-Y. Lin, C.-Y. Lee, Y.-G. Chen, and C.-S. Tsai Extracorporeal membrane oxygenation for refractory cardiogenic shock after cardiac surgery: predictors of early mortality and outcome from 51 adult patients Eur J Cardiothorac Surg, February 1, 2010; 37(2): 328 - 333. [Abstract] [Full Text] [PDF]

				J. Wang, J. Han, Y. Jia, W. Zeng, J. Shi, X. Hou, and X. Meng Early and Intermediate Results of Rescue Extracorporeal Membrane Oxygenation in Adult Cardiogenic Shock Ann. Thorac. Surg., December 1, 2009; 88(6): 1897 - 1903. [Abstract] [Full Text] [PDF]

				A. L. Meyer, M. Strueber, S. Tomaszek, A. Goerler, A. R. Simon, A. Haverich, and S. Fischer Temporary cardiac support with a mini-circuit system consisting of a centrifugal pump and a membrane ventilator Interact CardioVasc Thorac Surg, November 1, 2009; 9(5): 780 - 783. [Abstract] [Full Text] [PDF]

				D. T. Haile and G. J. Schears Optimal Time for Initiating Extracorporeal Membrane Oxygenation Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2009; 13(3): 146 - 153. [Abstract] [PDF]

				S. H. Shinn, Y. T. Lee, K. Sung, S. Min, W. S. Kim, P. W. Park, and Y.-K. Ha Efficacy of emergent percutaneous cardiopulmonary support in cardiac or respiratory failure: fight or flight? Interact CardioVasc Thorac Surg, August 1, 2009; 9(2): 269 - 273. [Abstract] [Full Text] [PDF]

				X.-j. Luo, W. Wang, S.-s. Hu, H.-s. Sun, H.-w. Gao, C. Long, Y.-h. Song, and J.-p. Xu Extracorporeal membrane oxygenation for treatment of cardiac failure in adult patients Interact CardioVasc Thorac Surg, August 1, 2009; 9(2): 296 - 300. [Abstract] [Full Text] [PDF]

				L. A. Bockeria, K. V. Shatalov, I. V. Arnautova, and M. M. Makhalin eComment: Re: Extracorporeal membrane oxygenation for treatment of cardiac failure in adult patients Interact CardioVasc Thorac Surg, August 1, 2009; 9(2): 300 - 300. [Full Text] [PDF]

				JingwenLi, Cun Long, Song Lou, Feilong Hei, Kun Yu, Shigang Wang, Shengshou Hu, Jianping Xu, Qian Chang, Ping Liu, et al. Venoarterial extracorporeal membrane oxygenation in adult patients: predictors of mortality Perfusion, July 1, 2009; 24(4): 225 - 230. [Abstract] [PDF]