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): Ardawan Julian Rastan Nicolas Doll Volkmar Falk Thomas Walther Friedrich Wilhelm Mohr Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rastan, A. J. Articles by Mohr, F. W. Search for Related Content PubMed Articles by Rastan, A. J. Articles by Mohr, F. W. Related Collections Mechanical Circulatory Assistance Myocardial infarction

J Thorac Cardiovasc Surg 2010;139:302-311
© 2010 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock

Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany

Read at the Eighty-ninth Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 9–13, 2009.

Received for publication July 13, 2009; revisions received September 2, 2009; accepted for publication October 15, 2009.

^_* Address for reprints: Ardawan Rastan, MD, PhD, University Leipzig, Department of Cardiac Surgery, Struempellstrasse 39, 04289 Leipzig, Germany. (Email: rastan{at}rz.uni-leipzig.de).

Objective: Adult postcardiotomy cardiogenic shock potentially requiring mechanical circulatory support occurs in 0.5% to 1.5% of cases. Risk factors influencing early or long-term outcome after extracorporeal membrane oxygenation implantation are not well described.

Methods: Between May 1996 and May 2008, 517 adult patients received extracorporeal membrane oxygenation support for postcardiotomy cardiogenic shock. Procedures were isolated coronary artery bypass grafting (37.4%), isolated valve surgery (14.3%), coronary artery bypass grafting plus valve surgery (16.8%), thoracic organ transplantion (6.5%), and other combinations (25.0%). Fifty-four preoperative and 42 procedural risk factors concerning in-hospital mortality were evaluated by logistic regression analyses.

Results: Mean age was 63.5 years, 71.5% were male, ejection fraction was 45.9% ± 17.6%, logistic EuroSCORE was 21.6% ± 20.7%. Extracorporeal membrane oxygenation was established through thoracic (60.8%) or extrathoracic (39.2%) cannulation. Extracorporeal membrane oxygenation support was 3.28 ± 2.85 days. Intra-aortic balloon pumps were implanted in 74.1%. Weaning from extracorporeal membrane oxygenation was successful for 63.3%, and 24.8% were discharged. Cerebrovascular events occurred in 17.4%, gastrointestinal complications in 18.8%, and renal replacement therapy in 65.0%. Risk factors for hospital mortality were age older than 70 years (odds ratio, 1.6), diabetes (odds ratio, 2.5), preoperative renal insufficiency (odds ratio, 2.1), obesity (odds ratio, 1.8), logistic EuroSCORE greater than 20% (odds ratio, 1.8), operative lactate greater than 4 mmol/L (odds ratio, 2.2). Isolated coronary artery bypass grafting (odds ratio, 0.44) was protective. Cumulative survivals were 17.6% after 6 months, 16.5% after 1 year, and 13.7% after 5 years.

Conclusions: Extracorporeal membrane oxygenation support is an acceptable option for patients with postcardiotomy cardiogenic shock who otherwise would die and is justified by good long-term outcome of hospital survivors. Because of high morbidity and mortality, extracorporeal membrane oxygenation must be decided by individual risk profile.

This article has been cited by other articles:

				C. Heilmann, G. Trummer, M. Berchtold-Herz, C. Benk, M. Siepe, and F. Beyersdorf Established markers of renal and hepatic failure are not appropriate to predict mortality in the acute stage before extracorporeal life support implantation Eur J Cardiothorac Surg, January 12, 2012; (2012) ezr249v1. [Abstract] [Full Text] [PDF]

				A. J. Bastin and R. Firmin Extracorporeal membrane oxygenation for severe acute respiratory failure in adults: NICE guidance Heart, October 15, 2011; 97(20): 1701 - 1703. [Abstract] [Full Text] [PDF]

				J.-P. Mazzucotelli, P. Leprince, P.-Y. Litzler, A. Vincentelli, A. Le Guyader, M. Kirsch, L. Camilleri, E. Flecher, and for the reflection group on mechanical circulatory Results of mechanical circulatory support in France Eur J Cardiothorac Surg, September 1, 2011; 40(3): e112 - e117. [Abstract] [Full Text] [PDF]

				A. J. Rastan, O. Akhavuz, and F. W. Mohr Chapter 46 Coronary artery bypass graft surgery The ESC Textbook of Acute and Intensive Cardiac Care, December 1, 2010; 1(1): med-9780199584314-chapter - med-9780199584314-chapter. [Abstract] [Full Text] [PDF]