Early venoarterial extracorporeal membrane oxygenation improves outcomes in post-cardiotomy shock

AbstractPost-cardiotomy shock (PCS) is associated with substantial morbidity and mortality. We reviewed our 12-year experience of venoarterial extracorporeal membrane oxygenation (VA-ECMO) therapy for PCS. Between July 2007 and June 2018, 156 consecutive patients underwent VA-ECMO for PCS. We retrospectively investigated patient characteristics, indications, and management to determine factors affecting outcomes. Secondary analysis was performed by dividing the cohort into Era 1 (2007 –2012,n = 52) and Era 2 (2013–2018,n = 104) for comparison. After a median of 4.70 days (interquartile range [IQR] 2.76–8.53) of ECMO support, 72 patients (46.1%) survived to discharge. In-hospital mortality decreased in Era 2 from 75 to 43.3% (P <  0.001). Survivors were cannulated at lower serum lactate (5.3 [IQR 2.8–8.2] versus 7.5 [4.7–10.7],P = 0.003) and vasoactive-inotropic score (22.7 [IQR 11.3–35.5] versus 28.1 [IQR 20.8–42.5],P = 0.017). Patients in Era 2 were more frequently cannulated intraoperatively (63.5% versus 34.6%,P = 0.002), earlier in their hospital course, and at lower levels of serum lactate and vasoactive-inotropic score than in Era 1. Independent risk factors for mortality included increased age (odds ratio [OR] 1.06,P = 0.002), serum lactate at cannulation (OR 1.17,P = 0.009), and vasoactive-inotropic score (OR 1.04,P = 0.009). Bleeding and limb ischemia were less common in Era 2. Overall, outcomes of ECMO for PCS im...
Source: Journal of Artificial Organs - Category: Transplant Surgery Source Type: research