Contemporary Outcomes of Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock at a Large Tertiary Care Center.

Published

Journal Article

Refractory cardiogenic shock (RCS) is associated with significant morbidity and mortality, and current mainstays of medical therapy appear inadequate. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) represents an increasingly accepted therapy for RCS. Demographics, past medical history, preoperative characteristics, outcomes, and adverse events were collected for consecutive patients who received VA-ECMO support for RCS at our institution from March 2007 to December 2013. One hundred and seventy-nine patients with a mean age of 56.9 ± 16.1 years were included. Etiologies of RCS included postcardiotomy shock in 70 patients (39%), acute myocardial infarction in 46 patients (26%), primary graft failure in 17 patients (10%), and acute decompensated heart failure in 24 patients (13%). Mean arterial pressure before VA-ECMO support was 59.4 ± 22.8 mm Hg and 30.7% (n = 55) were undergoing active cardiopulmonary resuscitation at the time of cannulation. Overall, 38.6% of patients (n = 69) survived to discharge and 44.7% of patients (n = 80) survived to 30 days. Myocardial recovery was achieved in 79.7% of survivors (n = 55) and 39.1% were transitioned to a more durable device. Univariate analysis identified age (p = 0.002) and etiology of RCS (p = 0.041) as the most significant predictors of in-hospital mortality. Venoarterial extracorporeal membrane oxygenation for RCS appears successful as salvage therapy. Age and etiology should be considered when evaluating patients for VA-ECMO.

Full Text

Duke Authors

Cited Authors

  • Truby, L; Mundy, L; Kalesan, B; Kirtane, A; Colombo, PC; Takeda, K; Fukuhara, S; Naka, Y; Takayama, H

Published Date

  • July 2015

Published In

Volume / Issue

  • 61 / 4

Start / End Page

  • 403 - 409

PubMed ID

  • 26125665

Pubmed Central ID

  • 26125665

Electronic International Standard Serial Number (EISSN)

  • 1538-943X

International Standard Serial Number (ISSN)

  • 1058-2916

Digital Object Identifier (DOI)

  • 10.1097/mat.0000000000000225

Language

  • eng