Extracorporeal membrane oxygenation for refractory cardiogenic shock after cardiac surgery：risk factors of early mortality and outcome
Du Zhong-tao
Yang Feng
Jiang Chun-jing
Xing Jia-lin
Miao Na
Liu Feng
Yang Xiao-fang
Jiang Yu
Li Jiao
Hou Xiao-tong
Abstract：[ Abstract]:Objective Analysis of risk factors of early mortality and outcome during extracorporeal membrane oxygenation ( ECMO) support for those with refractory cardiogenic shock after cardiac surgery. Methods Between January 2012 and December 2012, 6986 patients underwent cardiac surgery in our adult cardiac critical care unit. Among those, 54 patients (0.77%) were suppor?ted with veno-arterial ECMO for cardiac support because of refractory postcardiotomy cardiogenic shock. Indications for ECMO support included:failure to wean from cardiopulmonary bypass, or refractory cardiogenic shock development despite adequate filling volumes, large-dose inotropes and/or intra-aortic balloon pump support. 11 patients ( 20%) were excluded because the support time was less than 24 hours. The short-term and medium-term results of these patients were analyzed, and in addition, the prognostic factors of sur?vival were predicted. Results Patients'average age was 59.0 ±12.2 years. There were 30 male and 13 female patients. Overall mean support time was 5.1±4.1 days. Thirty-one (72.1%) patients could be successfully weaned from ECMO. The 30-day and 1-year mor?talities were 60.5% (27/43) and 69.8% (30/43), respectively. The in-hospital mortality was 65.1% (28/43). Thirteen (30.2%) patients were still alive at 1-year out-patient follow up. Stepwise logistic regression identified left-ventricular ejection fraction ( LVEF)≤30% at 72 h after ECMO initiation and number of packed red blood cells ( PRBCs) transfused during ECMO as significant predictors of mortality [ odds ratio ( OR)=14.76;95% confidence interval ( CI)=2.34-93.25;P =0.004 and OR=0.60;95% CI=0.38-0.94, P =0.03, respectively] . Conclusion ECMO provides a good temporary cardiopulmonary support in patients with postcardiotomy cardiogenic shock. The risk factor of mortality is poor LVEF after ECMO support, so the LVEF should be strictly monitored everyday during ECMO support.
Keywords：Mechanical circulatory assistanceExtracorporeal membrane oxygenationCardiacsurgeryCardiogenic shockRisk factors
Publication Date：2014-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 210-214 )