Combined use of extracorporeal membrane oxygenation and intra-aortic balloon pump for cardiogenic shock following valvular surgery

Wu Fang; Zhang Haibo; Han Jie; Li Yan; Meng Xu

doi:10.3760/j.issn.1673-4777.2019.08.007

Abstract：Objective To investigate the effect of extracorporeal membrane oxygenation (ECMO) combined with intra-aortic balloon pump (IABP) on patients with cardiogenic shock (CS) after valve surgery.Methods From January 2011 to August 2018,31 patients with CS after valve surgery undergoing ECMO were enrolled at Beijing Anzhen Hospital,Capital Medical University.According to the therapeutic regimen,they were divided into ECMO group(18 cases) and ECMO + IABP group(13 cases).Operation records,complications,biochemical indexes before operation and 48 h after using ECMO,clinical indicators at entry to intensive care unit,at the beginning of ECMO,24 h and 48 h after using ECMO were analyzed.Results There was no significant difference of weaning rate and in-hospital survival rate between groups (P ＞ 0.05).Endotracheal intubation time and postoperative 24 h drainage volume in ECMO + IABP group were significantly longer/more than those in ECMO group [(282 ± 244) h vs (140 ± 109) h,(867 ± 446) ml vs (372 ± 200) ml];incidence of postoperative cerebral hemorrhage in ECMO + IABP group was significantly higher than that in ECMO group(all P ＜ 0.05).At 48 h after using ECMO,serum levels of aspartate aminotransferase and alanine aminotransferase in ECMO + IABP group were significantly higher than those in ECMO group (all P ＜ 0.05).Level of bicarbonate ions at 24 h,48 h and pH value at 48 h after using ECMO in ECMO + IABP group were significantly lower than those in ECMO group;blood oxygen saturation at 24 h and blood lactic acid content at 24 h,48 h after using ECMO in ECMO + IABP group were significantly higher than those in ECMO group (all P ＜ 0.05).Conclusion Combined use of ECMO with IABP may increase cerebral bleeding and metabolic acidosis risk and shows no benefit on weaning rate and in-hospital survival.