Temporary extracorporeal membrane oxygenation in patients with refractory postoperative cardiogenic shock--a single center experience.

BACKGROUND: Approximately 1% of patients require temporary circulatory support due to refractory cardiogenic shock following cardiac surgery. Such patients are at very high risk for subsequent morbidity and mortality. We evaluated the results of temporary extracorporeal membrane oxygenation (ECMO) support in patients with postcardiotomy cardiogenic shock.

METHODS: From November 1997 to February 2000, 7900 patients underwent cardiac surgery in our institution. Ninety-five patients (1.2%) (CABG, n = 63; AVR, n = 16; CABG and AVR, n = 8; other procedures, n = 8) required temporary postoperative ECMO support. ECMO implantation was performed via the femoral vessels or via the right atrium and ascending aorta. Intraaortic balloon counterpulsation was employed in all patients.

RESULTS: Mean duration of ECMO support was 2.8 +/- 2.1 days. Forty-five patients (47%) were successfully weaned from ECMO. Of these, 28 patients were discharged from hospital 35.8 +/- 20.8 days post-ECMO support. Overall hospital mortality for all ECMO patients was considerable at 71%. Mortality rate in the combined CABG and AVR group was 100% (P < 0.05 versus the other surgical groups). ECMO support was complicated by renal failure in 64% of patients, bleeding requiring mediastinal reexploration in 62%, ischemia of the lower limbs in 16%, cerebral edema in 6%, and cerebral hemorrhage in 3%.

CONCLUSIONS: ECMO is a suitable technique for short-term treatment of refractory postoperative low cardiac output. Mortality rates are comparable to other cardiac assist devices, with approximately 30% of patients able to be discharged from hospital.