Summary: | Cardiogenic shock refractory to conventional therapy has very high mortality and limited therapeutical options. Aim of the study was to evaluate the impact of the use of ECMO as a life-saving measure when optimal conventional treatment has been reached and mechanical circulatory support is the only option for survival.
Material and methods: Between January 2009 and May 2011, 32 patients in cardiogenic shock refractory to optimal conventional therapy (inotropes and intra-aortic-balloonpump) were treated with the extracorporeal life support implantation. Veno-arterial extracorporeal membrane oxygenation has been implanted either at bedside under local anesthesia or in operating room.
Results: The mean age of the population (24 male and 8 female) was 49 ± 16 years, all patients presented with cardiogenic shock refractory to medical therapy due to various etiology. Veno-arterial extracorporeal membrane oxygenation was implanted at bedside under local anesthesia in 20 awake patients (63%) and in the operating room in the remaining 12 (37%). Average duration of ECMO support was 12.3 ± 10.2 days (range 1–46). Twenty-six patients (81%) were weaned from veno-arterial extracorporeal membrane oxygenation or bridged to either a ventricular assist device or heart transplantation. ECMO was used as bridge to transplantation in 7 patients (22%), bridge to recovery in 10 patients (31%) and bridge to bridge in 9 patients (28%). Six patients (18.7%) died during ECMO support, whereas 30-day overall survival after ECMO removal was 80.7% (21/26 pts). Sixteen patients (50%) were discharged from the hospital, with a 100% survival at sixmonths follow-up.
Conclusions: In our experience the use of ECMO as a "bridge to decision" significantly improved the outcome of cardiogenic shock patients, greatly reducing the expected mortality.
|