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| Early and Late Outcome of 517 Consecutive Adult Patients Treated with Extracorporeal Membrane Oxygenation for Refractory Postcardiotomy Cardiogenic Shock (PCS) | |
Ardawan J. Rastan, Andreas Dege, Matthias Mohr, Nicolas Doll, Sven Lehmann, Volkmar Falk, Friedrich W. Mohr; Heart Surgery, Heart Center Leipzig, Leipzig, Germany
Methods: Between 05/96 and 06/08 517 of 40.538 pts (1.3%) undergoing cardiac surgery (37.1% elective, 24.4% urgent, 38.5 emergency) received perioperative ECMO support. Data were prospectively recorded. Procedures were isolated CABG (32.4%), CABG+valve surgery (19.3%), valve surgery (38.1%), thoracic organ transplantation (6.4%) and others (3.8%). Fifty-four preoperative, 26 procedural and 37 postoperative risk factors were evaluated by uni- und multivariate logistic regression analyses to identify risk factors for early and late mortality. Cumulative survival was estimated by Kaplan-Meier methods. Mean follow-up was 2.9y (0.0-11.4y). Results: Age was 61.3y, 73.0% were male, ejection fraction was 44.2±17.3%. ECMO implantation was performed through thoracic (56.7%) or extrathoracic (42.3%) cannulation using femoral or axillary arterial and femoral venous cannulation. Additional IABP support was employed in 77.0%. Mean drainage loss was, 3.2 and 4.4 liter 24 and 48h, respectively. 52.7% were successfully weaned from ECMO after mean 86h and 24.4% were discharged from the hospital after 41±25d. Hospital mortality was 75.6%. Neurological complications occurred in 21.3%, renal replacement therapy was indicated in 62.6%. Multivariate risk factors for hospital mortality were emergency indication (odds ratio OR 2.4), preoperative cardiogenic shock (OR 1.7), EF<30% (OR 3.5), preoperative renal dysfunction (OR 4.2) and combined coronary and valve procedure (OR 5.7, p<0.01 each), while age>70y and diabetes were none. Estimated cumulative survival was 18.1±2.9% after 6 months, 16.7±2.7% after one, 15.5±1.6. and 16.1±3.3% after five years. Risk factors for late death were age, combined CABG+MV surgery and diabetes. Conclusion: Temporary ECMO support it is an acceptable option for patients with PCS that otherwise would die and justified by the good long-term survival of hospital survivors. However, because of high morbidity and mortality individual ECMO indication has to be made on the specific risk profile.  Overall cumulative survival after ECMO implantation in adults PCS Back to 2009 Annual Meeting Back to Program Outline Back to Main Program |
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