Concurrent Implantation of Intra‐Aortic Balloon Pump and Extracorporeal Membrane Oxygenation Improved Survival of Patients With Postcardiotomy Cardiogenic Shock

Abstract

The aim of this study is to report the combined application of extracorporeal membrane oxygenation (ECMO) with intra‐aortic balloon pumping (IABP) in postcardiotomy cardiac shock (PCS). A total of 60 consecutive patients who received both ECMO and IABP (concomitantly 24 hours) for PCS from February 2006 to March 2017 at Fuwai Hospital were included in our study. Clinical characteristics of the patients were collected retrospectively and compared between survivors and non‐survivors. Logistic regression analysis was used as predictors for survival to discharge. The study cohort had a mean age of 51.4±12.7 years with 75% males. ECMO was implanted intra‐operatively in 38 (63%) patients and post‐operatively in 22 (37%) patients. ECMO was implanted concurrently with IABP in 38 (63%) patients. Heart transplantation (38%) and coronary artery bypass graft (33%) were the main surgical procedures. ECMO was weaned successfully in 48% patients, and the rate of survival to discharge was 43%. Survivors showed less bedside ECMO implantation (12% vs. 41%, P=0.012) and more concurrent implantation of ECMO with IABP (81% vs. 50%, P=0.014). Concurrent implantation of IABP with ECMO (OR=0.177, P=0.015, 95% CI: 0.044‐0.718) was an independent predictor of survival to discharge. As for complications, the rate of renal failure (59% vs. 15%, P=0.001) and multiple organ dysfunction syndrome (29% vs. 0, P=0.003) was higher in patients who failed to survive to discharge. Patients who had heart transplantation had a better long‐term survival than others (P=0.0358). In summary, concurrent implantation of ECMO with IABP provides better short‐term outcome for PCS and combined application of ECMO with IABP for PCS after heart transplantation had a favorable long‐term outcome.

Interdependence of VA-ECMO output, pulmonary congestion and outcome after cardiac surgery

“…However, recently, routine use of IABP or Impella after implantation of VA-ECMO was found associated with decreased pulmonary congestion and improved ECMO weaning [8,9], however data on a survival benefit of IABP use in this setting are conflicting [10]. A retrospective study has suggested that combined application of ECMO with IABP for postcardiotomy cardiogenic shock after CABG or heart transplant was associated with a favorable outcome [11]. A prospective randomized clinical trial is currently investigating whether the addition of early direct ventricular unloading using Impella decreases pulmonary congestion and leads to improved survival in cardiogenic shock patients undergoing ECMO support (NCT03431467).…”

Mechanical circulatory support for early surgical repair of postinfarction ventricular septal defect with cardiogenic shock

“…The pigtail catheter is then connected to the venous line of the ECLS, and thus, serves as a left vent. Some studies described more successful weaning from ECLS therapy with the addition of an IABP compared to weaning without it in patients with CS, but without pVSD, 24,25 one paper even found a survival advantage compared to the weaning without IABP. 25 We could demonstrate by an animal study an impairment of the mean arterial pressure and consequently, the perfusion of the coronary arteries for retrograde ECLS perfusion in combination with IABP compared to antegrade perfusion.…”

Artificial Organs 2019: A year in review

“…Kai Chen et al of the Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China to reported on the combined application of extracorporeal membrane oxygenation (ECMO) with intra‐aortic balloon pumping (IABP) in postcardiotomy cardiac shock (PCS) in 60 consecutive patients. ECMO was weaned successfully in 48% patients.…”