Impact of Initial Operative Urgency on Short-Term Outcomes in Patients Treated with ECMO Due to Postcardiotomy Cardiogenic Shock

Abstract

The outcomes of patients with PCS and following ECMO therapy are associated with several preoperative risk factors. Our aim was to compare clinical presentation, ECMO-related data and in-hospital outcomes of patients treated with ECMO due to PCS after cardiac surgery, in regard to elective or emergent cardiac surgery procedures. Between April 2006 and October 2016, 164 consecutive patients that received VA-ECMO therapy due to PCS were identified and included in this retrospective cohort study. The patients were divided into groups based on the urgency of the initial procedures performed: elective group (ELG; n = 95) and an emergency group (EMG; n = 69). To compare the unequal patient groups, a propensity score-based matching (PSM) was applied (ELG, n = 56 vs. EMG, n = 56). The EMG primarily received ECMO intraoperatively (p ≤ 0.001). In contrast, the ELG were needed ECMO support more frequently postoperatively (p < 0.001). In-hospital mortality accounted for 71% (n = 40) in the ELG and 76% (n = 43) in the EMG (p = 0.518). Outcome data showed no major differences in the (abdominal ischemia (p = 0.371); septic shock (p = 0.393): rhythm disturbances (p = 0.575); emergency re-thoracotomy (p = 0.418)) between the groups. The urgency of the initial procedures performed is secondary in patients suffering PCS and following ECMO. In this regard, PCS itself seems to trigger outcomes in cardiac surgery ECMO patients substantially.

Comparison of On-Pump Beating Heart Surgery Versus Conventional Bypass Surgery in Patients with Acute Myocardial Infarction Requiring Urgent Revascularization

“…Cardiogenic shock following cardiac surgery is resistant to inotropic support, and the use of an IABP is uncommon but almost always results in death without mechanical circulatory support. It is commonly employed in numerous trials to treat poor blood flow or cardiogenic shock following any post-cardiotomy procedure [30][31][32]. ECMO was utilized in our patients with acute myocardial infarction following the surgical intervention.…”

Extracorporeal Membrane Oxygenation (VA-ECMO) in Management of Cardiogenic Shock

“…Extracorporeal membrane oxygenation has been increasingly used in the last two decades and has been shown to be an effective tool in the management of CS [2,9,10]. Venoarterial (VA) ECMO provides rapid, robust biventricular circulatory support and ventilatory support with impaired cardiac output [3,11].…”