Peripheral Extracorporeal Membrane Oxygenation System as Salvage Treatment of Patients With Refractory Cardiogenic Shock: Preliminary Outcome Evaluation

Abstract

The novel Permanent Life Support (PLS; Maquet, Jostra Medizintechnik AG, Hirrlingen, Germany) as peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) support system has been investigated as treatment for patients with refractory cardiogenic shock (CS). Between January 2007 and July 2011, 73 consecutive adult patients were supported on peripheral PLS ECMO system at our institution (55 men; age 60.3 ± 11.6 years, range: 23-84 years). Indications for support were failure to wean from cardiopulmonary bypass in the setting of postcardiotomy (n = 50) and primary donor graft failure (n = 8), post-acute myocardial infarction CS (n = 12), and CS on chronic heart failure (n = 3). Mean support time was 10.9 ± 7.6 days (range: 2-34 days). Overall, 26 (35.6%) patients died on ECMO. Among survivors on ECMO, 44 (60.2%) patients were successfully weaned from support, and three (4.1%) were switched to a mid-long-term ventricular assist device. Thirty-three (45.2%) were successfully discharged. The following variables were significantly different if survivors and nonsurvivors on ECMO were compared: age (P = 0.04), female gender (P < 0.01), cardiopulmonary resuscitation before ECMO (P < 0.01), lactate level before ECMO (P = 0.01), number of platelets, fresh frozen plasma units, and packed red blood cells (PRBCs) transfused during ECMO support (P = 0.03, P = 0.02, and P < 0.01), blood lactate level (P = 0.01), and creatine kinase isoenzyme MB (CK-MB) relative index 72 h after ECMO initiation (P < 0.001), and multiple organ failure on ECMO (P < 0.01). Stepwise logistic regression identified blood lactate level and CK-MB relative index at 72 h after ECMO initiation, and number of PRBCs transfused on ECMO as significant predictors of mortality on ECMO (P = 0.011, odds ratio [OR] = 2.48; 95% confidence interval [CI] = 1.11-3.12; P = 0.012, OR = 2.81, 95% CI = 1.026-2.531; and P = 0.012, OR = 1.94, 95% CI = 1.02-5.21; respectively). Patients with an initial poor hemodynamic status could benefit by rapid peripheral installation of PLS ECMO. The blood lactate level, CK-MB relative index, and PRBCs transfused should be strictly monitored during ECMO support.

Contemporary Outcomes of Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock at a Large Tertiary Care Center

“…10 Recently, Loforte et al 11 published their experience of 73 patients with RCS across all etiologies who were treated with VA-ECMO. They reported a 45.2% survival to discharge rate.…”

Simple new risk score model for adult cardiac extracorporeal membrane oxygenation: simple cardiac ECMO score

“…5,6,7,9,10 However, there remains limited data from previous studies to suggest which patients make good candidates for cardiac ECMO, and which patients are futile cases. While previous studies have determined various risk factors for cardiac ECMO patients, no studies to date have isolated a specific risk score for this patient population.…”

“…7,5,9,10 With the use of ECMO for patient salvage from refractory cardiogenic shock in adult populations increasing exponentially, a comprehensive analysis of risk factors associated with the treatment, with the aim of creating a simple risk model, has yet to be completed.…”

Role of New Therapies in Reducing Mortality and Major Morbidity in Patients with Systolic Heart Failure

“…Supporting data are case series from multiple countries [36][37][38][39][40][41]. In one study involving 45 patients with refractory cardiogenic shock, ECMO was associated with survival to hospital discharge in 29% (13/45) versus the expected total absence of survival without ECMO [40].…”