Extracorporeal membrane oxygenation support for adult postcardiotomy cardiogenic shock

Wen Je Ko, Ching Yuang Lin, Robert J. Chen, Shoei Shen Wang, Fang Yue Lin, Yih Sharng Chen

Research output: Contribution to journalArticle

176 Citations (Scopus)

Abstract

Background. Postcardiotomy cardiogenic shock occasionally develops in patients who have undergone cardiac procedures. We report our experience using extracorporeal membrane oxygenation (ECMO) in adult patients with postcardiotomy cardiogenic shock, and analyze the factors that affected outcomes for these ECMO patients. Methods. We retrospectively reviewed the medical records of ECMO patients. Results. From August 1994 to May 2000, 76 adult patients (48 men, 28 women; mean age, 56.8 ± 15.9 years) received ECMO support for postcardiotomy cardiogenic shock at the National Taiwan University Hospital. The mean ECMO blood flow was 2.53 ± 0.84 L/min. The cardiac operations included coronary artery bypass grafting (n = 37), coronary artery bypass grafting and valvular operation (n = 6), valvular operation alone (n = 14), heart transplantation (n = 12), correction of congenital heart defects (n = 3), implantation of a left ventricular assist device (n = 2), and aortic operations (n = 2). Fifty-four patients received ECMO support after intraaortic balloon pumping, but 22 patients directly received ECMO support. Two patients were bridged to heart transplantation and two bridged to ventricular assist devices. Thirty patients died on ECMO support. The causes of mortality included brain death (n = 3), refractory arrhythmia (n = 2), near motionless heart (n = 2), acute graft rejection (n = 1), primary graft failure (n = 1), uncontrolled bleeding (n = 5), and multiple organ failure (n = 16). Twenty-two patients were weaned off ECMO support but presented intrahospital mortality. The cause of mortality included brain death (n = 1), sudden death (n = 4), and multiple organ failure (n = 17). Twenty patients were weaned off ECMO support and survived to hospital discharge. During the follow-up of 33 ± 22 months, all were in New York Heart Association functional status I or II except two cases of late deaths. Among the ECMO-weaned patients, "dialysis for acute renal failure" was a significant factor in reducing the chance of survival. Conclusions. The ECMO provided a satisfactory partial cardiopulmonary support to patients with postcardiotomy cardiogenic shock, and allowed time for clinicians to assess the patients and make appropriate decisions.

Original languageEnglish
Pages (from-to)538-545
Number of pages8
JournalAnnals of Thoracic Surgery
Volume73
Issue number2
DOIs
Publication statusPublished - Feb 12 2002
Externally publishedYes

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Extracorporeal Membrane Oxygenation
Cardiogenic Shock
Heart-Assist Devices
Brain Death
Multiple Organ Failure
Heart Transplantation
Coronary Artery Bypass
Mortality
Intra-Aortic Balloon Pumping
Congenital Heart Defects
Graft Rejection
Sudden Death
Taiwan
Acute Kidney Injury
Statistical Factor Analysis
Medical Records
Cardiac Arrhythmias

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Extracorporeal membrane oxygenation support for adult postcardiotomy cardiogenic shock. / Ko, Wen Je; Lin, Ching Yuang; Chen, Robert J.; Wang, Shoei Shen; Lin, Fang Yue; Chen, Yih Sharng.

In: Annals of Thoracic Surgery, Vol. 73, No. 2, 12.02.2002, p. 538-545.

Research output: Contribution to journalArticle

Ko, Wen Je ; Lin, Ching Yuang ; Chen, Robert J. ; Wang, Shoei Shen ; Lin, Fang Yue ; Chen, Yih Sharng. / Extracorporeal membrane oxygenation support for adult postcardiotomy cardiogenic shock. In: Annals of Thoracic Surgery. 2002 ; Vol. 73, No. 2. pp. 538-545.
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AU - Lin, Fang Yue

AU - Chen, Yih Sharng

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N2 - Background. Postcardiotomy cardiogenic shock occasionally develops in patients who have undergone cardiac procedures. We report our experience using extracorporeal membrane oxygenation (ECMO) in adult patients with postcardiotomy cardiogenic shock, and analyze the factors that affected outcomes for these ECMO patients. Methods. We retrospectively reviewed the medical records of ECMO patients. Results. From August 1994 to May 2000, 76 adult patients (48 men, 28 women; mean age, 56.8 ± 15.9 years) received ECMO support for postcardiotomy cardiogenic shock at the National Taiwan University Hospital. The mean ECMO blood flow was 2.53 ± 0.84 L/min. The cardiac operations included coronary artery bypass grafting (n = 37), coronary artery bypass grafting and valvular operation (n = 6), valvular operation alone (n = 14), heart transplantation (n = 12), correction of congenital heart defects (n = 3), implantation of a left ventricular assist device (n = 2), and aortic operations (n = 2). Fifty-four patients received ECMO support after intraaortic balloon pumping, but 22 patients directly received ECMO support. Two patients were bridged to heart transplantation and two bridged to ventricular assist devices. Thirty patients died on ECMO support. The causes of mortality included brain death (n = 3), refractory arrhythmia (n = 2), near motionless heart (n = 2), acute graft rejection (n = 1), primary graft failure (n = 1), uncontrolled bleeding (n = 5), and multiple organ failure (n = 16). Twenty-two patients were weaned off ECMO support but presented intrahospital mortality. The cause of mortality included brain death (n = 1), sudden death (n = 4), and multiple organ failure (n = 17). Twenty patients were weaned off ECMO support and survived to hospital discharge. During the follow-up of 33 ± 22 months, all were in New York Heart Association functional status I or II except two cases of late deaths. Among the ECMO-weaned patients, "dialysis for acute renal failure" was a significant factor in reducing the chance of survival. Conclusions. The ECMO provided a satisfactory partial cardiopulmonary support to patients with postcardiotomy cardiogenic shock, and allowed time for clinicians to assess the patients and make appropriate decisions.

AB - Background. Postcardiotomy cardiogenic shock occasionally develops in patients who have undergone cardiac procedures. We report our experience using extracorporeal membrane oxygenation (ECMO) in adult patients with postcardiotomy cardiogenic shock, and analyze the factors that affected outcomes for these ECMO patients. Methods. We retrospectively reviewed the medical records of ECMO patients. Results. From August 1994 to May 2000, 76 adult patients (48 men, 28 women; mean age, 56.8 ± 15.9 years) received ECMO support for postcardiotomy cardiogenic shock at the National Taiwan University Hospital. The mean ECMO blood flow was 2.53 ± 0.84 L/min. The cardiac operations included coronary artery bypass grafting (n = 37), coronary artery bypass grafting and valvular operation (n = 6), valvular operation alone (n = 14), heart transplantation (n = 12), correction of congenital heart defects (n = 3), implantation of a left ventricular assist device (n = 2), and aortic operations (n = 2). Fifty-four patients received ECMO support after intraaortic balloon pumping, but 22 patients directly received ECMO support. Two patients were bridged to heart transplantation and two bridged to ventricular assist devices. Thirty patients died on ECMO support. The causes of mortality included brain death (n = 3), refractory arrhythmia (n = 2), near motionless heart (n = 2), acute graft rejection (n = 1), primary graft failure (n = 1), uncontrolled bleeding (n = 5), and multiple organ failure (n = 16). Twenty-two patients were weaned off ECMO support but presented intrahospital mortality. The cause of mortality included brain death (n = 1), sudden death (n = 4), and multiple organ failure (n = 17). Twenty patients were weaned off ECMO support and survived to hospital discharge. During the follow-up of 33 ± 22 months, all were in New York Heart Association functional status I or II except two cases of late deaths. Among the ECMO-weaned patients, "dialysis for acute renal failure" was a significant factor in reducing the chance of survival. Conclusions. The ECMO provided a satisfactory partial cardiopulmonary support to patients with postcardiotomy cardiogenic shock, and allowed time for clinicians to assess the patients and make appropriate decisions.

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