Results of 50 adult patients treated with extracorporeal membrane oxygenation for refractory postoperative cardiogenic shock / 中华胸心血管外科杂志

ABSTRACT

Objective Extracorporeal membrane oxygenation is a cardiopulmonary supportive therapy. Since 2004, our institution has adopted venoarterial ECMO for adult patients who otherwise could not be weaned from cardiopulmonary bypass and patients experiencing postcardiotomy cardiogenic shock and/or pulmonary dysfunction unresponsive to conventional treatment algorithms. In this study, we reviewed our experience with ECMO support and tried to identify measurable values which might predict in-hospital mortality. Methods From January 2004 through December 2008, 50 of 21,298 adult patients received VA ECMO. We retrospectively analyzed clinical records of these 50 consecutive patients. Demographics, preoperative measurements, clinical characteristics at the time of ECMO implantation, ECMO related complications and in-hospital mortality were collected. Logistic regression analyses were performed to investigate predictors of mortality. A p value ≤0. 05 was accepted as significant. Results Mean ECMO duration was ( 110 ± 17 ) hours. 38 patients were weaned from ECMO and 33 patients survived upon discharge. The overall survival was 66%. In univariate analyses, duration of ECMO support, receiving cardiopulmonary resuscitation prior to ECMO setup, ECMO setup in ICU, pre-ECMO plasma lactate level, infection, lower limbs ischemia, renal failure, experiencing at least one ECMO related complications were all associated with in-hospital death. In a multiple logistic regression adjusted for other factors mentioned above, blood lactate level before initiation of ECMO was a risk factor associated with in-hospital mortality (OR 1. 27 95% CI 1. 042-1. 542 ). To evaluate the utility of pre-ECMO lactate in predicting mortality, a conventional receiver operating characteristic curve was produced. Sensitivity and specificity were optimal at a cut-off point of 12.6 mmol/L, with an AUC of 0. 752. The positive and negative predictive values were 73.3% and 83.9% respectively. Conclusion ECMO is a justifiable alternative treatment for postoperative refractory cardiac and pulmonary dysfunction which could rescue more than 60 percent of otherwise fatal patients. Patients with pre-ECMO lactate above 12.6mmol/L are at higher risks for in-hospital death. Evidence based therapy for this group of high risk patients is needed.