Is it possible to predict outcome in cardiac ECMO? Analysis of preoperative risk factors.

BACKGROUND: Serious heart failure may be treated with extracorporeal membrane oxygenation (ECMO) when other treatment fails. The aim of the present study was to analyse preoperative risk factors of early mortality in patients treated with veno-arterial (VA)-ECMO. METHODS: We studied a total of 18 possible risk factors in 80 patients with severe cardiac insufficiency treated with VA-ECMO. All consecutive cases treated at our institution between Sept.1990 and May 2006 were included. Univariate analysis and multiple logistic regression analysis were performed on 16 risk factors. The endpoint was early mortality (any death within 30 days of ECMO treatment). RESULTS: Thirty patients (37.5%) died within 30 days. Age, gender, cause of cardiac failure, pre-ECMO treatment (ventilator, NO, IABP) did not significantly influence early mortality. A higher SvO2 was associated with survival and remained significant in the multivariate analysis. CONCLUSION: Treatment with VA-ECMO in patients with severe cardiac failure may save lives. It is, however, difficult to predict outcome. In this study, only SvO2 values prior to ECMO were positively associated with survival.

[Treatment of cardiac failure with an intra-aortic balloon pump]. / Behandling av hjertesvikt med intraaortal ballongpumpe.

BACKGROUND: Cardiogenic shock is associated with high mortality. This retrospective study examined the effect of an intra aortic balloon pump (IABP) in patients with decompensated heart failure and hypotension, with or without cardiogenic shock. MATERIAL AND METHODS: 94 patients were treated with IABP from January 1998 to December 2002, at the Department of Cardiology, Rikshospitalet University Hospital, Oslo, Norway. The indications for use of IABP were decompensated heart failure with hypotension with or without cardiogenic shock in patients with acute myocardial infarction (n = 41), ventricular septal rupture or mitral insufficiency as a complication to acute cardiac failure (n = 23), severe heart failure waiting for heart transplant (n = 10), unstable angina pectoris (n = 8), myocarditis (n = 6) and miscellaneous (n = 6). RESULTS: Mortality after 30 days was 24 % for all patients, with little variation between the above-mentioned subgroups. Median duration for IABP was 96 hours. Systolic blood pressure and diuresis per hour increased significantly from before to after application of IABP (35 +/- 34 mL/hour versus 95 +/- 77 mL/hour, p < 0.001 and 90 +/- 20 mmHg versus 115 +/- 22 mmHg, p < 0.001). The rate of complications requiring treatment was low with use of IABP (5 out of 94 patients). INTERPRETATION: Treatment with IABP in patients with decompensated heart failure and hypotension is an efficient stabilising treatment and safe to use.