The use of extra-corporeal membrane oxygenation in post-cardiotomy cardiogenic shock.

Abstract

Post-cardiotomy cardiogenic shock (PCCS) is an infrequent occurrence reported from 3-5% (1). Where inotropic support and intra-aortic balloon pump fail to resuscitate the patient, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is the next step to avert certain death. Aim: to determine survival in post-cardiotomy ECMO, and identify adverse prognostic indicators (APIs) to ensure optimal selection of patients. Methods: A literature search identified 16 publications on post-cardiotomy ECMO. Following this, an Australia-wide dataset of 387 patients (2012-2017) was acquired, as was the cohort of post-cardiotomy ECMO patients from The Alfred Hospital (2008-2017). Survival to discharge and adverse prognostic indicators were determined based upon procedure, age group, and use of intra-aortic balloon pump. Results: A literature review of 16 publications showed 0.5-3% of cardiac surgical cohorts needed ECMO for PCCS. Survival to discharge was reported in all studies and ranged from 23.7% - 41.8% (4,5). Survival at 1 year was reported in 7 of the studies and dropped to 16.5 - 37%. The most commonly reported API was age. In review of the Australia-wide database, survival to discharge was reportedly higher at 51.7%. Age also predicted survival, with only 33.3% of patients over 75 surviving. Of the 67 Alfred patients, survival to discharge was 44.8%. Similarly, the average age of those patients who survived was lower (48.8 vs 55.8yo). Conclusion: Ongoing research of PCCS ECMO may indicate APIs that may be modified to prevent poor outcome, or identified to avert disasters.