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Med Intensiva. 2017 Dec;41(9):513-522. doi: 10.1016/j.medin.2016.12.013. Epub 2017 Mar 2.

Mechanical support with venoarterial extracorporeal membrane oxygenation (ECMO-VA): Short-term and long-term prognosis after a successful weaning.

[Article in English, Spanish]

Author information

1
UCI Cardiológica, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España. Electronic address: rennygg@hotmail.com.
2
UCI Cardiológica, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
3
Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, España.
4
Servicio de Cirugía Cardíaca, Hospital Universitario 12 de Octubre, Madrid, España.
5
Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.

Abstract

OBJECTIVE:

Extracorporeal membrane oxygenation (ECMO) affords mechanical circulatory assistance associated to high mortality. However, weaning from such mechanical support may not imply improved short- or long-term survival. This study describes the characteristics and evolution of patients with refractory cardiogenic shock (RCS) subjected to venoarterial ECMO (VA-ECMO) in a hospital with a heart transplant program.

DESIGN:

A single-center, retrospective cohort study was carried out.

SETTING:

The cardiovascular ICU of a tertiary hospital.

PATIENTS:

Forty-six patients consecutively subjected to VA-ECMO over 6 years.

INTERVENTIONS:

Hospital mortality after weaning from ECMO and overall survival (OS) were analyzed.

RESULTS:

Fifteen patients (33%) died with VA-ECMO and 31 (67%) were weaned after 8 days of support (IQR: 5-15). Fourteen patients under went transplantation. Hospital mortality in these patients was 32% (10/31), and was associated to age (P=.001), SAPS II score (P=.009), cannulation bleeding (P=.01) and post-acute myocardial infarction RCS (P=.001). After a median follow-up of 27 months (IQR: 11-49), 91% of the patients discharged from hospital were still alive. Overall survival after weaning from assistance was associated to the type of cardiac disease (P=.002). Patients with RCS after acute myocardial infarction had a poorer prognosis.

CONCLUSIONS:

In our experience, VA-ECMO can be used as mechanical assistance in the management of RCS. The technique is associated to high early mortality, though the long-term survival rate after hospital discharge is good.

KEYWORDS:

Acute cardiac care; Cardiovascular support; Cuidados cardiológicos agudos; Hospital mortality; Membrana de oxigenación extracorpórea veno-arterial; Mortalidad hospitalaria; Overall survival; Soporte cardiovascular; Supervivencia global; Venoarterial extracorporeal membrane oxygenation

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PMID:
28259366
DOI:
10.1016/j.medin.2016.12.013
[Indexed for MEDLINE]
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