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Mechanical cardiopulmonary support for refractory cardiogenic shock
J E Reedy1, M T Swartz, S C Raithel
1Department of Surgery, St. Louis University Medical Center, MO 63110-0250.
Heart & Lung : the Journal of Critical Care
|September 1, 1990
Summary
Extracorporeal membrane oxygenation (ECMO) can successfully resuscitate patients with cardiac arrest or cardiogenic shock unresponsive to other treatments. This life support system offers improved survival rates in carefully selected patients when used for short durations.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Refractory cardiogenic shock and cardiac arrest present significant therapeutic challenges.
- Conventional resuscitation methods, including intraaortic balloon pumps, are often insufficient for critically ill cardiac patients.
- Arteriovenous extracorporeal membrane oxygenation (ECMO) has emerged as a potential resuscitative tool.
Purpose of the Study:
- To evaluate the efficacy and outcomes of using arteriovenous extracorporeal membrane oxygenation (ECMO) as a resuscitative system for patients in cardiac arrest or cardiogenic shock.
- To identify patient characteristics and clinical scenarios where ECMO support is most beneficial.
- To determine the optimal duration and application criteria for resuscitative ECMO.
Main Methods:
- A retrospective analysis of 38 patients (mean age 49.4 years) treated with arteriovenous ECMO between February 1982 and February 1990.
- Patients received ECMO support in intensive care units, cardiac catheterization laboratories, or emergency departments.
- Outcomes assessed included hemodynamic stability, duration of ECMO support, weaning success, and long-term survival.
Main Results:
- Ninety-two percent (35/38) of patients achieved hemodynamic stability with ECMO flows greater than 2 L/min/m2.
- Twenty-four patients were successfully weaned from ECMO after further interventions such as coronary artery bypass, cardiac transplantation, or ventricular assist device insertion.
- Nine patients (24%) were discharged as long-term survivors.
Conclusions:
- Resuscitative ECMO is a valuable intervention for selected patients with refractory cardiogenic shock or cardiac arrest, particularly when used for 12 to 24 hours.
- Optimal candidates for ECMO include patients younger than 60, those with acute events amenable to surgical intervention, and potential cardiac transplant recipients.
- Careful patient selection and timely transition to definitive therapy are crucial for maximizing survival benefits with ECMO.