Extracorporeal Membrane Oxygenation in Refractory Cardiogenic Shock

Many clinicians do not know under what exact conditions extracorporeal membrane oxygenation (ECMO) can get the best results. In this study, we explored the optimal indications for ECMO in patients with refractory cardiogenic shock.

From October 2014 to November 2019, 23 patients with refractory cardiogenic shock were treated with ECMO in our hospital, including 11 cases with acute left anterior myocardial infarction, 3 with acute left inferior and right ventricular myocardial infarction, and 9 with fulminant myocarditis. These cases were divided into survivors (n = 10) and nonsurvivors (n = 13), and the clinical data of the 2 groups were compared.

The weaning rate of ECMO was 60.9%. The discharge survival rate was 43.5%. There were significant differences in age, sequential organ failure assessment (SOFA) score, vasoactive-inotropic (VIS) score, lactic acid concentrations, primary disease, and smoking history between survivors and nonsurvivors before ECMO (P < .05). There were significant differences in blood pressure (systolic and diastolic), oxygen partial pressure, and left ventricular ejection fraction between survivors and nonsurvivors 1 day before the removal of ECMO (P < .05).

The reversibility of the primary disease causing refractory cardiogenic shock is critical to the survival rate of ECMO. Etiological treatment is essential, and extra attention should be paid to the use of ECMO in patients with irreversible primary disease. ECMO should be regarded as a first aid device and is not suitable for long-term cardiac assistance; left ventricular assist or heart transplantation is a better option.