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ECMO POST-CARDIOTOMY, A SINGLE CENTRE EXPERIENCE
Daniela Gouveia1, José Máximo1, Nuno Costa1
1Cardiothoracic Surgery Department - Centro Hospitalar Universitário de São João, Portugal.
Insights
Extracorporeal membrane oxygenation (ECMO) after cardiac surgery can save lives, with one in three patients experiencing refractory cardiogenic shock surviving. Survivors of this advanced cardiopulmonary support generally maintain good health, despite associated risks.
Area of Science:
- Cardiology
- Cardiothoracic Surgery
- Intensive Care Medicine
Background:
- Refractory cardiogenic shock post-cardiotomy presents a critical challenge in cardiac surgery.
- Extracorporeal membrane oxygenation (ECMO) is an advanced life support option for such severe cases.
Purpose of the Study:
- To evaluate the outcomes of veno-arterial (VA) ECMO in patients with refractory cardiogenic shock following cardiac surgery at Centro Hospitalar Universitário S. João (CHUSJ).
Main Methods:
- A retrospective analysis of 13 adult patients who underwent VA ECMO for post-cardiotomy cardiogenic shock between 2011 and 2019.
- Data collected included preoperative comorbidities, surgical details, ECMO parameters, postoperative complications, and mortality.
- Survival rates at 12, 36, and 60 months post-discharge were assessed.
Main Results:
- Seven patients (53.8%) were successfully decannulated after a median ECMO duration of 6 days.
- Overall hospital mortality was 61.5% (8 patients).
- Five patients (38.5%) survived, with 4 discharged home; long-term survival at 60 months was 8.3%.
Conclusions:
- Veno-arterial ECMO offers a life-saving option for approximately one-third of patients with refractory cardiogenic shock post-cardiac surgery.
- Despite significant risks, survivors of VA ECMO can achieve and maintain a good health status.
Objectives:
Our objective was to examine the results of ECMO post cardiotomy in Centro Hospitalar Universitário S. João (CHUSJ).
Methods:
Between 2011 and 2019, 13 patients were cannulated for refractory cardiogenic shock post-cardiotomy; 8 (61,5%) male and 5 (38,5%) female. Patients under 18 years old were excluded. Data was collected from hospital archives concerning preoperative comorbidities, open-heart surgery procedure, dates of ECMO cannulation and decannulation, postoperative complications, hospital mortality and cause of death. Follow-up was obtained by review of the last outpatient observation. The outcomes investigated were hospital mortality and survival at 12, 36 and 60 months.
Results:
After a median ECMO-VA therapy of 6 days (1-16 days), 7 (53,8%) patients were successfully decannulated; from these 2 succumbed from stroke and septic shock, one is still in intermediate care convalescing steadily and 4 were discharged. Overall 8 (61,5%) patients died. 5 (38,5%) survived, 4 were discharged home and 1 is still in intermediate care. Survival (after discharge) at 12, 36 and 60 months was respectively 25%, 16,7% and 8,3%. Regarding postoperative complications, reoperation for bleeding was necessary in 5 (38.5%), stroke was diagnosed in 2 (15,4%), dialysis in 6 (46,2%), leg ischemia affected 5 (38,5%) and mediastinitis occurred in 1 (7,7%).
Conclusions:
VA ECMO saves a life in each three patients suffering from refractory cardiogenic shock after cardiac surgery. Despite risks associated with advanced cardiopulmonary support, survivors maintain good health condition.
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