Extracorporeal Membrane Oxygenation Uses in Refractory Cardiogenic Shock After Open-Heart Surgery
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Sociedade Brasileira de Cirurgia Cardiovascular
2024
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| author | Pablo Salazar Elizalde |
| author_facet | Pablo Salazar Elizalde |
| contents | Extracorporeal Membrane Oxygenation Uses in Refractory Cardiogenic Shock After Open-Heart Surgery Pablo Salazar Elizalde German J. Chaud Joaquín Gundelach Barbara Gaete Marcos Durand Ignacio Cuadra Sinthya Provoste Enrique Yanten Marcelo Tiznado Cristóbal Alvarado Medicina Morbidity Stroke Volume Heart Failure Catheterization Left Ventricular Function Introduction: Extracorporeal membrane oxygenation (ECMO) is the first-line therapy for temporary mechanical circulatory support allowing cardiac and pulmonary recovery or as a bridge to further therapeutic alternatives. The aim of this study was to report clinical outcomes in adult patients with refractory cardiac failure after open-heart surgery undergoing ECMO in a single center with an ECMO unit in Chile.Methods: We retrospectively analyzed adults with refractory cardiac failure after open-heart surgery who required a venoarterial (VA) ECMO between 2016 and 2021.Results: Of 16 patients with VA ECMO, 60% were men (n=10), 90% had hypertension (n=14), 69% had < 30% of left ventricular ejection fraction (n=11), and mean European System for Cardiac Operative Risk Evaluation II score was 12 ± 11%. ECMO support with central cannulation accounts for 81% (n=13), and an intra-aortic balloon pump was used in nine patients (56%). The mean time support was 4.7 ± 2.6 days (1.5 - 12 days). ECMO weaning was achieved in 88% of patients, and in-hospital mortality was 44% (n=7) after discharge. The freedom from all-cause mortality at one year of follow-up of the entire cohort was 38% (n=6).Conclusion: VA ECMO is now a well-known life-saving therapeutic option, but mortality and morbidity remain high. Implementation of an ECMO program with educational training is mandatory in order to find the proper balance between patient benefits, ethical considerations, and public health financial input in South America. 2024 artículo científico 0102-7638 https://www.redalyc.org/articulo.oa?id=398975996002 https://www.redalyc.org/journal/3989/398975996002/ https://www.redalyc.org/journal/3989/398975996002/html/ https://www.redalyc.org/journal/3989/398975996002/398975996002.epub https://www.redalyc.org/journal/3989/398975996002/movil https://doi.org/10.21470/1678-9741-2022-0344 en http://www.redalyc.org/revista.oa?id=3989 Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery application/pdf Sociedade Brasileira de Cirurgia Cardiovascular Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery (Brasil) Num.1 Vol.39 |
| format | Artículo científico |
| id | redalyc_398975996002 |
| institution | Redalyc |
| language | en |
| publishDate | 2024 |
| publisher | Sociedade Brasileira de Cirurgia Cardiovascular |
| spellingShingle | Extracorporeal Membrane Oxygenation Uses in Refractory Cardiogenic Shock After Open-Heart Surgery Pablo Salazar Elizalde Medicina Morbidity Stroke Volume Heart Failure Catheterization Left Ventricular Function Extracorporeal Membrane Oxygenation Uses in Refractory Cardiogenic Shock After Open-Heart Surgery Pablo Salazar Elizalde German J. Chaud Joaquín Gundelach Barbara Gaete Marcos Durand Ignacio Cuadra Sinthya Provoste Enrique Yanten Marcelo Tiznado Cristóbal Alvarado Medicina Morbidity Stroke Volume Heart Failure Catheterization Left Ventricular Function Introduction: Extracorporeal membrane oxygenation (ECMO) is the first-line therapy for temporary mechanical circulatory support allowing cardiac and pulmonary recovery or as a bridge to further therapeutic alternatives. The aim of this study was to report clinical outcomes in adult patients with refractory cardiac failure after open-heart surgery undergoing ECMO in a single center with an ECMO unit in Chile.Methods: We retrospectively analyzed adults with refractory cardiac failure after open-heart surgery who required a venoarterial (VA) ECMO between 2016 and 2021.Results: Of 16 patients with VA ECMO, 60% were men (n=10), 90% had hypertension (n=14), 69% had < 30% of left ventricular ejection fraction (n=11), and mean European System for Cardiac Operative Risk Evaluation II score was 12 ± 11%. ECMO support with central cannulation accounts for 81% (n=13), and an intra-aortic balloon pump was used in nine patients (56%). The mean time support was 4.7 ± 2.6 days (1.5 - 12 days). ECMO weaning was achieved in 88% of patients, and in-hospital mortality was 44% (n=7) after discharge. The freedom from all-cause mortality at one year of follow-up of the entire cohort was 38% (n=6).Conclusion: VA ECMO is now a well-known life-saving therapeutic option, but mortality and morbidity remain high. Implementation of an ECMO program with educational training is mandatory in order to find the proper balance between patient benefits, ethical considerations, and public health financial input in South America. 2024 artículo científico 0102-7638 https://www.redalyc.org/articulo.oa?id=398975996002 https://www.redalyc.org/journal/3989/398975996002/ https://www.redalyc.org/journal/3989/398975996002/html/ https://www.redalyc.org/journal/3989/398975996002/398975996002.epub https://www.redalyc.org/journal/3989/398975996002/movil https://doi.org/10.21470/1678-9741-2022-0344 en http://www.redalyc.org/revista.oa?id=3989 Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery application/pdf Sociedade Brasileira de Cirurgia Cardiovascular Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery (Brasil) Num.1 Vol.39 |
| title | Extracorporeal Membrane Oxygenation Uses in Refractory Cardiogenic Shock After Open-Heart Surgery |
| topic | Medicina Morbidity Stroke Volume Heart Failure Catheterization Left Ventricular Function |
| url | https://www.redalyc.org/articulo.oa?id=398975996002 https://www.redalyc.org/journal/3989/398975996002/ https://www.redalyc.org/journal/3989/398975996002/html/ https://www.redalyc.org/journal/3989/398975996002/398975996002.epub https://www.redalyc.org/journal/3989/398975996002/movil https://doi.org/10.21470/1678-9741-2022-0344 |