Have Changes in ECMO Technology Impacted Outcomes in Adult Patients Developing Postcardiotomy Cardiogenic Shock?

Abstract

Extracorporeal membrane oxygenation (ECMO) technology has undergone several advancements over the last decade. We sought to compare current ECMO technology to older ones to determine how these technological improvements have impacted outcomes in patients suffering from postcardiotomy cardiogenic shock (PCS). Between 2005 and 2010, 49 patients received ECMO as support for PCS following elective cardiac surgery. Patients were divided into three groups. Group 1 (Gp 1, n = 11) patients received a Biomedicus pump with an Affinity oxygenator, Group 2 (Gp 2, n = 11) patients received a Biomedicus pump with a Quadrox D oxygenator, and Group 3 (Gp 3, n = 27) patients received a Rotaflow pump with a Quadrox D oxygenator. Groups were compared with regards to adverse events and ability to wean. Adverse event analysis showed no statistically significant difference between groups in incidence of stroke (p = 0.08), renal failure (p = 0.88), or bleeding requiring reexploration (p = 0.10). Changes in technology did little to improve weaning rates from ECMO (Gp 1 = 63.6%, Gp 2 = 45.5%, and Gp 3 = 55.6%). Similar trends were detected in hospital survival (Gp 1 = 27.3%, Gp 2 = 27.3%, and Gp 3 = 33.3%). Technology did impact oxygenator durability with Gp 1 requiring seven (63.6%) oxygenator exchanges compared to zero (0.0%) in Gp 2 and two (7.4%) in Gp 1. While advancements in ECMO technology have resulted in improved oxygenator durability, outcomes in patients requiring such support for PCS continue to be poor.

Effects of intra-aortic balloon pump on cerebral blood flow during peripheral venoarterial extracorporeal membrane oxygenation support

“…At one academic medical center, combined ischemic and hemorrhagic stroke affected 7% of the adult patients supported with ECMO and significantly increased the odds ratio of death [17]. Brain death occurred in 7% to 21% of the cases of ECMO-treated adults in some ECMO centers [6]. In 2009, the national Extracorporeal Life Support Organization (ELSO) registry reported that 21% of 295 adults treated with ECPR experienced brain death.…”

Extracorporeal life support for adult cardiopulmonary failure

“…Mortality among patients who require ECMO support following cardiac surgery remains unacceptably high, ranging from 67% to 75% in published series. [50,51] Sepsis-induced cardiomyopathy. Evaluations of cardiac function by echocardiography in septic adult patients demonstrate 30% to 60% will have some degree of myocardial dysfunction.…”

“…As a distinct etiology of cardiogenic shock, postcardiotomy cardiogenic shock occurs in 0.5% to 1.5% of postoperative adult cardiac surgery patients. [50,51] The application of VA ECMO in this setting can provide necessary circulatory support until myocardial recovery or bridge to mechanical assist device implantation. Mortality among patients who require ECMO support following cardiac surgery remains unacceptably high, ranging from 67% to 75% in published series.…”

Examining Noncardiac Surgical Procedures in Patients on Extracorporeal Membrane Oxygenation

“…2,[5][6][7] Although outcomes in patients supported by ECMO are poor, [8][9][10] they have improved in recent years. 11,12 As more and more patients are supported with these temporary devices, 13 many will go on to develop noncardiac surgical problems. Few studies to date have examined noncardiac surgical procedures (NCSPs) in patients supported with temporary ECMO, and little data are available to guide perioperative management of these patients.…”