The use of extracorporeal membrane oxygenation postcardiotomy—A systematic review

Abstract

Objectives The use of extracorporeal membrane oxygenation (ECMO) in cardiac surgery has been established in cases of postcardiotomy cardiogenic shock, which is refractory to conventional therapy with inotropes and intra‐aortic balloon pulsation support. We sought to examine the literature in a systematic review manner on the outcomes of using ECMO postcardiac surgery. Methods A comprehensive electronic literature search was done to identify all the articles that have discussed the use of ECMO postcardiac surgery. The keywords and medical subject headings terms were used to identify the relevant articles. Studies have been screened according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Results The identified studies have been summarized in each relevant section of this study. Cardiogenic shock postcardiac surgery can benefit from ECMO to varying degrees and the survival for this; otherwise, fatal condition has been shown to be improving through the use of ECMO. However, the decision and timing to initiate ECMO therapy remains selective and is dependent on a range of factors such as patient factor, clinician's judgment, meaning there is no consistent and solid ground regarding the timing of ECMO initiation. Conclusion Current evidence suggests that the circulatory support provided by ECMO improves survival rates for postcardiac surgery cardiogenic shock patients who are refractory to inotropic management, without such ECMO support patient mortality rates would be much greater.

Predictors associated with mortality of extracorporeal life support therapy for acute heart failure: single-center experience with 679 patients

“…In our study, we decided on four groups. Three of them are widely used in current literature [postcardiotomy (3,10,17,18), cardiopulmonary An event is defined as any reason for termination of ECLS therapy except death, which is defined as a censoring event. ECLS, extracorporeal life support.…”

Troponin T and Survival following Cardiac Surgery in Patients Supported with Extracorporeal Membrane Oxygenation for Post-Cardiotomy Shock

“…Still, given that patients after open-heart surgery have very different risk characteristics among themselves, and even more than patients without preceding operation, including different baseline parameters and additional inherent risk associated with intra- and post-operative course, it is justifiable to statistically treat PCCS–ECMO and non-post-cardiotomy ECMO groups separately to reduce data heterogeneity. Cardiovascular insult during or following heart surgery, causing drastic impairment of cardiac performance and cardiogenic shock, is commonly associated with multi-organ damage and general critical illness which may explain the lack of statistical association with mortality attributable to early perioperative troponin ( Figure 3 ) [ 15 ].…”

“…Nowadays, troponin is also routinely evaluated in PCCS–ECMO patients to assess the degree of myocardial injury, despite the lack of prognostic evidence in this subset of post-cardiotomy patients. Multiple papers have tried to provide insights into the risk factors of mortality in PCCS–ECMO patients [ 3 , 4 , 5 , 15 ]. Unfortunately, none of the papers directly address the specific research question regarding whether troponin could be a prognostic marker in adult PCCS–ECMO.…”

Venoarterial Extracorporeal Membrane Oxygenation for Postcardiomyotomy Shock in ICU Patients: The Jury Is Still Out!*

“…ECMO is increasingly used in intensive care (2, 3). PCS has an incidence of 2–6% of patients undergoing cardiac surgery, and it is estimated that 0.5–1% are refractory (4). VA-ECMO has been used for around 50 years in postcardiac surgery (5).…”