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Salvage Peripheral Extracorporeal Membrane Oxygenation Using Cobe Revolution ® Centrifugal Pump as a Bridge to Decision for Acute Refractory Cardiogenic Shock
Author(s) -
Moraca Robert J.,
Wanamaker Kelly M.,
Bailey Stephen H.,
McGregor Walter E.,
Murali Srinivas,
Benza Raymond,
Sokos George,
Magovern George J.
Publication year - 2012
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/j.1540-8191.2012.01467.x
Subject(s) - cardiogenic shock , medicine , extracorporeal membrane oxygenation , refractory (planetary science) , myocardial infarction , percutaneous , cardiology , shock (circulatory) , percutaneous coronary intervention , extracorporeal , heart transplantation , heart failure , surgery , physics , astrobiology
Objectives: Acute refractory cardiogenic shock with early multisystem organ failure has a poor outcome without mechanical circulatory support. We review our experience with emergent peripheral cardiopulmonary support as a bridge to decision in these patients. Methods: A retrospective review from January 2009 through December 2010 was conducted of 26 consecutive adult patients at a single institution with acute refractory cardiogenic shock who underwent salvage peripheral cardiopulmonary support. Results: There were 18 men and 8 women with a mean age of 54 years (range 18 to 76). Indications for support: acute myocardial infarction (n = 16), decompensated chronic heart failure (n = 2), refractory arrhythmic arrest (n = 3), acute valvular pathology (n = 4), and unknown (n = 1). Patients with primary postcardiotomy shock were excluded. Median duration of support was 3 days (range 1 to 14). Decisions included: withdraw of support (n = 4), recovery (n = 5), and bridge to a procedure (n = 17). The procedures were percutaneous coronary intervention (n = 4), left ventricular assist device (n = 9), heart transplantation (n = 1), and miscellaneous cardiac surgery (n = 3). Overall survival to discharge was 65%. In the recovery and bridge to a procedure group, 78% were discharged from the hospital and survival at three months was 72%. Conclusions: Salvage peripheral cardiopulmonary support is a useful tool to rapidly stabilize acute refractory cardiogenic shock permitting an assessment of neurologic and end‐organ viability. (J Card Surg 2012;27:521‐527)