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Single center experience with patients on veno arterial ECMO due to postcardiotomy right ventricular failure
Author(s) -
Djordjevic Ilija,
Eghbalzadeh Kaveh,
Sabashnikov Anton,
Deppe Antje C.,
Kuhn Elmar W.,
Seo Joon,
Weber Carolyn,
Merkle Julia,
Adler Christoph,
Rahmanian Parwis B.,
Liakopoulos Oliver J.,
Mader Navid,
KuhnRegnier Ferdinand,
Zeriouh Mohamed,
Wahlers Thorsten
Publication year - 2020
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/jocs.14332
Subject(s) - medicine , extracorporeal membrane oxygenation , cardiogenic shock , cardiology , heart failure , cardiopulmonary bypass , retrospective cohort study , mortality rate , surgery , myocardial infarction
Abstract Objectives Right ventricular (RV) failure is associated with poor outcome and increased mortality in cardiac surgery. Aim of our study was to analyze the outcome of veno arterial extracorporeal membrane oxygenation (va ECMO) therapy in patients with isolated RV failure in postcardiotomy cardiogenic shock (PCS) and to evaluate risk factors associated with 30‐day‐mortality. Methods Between August 2006 until August 2016, 64 consecutive patients with va ECMO therapy due to fulminant RV failure in PCS were identified and included in this retrospective observation. Further, outcome data and a comparison of va ECMO survivors and nonsurvivors was conducted. Results The mean age of the patient cohort was 63 ± 14 years. Patients were treated with va ECMO for 79 ± 61 hours. Twenty‐eight patients (44%) were successfully weaned off ECMO support. Overall 30‐day‐mortality was 88% (56/64). Hemoglobin concentration before ECMO implantation, maximum rise of muscle‐brain type creatine kinase during ECMO therapy, as well as lactic acid concentration 24 hours after initiation of va ECMO therapy were predictive for 30‐day mortality. Conclusion ECMO therapy in RV failure due to PCS is shown to be associated with an excessive mortality. Regarding our data, va ECMO might only be an appropriate short‐term mechanical assist device separating patients form cardiopulmonary bypass with an acceptable weaning rate. Particularly, in case of failed hemodynamic recovery of the right heart on va ECMO, direct RV bypass systems might function as a bailout option. Additionally, cardiac enzymes and lactic acid might provide valuable information in meeting therapy‐related decisions.