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Central vs peripheral venoarterial ECMO in postcardiotomy cardiogenic shock
Author(s) -
Djordjevic Ilija,
Eghbalzadeh Kaveh,
Sabashnikov Anton,
Deppe AntjeChristin,
Kuhn Elmar,
Merkle Julia,
Weber Carolyn,
Ivanov Borko,
Ghodsizad Ali,
Rustenbach Christian,
Adler Christoph,
Rahmanian Parwis,
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.14526
Subject(s) - medicine , cardiogenic shock , extracorporeal membrane oxygenation , peripheral , incidence (geometry) , shock (circulatory) , cohort , retrospective cohort study , cardiology , surgery , myocardial infarction , physics , optics
Objectives Central or peripheral venoarterial extracorporeal membrane oxygenation (va ECMO) is widely used in postcardiotomy cardiogenic shock (PCS). Available data suggest controversial results for both types. Our aim was to investigate PCS patients treated with either peripheral (pECMO) or central ECMO (cECMO) concerning their outcome. Methods Between April 2006 and October 2016, 156 consecutive patients with va ECMO therapy due to PCS were identified and included in this retrospective analysis. Patients were divided into cECMO and pECMO groups. Statistical analysis of risk factors concerning 30‐day mortality of the mentioned patient cohort was performed using IBM SPSS Statistics. Results Fifty‐six patients received cECMO and 100 patients were treated with pECMO due to PCS. In the group of cECMO peripheral vascular disease was significantly more present (cECMO 19 [34%] vs pECMO 14 [14%]; P < .01). On‐site ECMO complications occurred significantly more frequent in patients treated with cECMO (cECMO 44 [79%] vs pECMO 54 [54%] g/dL; P < 0.01). More often cECMO patients required a second look operation due to mediastinal bleeding (cECMO 52 [93%] vs pECMO 61 [61%] g/dL; P < .01). Thirty‐day mortality was comparable with nearly 70% in both cohorts (cECMO 39 [70%] vs pECMO 69 [69%]; P = .93). Conclusion Patients supported by cECMO or pECMO due to refractory PCS did not show significant differences in 30‐day mortality, despite a lower incidence of on‐site ECMO complications and re‐exploration in pECMO patients. PCS itself is associated with high mortality and peripheral cannulation might help to save resources compared with central cannulation.