Original articleAdult cardiacExtracorporeal Membrane Oxygenation for Advanced Refractory Shock in Acute and Chronic Cardiomyopathy
Section snippets
Study Protocol
Between January 2003 and February 2009, 42 patients required the use of ECMO support at the UPMC (University of Pittsburgh Medical Center). In 33 patients, the primary cause of CS was a confirmed AMI, while in the other 9 patients the etiology was an acutely decompensated CCM (7 dilated and 2 ischemic) in the absence of an acute coronary event, as assessed by electrocardiographic, enzymatic, or angiographic criteria. Data were obtained from the UPMC transplant and mechanical support database
Results
Demographic and clinical characteristics of the patients in both groups are presented in Table 1. Patients with CCM-CS had higher creatinine, bilirubin, and blood lactate levels at the time of initiation of ECMO support than patients with AMI-CS. Twenty-seven patients with AMI-CS (27 of 33; 82%) underwent an initial PCI attempt prior to or simultaneously with ECMO implantation. Revascularization was possible in 21 patients receiving ECMO for AMI-CS, by PCI alone (13 patients), CABG alone (3
Comment
In this study, we report a single-center experience with the use of ECMO to stabilize patients with advanced refractory CS secondary to an AMI and unresponsive to medical management, including considerations for patient selection, implantation, and subsequent management. We found that ECMO provided effective support in patients after an AMI complicated by advanced refractory CS as a bridge to recovery or to a more durable support (VAD) while waiting for a heart transplant. Mechanical support in
References (18)
- et al.
Improved survival after acute myocardial infarction complicated by cardiogenic shock with circulatory support and transplantation: comparing aggressive intervention with conservative treatment
J Heart Lung Transplant
(2006) - et al.
Experience with the Levitronix CentriMag circulatory support system as a bridge to decision in patients with refractory acute cardiogenic shock and multisystem organ failure
J Thorac Cardiovasc Surg
(2007) - et al.
Veno-arterial extracorporeal membrane oxygenation using Levitronix centrifugal pump as bridge to decision for refractory cardiogenic shock
J Thorac Cardiovasc Surg
(2010) - et al.
Outcome evaluation of the bridge-to-bridge concept in patients with cardiogenic shock
Ann Thorac Surg
(2006) - et al.
Use of the AB5000 ventricular assist device in cardiogenic shock after acute myocardial infarction
Ann Thorac Surg
(2010) - et al.
An extracorporeal membrane oxygenation-based approach to cardiogenic shock in an older population
Ann Thorac Surg
(2001) - et al.
Short- and long-term survival of patients transferred to a tertiary care center on temporary extracorporeal circulatory support
Ann Thorac Surg
(2009) - et al.
Clinical characteristics and in-hospital outcomes of patients with cardiogenic shock undergoing coronary artery bypass surgery: insights from the Society of Thoracic Surgeon National Cardiac Database
Circulation
(2008) - et al.
Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock
JAMA
(2005)