Does an Early Implantation of Extracorporeal Membrane Oxygenator in High-Risk Emergency Open Heart Surgery Patients Improve the Outcome in Comparison with Elective Patients? A Prospective Cohort Comparative Study
DOI:
https://doi.org/10.1532/hsf.4431Keywords:
Extracorporeal Membrane Oxygenator, Central and Peripheral Cannulation, Postcardiotomy cardiogenic shock, Emergency cardiac surgery, Intra-Aortic Balloon PumpAbstract
Background: Extracorporeal membrane oxygenator (ECMO) has been implemented in refractory postcardiotomy cardiogenic shock (PCCS) patients to maintain excellent oxygenation and hemodynamic support. The aim of this study is to compare the results of early ECMO implantation to treat refractory PCCS in emergency versus elective patients who developed univentricular or biventricular pump failure.
Patients and methods: Between January 2019 and June 2021, 35 patients received ECMO after refractory PCCS. Patients have been categorized into two groups: Group A contains 18 patients who were urgently operated on and Group B, which includes 17 patients who were electively operated on. ECMO was implanted through central cannulation (right atrium and ascending aorta), or through peripheral cannulation (femoral vessels or through axillary artery).
Results: There was no statistically significant difference between the two ECMO groups in the preoperative patient’s characteristics, complication rate, duration of mechanical ventilation, post-ECMO weaning hospital stay, duration of ICU stay, in-hospital mortality, and number of patients discharged from the hospital or in 1-year survival on follow up.
Conclusion: Early use of ECMO in high-risk emergency cardiac surgery should be taken into consideration when possible, without hesitance. Emergency and elective patients benefit equally from ECMO implantation and show comparable complication rates.
References
Bakhtiary F, Keller H, Dogan S, Dzemali O, Oezaslan F, Meininger D, et al. 2008. Veno-arterial extracorporeal membrane oxygenation for treatment of cardiogenic shock : clinical experiences in 45 adult patients. J Thorac Cardiovasc Surg. 135:382-88.
Doll N, Fabricius A, Borger MA, Bucerius J, Doll S, Kramer K, et al. 2003. Temporary extracorporeal membrane oxygenation in patients with refractory postoperative cardiogenic shock – a single center experience. J Card Surg. 18:512-18.
Golding LA, Crouch RD, Stewart RW, Novoa R, Lytle BW, McCarthy PM, et al. 1992. Postcardiotomy centrifugal mechanical ventricular support. Ann Thorac Surg. 54:1059-64.
Hill D, O‘Brien TG, Murray JJ, Dontigny L, Bramson ML, Osborn JJ, et al. 1972. Prolonged extra-corporeal oxygenation of acute post traumatic respiratory failure (shock lung syndrome).
N Engl J Med. 286:629-34.
Kawahito K, Ino T, Adachi H, Mizuhara A, Yamaguci A. 1994. Heparin coated percutaneous cardiopulmonary support for the treatment of circulatory collapse after cardiac surgery. ASAIO Trans. 40:972-76.
Morris AH. 2006. Extracorporeal support and patient outcome: credible causality remains elusive. Critical Care Med. 34:1551-52.
Muehrcke DD, McCarthy PM, Stewart RW, Foster RC, Ogella DA, Borsh JA, et al. 1996. Extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock. Ann Thorac Surg. 61: 684-91.
Pagani FD, Lynch W, Swaniker F, Dyke DB, Bartlett R, Koelling T, et al. 1999. Extracorporeal life support to left ventricular assist device Bridge to heart transplant: a strategy to optimize survival and resource utilization. Circulation. 2:206-10.
Rastan AJ, Dege A, Mohr M, Doll N, Falk V, Walther T, et al. 2010. Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. J Thorac Cardiovasc Surg. 139:302-11.
Rastan AL, Lachmann N, Walther T, Doll N, Gradistance T, Gummert JF, et al. 2006. Autopsy findings in patients on postcardiotomy extracorporeal membrane oxygenation (ECMO). Int J Artif Organs. 29: 1121-31.
Smedira NG, Moazami N, Golding CM, McCarthy PM, Apperson-Hansen C, Blackstone EH, et al. 2001. Clinical experience with 202 adults receiving extracorporeal membrane oxygenation for cardiac failure ; survival at five years. J Thorac Cardiovasc Surg. 122:92-102.
Smith C, Bellomo R, Raman JS, Matalanis G, Rosalion A, Buckmaster J, et al. 2001. An extracorporeal membrane oxygenation based approach to cardiogenic shock in an older population. Ann Thorac Surg. 71:1421-27.
Thiagarajan RR, Bratton SL. 2006. Extracorporeal membrane oxygenation for cardiac arrest: when to use it, and what are the outcomes? Critical Care Med. 34:1285-86.
Wagner J, Tiller C, Dietl M, Ulmer H, Brenner C, Stastny L, et al. 2019. Extracorporeal life support in myocardial infarction-induced cardiogenic shock: weaning success. Ann Thorac Surg. 108:1383-90.
