Longterm Follow- Up of 1040 Consecutive Adult Patients Treated with Extracorporeal Membrane Oxygenation for Refractory Postcardiotomy Cardiogenic Shock

Objective: Adult postcardiotomy cardiogenic shock potentially requiring mechanical circulatory support occurs in 0.5% to 1.5% of cases. The aim of the study was to evaluate the clinical outcome, 30 day- and longterm follow up in patients undergoing extracorperal membrane oxygenation (ECMO) for refractory postcardiotomy cardiogenic shock at our high volume tertiary care center.

Methods: We analyzed all patients undergoing ECMO-Therapie (n = 1040; age = 55.8 ± 20.8; 67.2% male) between November 1997 and December 2013 at our institution. Follow-up range was from 0 to 13.9 years and was complete in 100%.

Results: Patient mean body mass index was 26.6 ± 5.4 kg/m², diabetes in 23.6%, arterially hypertension in 56.4%, pulmonary hypertension in 15.6%, active smoking in 25.1%, chronic obstructive pulmonary disease in 5.8%, peripheral arterial disease in 21.3%, preoperative intravenous inotropic in 9.2%, preoperative dialysis was in 4.6% and ejection fraction of 43.9 ± 18%. Isolated CABG procedure was performed in 21% and isolated valve procedure in 12.2%. 30 day survival rate was 53 ± 1.6%, 5 year survival rate was 19.8 ± 1.5% and 16.4 ± 1.9% after 10 years. Patient who were discharged from hospital had a 5 year survival rate of 60.6% ± 3.6% and 10 year survival rate of 50.3 ± 5.3%. Additional surgery procedure increased mortality rate significant. Multivariate regression analysis revealed older age (p = 0.01; OR 1.01 per year), preoperative β blocker (p = 0.005; OR 1.6) and active smoking (p = 0.002; OR 1.7) as independent risk factors for mortality. Cox analysis revealed following predictors for long term mortality: preoperative calcium antagonist (p = 0.01; OR 5.9), active smoking (p = 0.013; OR 1.8), active endocarditis (p = 0.013; OR 1.5), CABG operation (p = 0.004; OR 1.3), aortic valve replacement operation (p = 0.008; OR 1.3), mitral valve replacement (p = 0.005; OR 1.4), replacement of the ascendens aorta (p = 0.002; OR 1.5), postoperative cardiac arrhythmia (p = 0.005; OR 5.6), symptomatic postoperative transitory psychotic syndrome (p < 0.001; OR 2.4), gastrointestinal complication (p = 0.031; OR 8.9).

Conclusions: ECMO support is an acceptable option for patients with postcardiotomy cardiogenic shock who otherwise would die and is justified by good long-term outcome of hospital survivors. By high morbidity and mortality and also high resource management ECMO support must be definite by individual risk profile.