Extracorporeal membrane oxygenation as a rescue measure for postcardiotomy cardiogenic shock: A retrospective observational analysis

Abstract

Background

Nearly 500,000 open-heart operations are performed annually in the United States, with complications such as postcardiotomy cardiogenic shock (PCCS) occurring in 2–9% of cases. Extracorporeal membrane oxygenation (ECMO) is a critical salvage therapy for patients unable to wean from cardiopulmonary bypass (CPB). This study aims to review our institution's experience with ECMO in managing PCCS and to analyze patient outcomes.

Methods

Following IRB approval, a retrospective observational study was conducted on adult patients aged 32–84 years who underwent open-heart procedures with the use of CPB requiring ECMO support due to failed wean from CPB from 1 April 2014 to 31 December 2022. Data were analyzed from electronic medical records for demographics, procedural details, ECMO therapy duration, and outcomes.

Results

Of 45 patients identified from 6346 open-heart procedures, 33 were male, and 12 were female, with an average age of 59.9 years. The majority of patients were Caucasian (88.8%, n = 40). Extracorporeal membrane oxygenation was initiated using venoarterial configurations in 100% (n = 45) of cases, with three patients transitioning to venovenous configurations. The median ECMO duration for all patients in the study was 4 days. In-hospital mortality was 51.1% (n = 23), while 48.9% (n = 22) of patients survived to discharge. Survivors were discharged to rehabilitation facilities (54.5%, n = 12), home (31.8%, n = 7), long-term acute care hospitals (9.1%, n = 2), or detention centers (4.5%, n = 1).

Conclusions

Extracorporeal membrane oxygenation remains a valuable rescue therapy for PCCS, achieving a 48.9% survival rate. This study highlights the importance of timely intervention and underscores the need for future research into optimizing patient selection and perioperative management.