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Extracorporeal membrane oxygenation: Preliminary results in patients with postcardiotomy cardiogenic shock
Journal article   Open access   Peer reviewed

Extracorporeal membrane oxygenation: Preliminary results in patients with postcardiotomy cardiogenic shock

George J. Magovern, James A. Magovern, Daniel H. Benckart, Robert R. Lazzara, Tamara Sakert, Thomas D. Maher and Richard E. Clark
The Annals of thoracic surgery, v 57(6), pp 1462-1470
Jun 1994
DOI: https://doi.org/10.1016/0003-4975(94)90101-5
PMID: 8010788
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1016/0003-4975(94)90101-5View
Published, Version of Record (VoR)Maybe Open Access (Publisher Bronze),  Open

Abstract

Long-term survival at our institution for postcardiotomy cardiogenic shock patients supported with the BioPump is 36% (29/80 patients). A heparin-coated extracorporeal membrane oxygenator (ECMO), first introduced in 1991, may reduce organ injury associated with cardiopulmonary bypass. The device can be employed rapidly because it connects directly to the cardiopulmonary bypass cannula. In an effort to improve our results in the treatment of postcardiotomy cardiogenic shock, we used ECMO in 21 patients with this syndrome and accompanying complications. The patients were divided into three groups: group 1, ECMO after coronary artery bypass grafting; group 2, ECMO after mitral valve operation; and group 3, ECMO after open heart operation with prolonged cardiac arrest. Survival in group 1 was 80% with 12 of 14 patients discharged to home. All three deaths were caused by cardiac failure. Bleeding complications in this group were moderate. There was no evidence of disseminated intravascular coagulation, and levels of fibrin split products remained within the normal range. Postoperative complications included stroke (2), renal failure (1), mediastinitis (1), and prolonged respiratory failure (6). Mortality in group 2 was 100%. The major problem limiting recovery was left ventricular distention secondary to inadequate left ventricular decompression. Mortality in group 3 was 100%; all 4 died of brain death. Extracorporeal membrane oxygenation without left ventricular drainage clearly is not effective in patients undergoing mitral valve operations as it does not effectively decompress the left ventricle, but it was highly effective in treating postcardiotomy cardiogenic shock in our coronary artery bypass grafting patients. Extracorporeal membrane oxygenation also proved to be safe as the patient-related complications of stroke, renal failure, and mediastinitis were low. Our preliminary success with heparin-coated ECMO now needs to be confirmed by studies from other centers with larger groups of patients.

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66 citations in Web of Science
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Collaboration types
Domestic collaboration
Web of Science research areas
Cardiac & Cardiovascular Systems
Respiratory System
Surgery
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