292. Extracorporeal membrane oxygenation for refractory cardiogenic shock: a bridge to decision?

Abstract

Cardiogenic shock refractory to conventional therapy has very high mortality and limited therapeutical options. Aim of the study was to evaluate the impact of the use of ECMO as a life-saving measure when optimal conventional treatment has been reached and mechanical circulatory support is the only option for survival. Material and methods: Between January 2009 and May 2011, 32 patients in cardiogenic shock refractory to optimal conventional therapy (inotropes and intra-aortic-balloonpump) were treated with the extracorporeal life support implantation. Veno-arterial extracorporeal membrane oxygenation has been implanted either at bedside under local anesthesia or in operating room. Results: The mean age of the population (24 male and 8 female) was 49 ± 16 years, all patients presented with cardiogenic shock refractory to medical therapy due to various etiology. Veno-arterial extracorporeal membrane oxygenation was implanted at bedside under local anesthesia in 20 awake patients (63%) and in the operating room in the remaining 12 (37%). Average duration of ECMO support was 12.3 ± 10.2 days (range 1–46). Twenty-six patients (81%) were weaned from veno-arterial extracorporeal membrane oxygenation or bridged to either a ventricular assist device or heart transplantation. ECMO was used as bridge to transplantation in 7 patients (22%), bridge to recovery in 10 patients (31%) and bridge to bridge in 9 patients (28%). Six patients (18.7%) died during ECMO support, whereas 30-day overall survival after ECMO removal was 80.7% (21/26 pts). Sixteen patients (50%) were discharged from the hospital, with a 100% survival at sixmonths follow-up. Conclusions: In our experience the use of ECMO as a "bridge to decision" significantly improved the outcome of cardiogenic shock patients, greatly reducing the expected mortality.