EXTRACORPOREAL MEMBRANE-OXYGENATION - PRELIMINARY-RESULTS IN PATIENTSWITH POSTCARDIOTOMY CARDIOGENIC-SHOCK

Long-term survival at our institution for postcardiotomy cardiogenic s hock patients supported with the BioPump is 36% (29/80 patients). A he parin-coated extracorporeal membrane oxygenator (ECMO), first introduc ed in 1991, may reduce organ injury associated with cardiopulmonary by pass. The device can be employed rapidly because it connects directly to the cardiopulmonary bypass cannula. In an effort to improve our res ults in the treatment of postcardiotomy cardiogenic shock, we used ECM O in 21 patients with this syndrome and accompanying complications. Th e patients were divided into three groups: group 1, ECMO after coronar y artery bypass grafting; group 2, ECMO after mitral valve operation; and group 3, ECMO after open heart operation with prolonged cardiac ar rest. Survival in group 1 was 80% with 12 of 14 patients discharged to home. All three deaths were caused by cardiac failure. Bleeding compl ications in this group were moderate. There was no evidence of dissemi nated intravascular coagulation, and levels of fibrin split products r emained within the normal range. Postoperative complications included stroke (2), renal failure (1), mediastinitis (1), and prolonged respir atory failure (6). Mortality in group 2 was 100%. The major problem li miting recovery was left ventricular distention secondary to inadequat e 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 car diogenic shock in our coronary artery bypass grafting patients. Extrac orporeal membrane oxygenation also proved to be safe as the patient-re lated complications of stroke, renal failure, and mediastinitis were l ow. Our preliminary success with heparin-coated ECMO now needs to be c onfirmed by studies from other centers with larger groups of patients.