When to discontinue extracorporeal membrane oxygenation for postcardiotomysupport

Background. Extracorporeal membrane oxygenation (ECMO) has demonstrated lim ited success in adult postcardiotomy shock. The goal of this study was to d etermine when to discontinue ECMO for postcardiotomy support. Methods. During a 7-year period ECMO was used in 51 postcardiotomy patients , of whom 16 (31%) weaned and 8 (16%) survived. Results. Patients in the heart transplant group were more likely to wean co mpared with patients in the non-heart transplant group (p = 0.03). Patients aged greater than 65 years (p = 0.04) or with ejection fractions of less t han 30% after 48 hours of ECMO (p < 0.001) were less likely to wean. Time o n ECMO was significantly longer for survivors in the heart transplant group (101.3 +/- 7.5 hours) compared with survivors in the non-heart transplant group (28.3 +/- 11.9 hours, p < 0.001). Conclusions. After 48 to 72 hours, consideration should be given to discont inuing ECMO, either by moving to an implantable ventricular assist device o r by withdrawal of support, except in those patients with heart transplants . In the latter, both severe postoperative pulmonary hypertension and reper fusion injury may take as long as 120 hours to reverse. (Ann Thorac Surg 20 01;71:210-4) (C) 2001 by The Society of Thoracic Surgeons.