An extracorporeal membrane oxygenation-based approach to cardiogenic shockin an older population

Background. We investigated the efficacy of an integrated system of advance d supportive care based on extracorporeal membrane oxygenation (ECMO) in ol der patients with an estimated mortality of more than 90% to establish whet her its use is justifiable. Methods. Treatment was provided by cardiac surgeons and critical care physi cians and included the following key elements: (1) ECMO, (2) early applicat ion of continuous venovenous hemofiltration, (3) inhaled nitric oxide, (4) maintenance of perfusion pressure with norepinephrine, (5) maintenance of p ulmonary blood flow by ventricular filling with intravenous colloids, (6) a voidance of early postoperative anticoagulation, (7) frequent use of transe sophageal echocardiography, and (8) low tidal volume ventilation. Demograph ic features, intraoperative details, postoperative course, ECMO weaning rat e, morbidity, survival to hospital discharge, and the quality of life of su rvivors were recorded. Results. Seventeen consecutive patients (median age, 69 years) with refract ory cardiogenic shock were studied. The median duration of ECMO was 86 hour s (20 to 201 hours). Eleven patients (65%) were successfully weaned from EC MO. Seven patients (41%) survived to discharge. The major causes of morbidi ty were bleeding and leg ischemia. All patients who survived to discharge w ere alive and well at follow-up (median, 21 months) and reported a satisfac tory quality of life. Conclusions. An ECMO-based approach can be used with acceptable results in the treatment of refractory cardiogenic shock, even in older patients. (Ann Thorac Surg 2001;71:1421-7) (C) 2001 by The Society of Thoracic Surgeons.