Application of "double bridge mechanical" resuscitation for profound cardiogenic shock leading to cardiac transplantation

Background. In patients with acute profound cardiogenic circulatory failure unresponsive to conventional resuscitation, we instituted immediate aggres sive application of extracorporeal membrane oxygenation (ECMO) to restore c irculatory stability. Long-term hemodynamic support was accomplished with a n early "bridge" to ventricular assist device (VAD) before definitive treat ment with cardiac transplantation. Methods. A respective review of ECMO and VAD data registries was instituted . Results. From May 1996 to July 2000, 23 patients were placed on ECMO suppor t for profound cardiogenic circulatory failure. Eleven patients (47%) were withdrawn from support due to severe neurologic injury or multisystem organ failure. Three patients (13%) were weaned oft: ECMO with good outcome. Nin e patients (39%) were transferred to a VAD. Two patients expired while on V AD support, and 7 of the VAD-supported patients (78%) survived to transplan tation. Overall survival was 43%. Conclusions. Emergent ECMO support is a salvage approach for cardiac resusc itation once conventional measures have failed. In neurologically intact pa tients, the early transfer to a VAD quickly stabilizes hemodynamics, avoids complications, and is essential for longterm circulatory support before de finitive treatment with cardiac transplantation. (C) 2001 by The Society of Thoracic Surgeons.