Extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock
| Autor: | Derek D. Muehrcke, Delos M. Cosgrove, David A. Ogella, Robert C. Foster, Judith A. Borsh, Patrick M. McCarthy, Robert W. Stewart |
|---|---|
| Rok vydání: | 1996 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine Adolescent Heart Diseases Membrane oxygenator medicine.medical_treatment Shock Cardiogenic Hemorrhage Extracorporeal law.invention Extracorporeal Membrane Oxygenation Sex Factors Ischemia law Extracorporeal membrane oxygenation medicine Cardiopulmonary bypass Humans Cardiac Surgical Procedures Child Aged Retrospective Studies Ultrasonography Leg Cardiopulmonary Bypass business.industry Cardiogenic shock Thrombosis Bacterial Infections Acute Kidney Injury Middle Aged medicine.disease Survival Rate Transplantation Child Preschool Shock (circulatory) Ventricular assist device Anesthesia Regression Analysis Female Surgery medicine.symptom Cardiology and Cardiovascular Medicine business Ventilator Weaning |
| Zdroj: | The Annals of Thoracic Surgery. 61:684-691 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/0003-4975(95)01042-4 |
| Popis: | Background. Extracorporeal membrane oxygenation circuits have recently been introduced for extracorporeal life support (ECLS) in adult patients in cardiogenic shock and have been shown to provide excellent oxygenation and hemodynamic support. Heparin coating of the extracorporeal circuit provides a more biocompatible surface, which has been shown to minimize early surface-induced complement activation and platelet dysfunction and hence may improve patient survival. This report reviews our experience with extracorporeal membrane oxygenation to treat postcardiotomy cardiogenic shock using minimal to no systemic heparinization in 23 patients. Methods. During the 22-month period September 1992 through July 1994, 23 patients in cardiogenic shock were placed on venoarterial ECLS using a heparin-bonded circuit. These patients' charts were retrospectively reviewed. A logistic regression analysis of the variables collected was performed to identify clear-cut predictors of ability to be weaned from ECLS. Results. Average patient age was 47.3 ± 16.4 years (range, 5 to 72 years). There were 17 male patients. Average time on ECLS was 58.4 ± 35.1 hours (range, 0.5 to 144 hours). Statistical analysis revealed that patients unable to be weaned from ECLS were more likely to have a critically dilated left ventricle on echocardiography and were female. Ten patients (43.5%) died while on ECLS. Four patients were transferred to an implantable left ventricular assist device, and 3 underwent successful transplantation. The 9 other patients were successfully weaned from ECLS, and 4 were discharged home from the hospital. Overall, 7 patients (30.4%) who were placed on ECLS were successfully discharged home. Conclusions. Extracorporeal life support using an extracorporeal membrane oxygenation system provides excellent cardiac support with similar hospital survival rates as centrifugal mechanical support. Extracorporeal life support has complications unique to itself, but with time, these are likely to be overcome. Women and patients with persistent left ventricular dilatation are less likely to be weaned. |
| Databáze: | OpenAIRE |
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