1. Comparing Outcomes of Post-Cardiotomy Cardiogenic Shock Patients: On-Site Cannulation vs. Retrieval for V-A ECMO Support.
- Author
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Mihu, Mircea R., El Banayosy, Ahmed M., Harper, Michael D., Cain, Kaitlyn, Maybauer, Marc O., Swant, Laura V., Brewer, Joseph M., Schoaps, Robert S., Sharif, Ammar, Benson, Clayne, Freno, Daniel R., Bell, Marshall T., Chaffin, John, Elkins, Charles C., Vanhooser, David W., and El Banayosy, Aly
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CARDIOGENIC shock , *CORONARY artery bypass , *ARTIFICIAL blood circulation , *HEART assist devices , *EXTRACORPOREAL membrane oxygenation , *INTRA-aortic balloon counterpulsation - Abstract
Background: Post-cardiotomy cardiogenic shock (PCCS) remains a life-threatening complication after cardiac surgery. Extracorporeal membrane oxygenation (ECMO) represents the mainstay of mechanical circulatory support for PCCS; however, its availability is limited to larger experienced centers, leading to a mismatch between centers performing cardiac surgery and hospitals offering ECMO management beyond cannulation. We sought to evaluate the outcomes and complications of PCCS patients requiring veno-arterial (V-A) ECMO cannulated at our hospital compared to those cannulated at referral hospitals. Methods: A retrospective analysis of PCCS patients requiring V-A ECMO was conducted between October 2014 to December 2022. Results: A total of 121 PCCS patients required V-A ECMO support, of which 62 (51%) patients were cannulated at the referring institutions and retrieved (retrieved group), and 59 (49%) were cannulated at our hospital (on-site group). The baseline demographics and pre-ECMO variables were similar between groups, except retrieved patients had higher lactic acid levels (retrieved group: 8.5 mmol/L ± 5.8 vs. on-site group: 6.6 ± 5; p = 0.04). Coronary artery bypass graft was the most common surgical intervention (51% in the retrieved group vs. 47% in the on-site group). There was no difference in survival-to-discharge rates between the groups (45% in the retrieved group vs. 51% in the on-site group; p = 0.53) or in the rate of patient-related complications. Conclusions: PCCS patients retrieved on V-A ECMO can achieve similar outcomes as those cannulated at experienced centers. An established network in a hub-and-spoke model is critical for the PCCS patients managed at hospitals without ECMO abilities to improve outcomes. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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