Long-term survival at our institution for postcardiotomy
cardiogenic shock patients supported with the BioPump is 36% (29/80 patients). A
heparin-coated extracorporeal
membrane oxygenator (ECMO), first introduced in 1991, may reduce organ injury associated with
cardiopulmonary bypass. The device can be employed rapidly because it connects directly to the
cardiopulmonary bypass cannula. In an effort to improve our results in the treatment of postcardiotomy
cardiogenic shock, we used ECMO in 21 patients with this syndrome and accompanying complications. The patients were divided into three groups: group 1, ECMO after
coronary artery bypass grafting; group 2, ECMO after mitral valve operation; and group 3, ECMO after open heart operation with prolonged
cardiac arrest. Survival in group 1 was 80% with 12 of 14 patients discharged to home. All three deaths were caused by
cardiac failure.
Bleeding complications in this group were moderate. There was no evidence of
disseminated intravascular coagulation, and levels of
fibrin split products remained within the normal range. Postoperative complications included
stroke (2),
renal failure (1),
mediastinitis (1), and prolonged
respiratory failure (6). Mortality in group 2 was 100%. The major problem limiting recovery was left ventricular distention secondary to inadequate left ventricular
decompression. Mortality in group 3 was 100%; all 4 died of
brain death.
Extracorporeal membrane oxygenation without left ventricular drainage clearly is not effective in patients undergoing mitral valve operations as it does not effectively decompress the left ventricle, but it was highly effective in treating postcardiotomy
cardiogenic shock in our
coronary artery bypass grafting patients.
Extracorporeal membrane oxygenation also proved to be safe as the patient-related complications of
stroke,
renal failure, and
mediastinitis were low. Our preliminary success with
heparin-coated ECMO now needs to be confirmed by studies from other centers with larger groups of patients.