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. 2024 May 31;13(11):3265.
doi: 10.3390/jcm13113265.

Comparing Outcomes of Post-Cardiotomy Cardiogenic Shock Patients: On-Site Cannulation vs. Retrieval for V-A ECMO Support

Affiliations

Comparing Outcomes of Post-Cardiotomy Cardiogenic Shock Patients: On-Site Cannulation vs. Retrieval for V-A ECMO Support

Mircea R Mihu et al. J Clin Med. .

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.

Keywords: ECLS; ECMO retrieval; PCCS; V-A ECMO; post-cardiotomy shock.

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Conflict of interest statement

AEB is on the medical advisory board for SynCardia, MC3, and Fresenius, and is a medical consultant for Abbott. The remaining authors have disclosed that they do not have any conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart diagram of the total number of patients placed on V-A ECMO during the study period, excluding E-CPR cases, focusing on patients who required ECLS for post-cardiotomy cardiogenic shock, with the number of patients retrieved on ECMO vs. cannulated on site. V-A ECMO—veno-arterial extracorporeal membrane oxygenation; E-CPR—ECMO cardio-pulmonary resuscitation.

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