Virtual Conference
Heart 2022 Conference

Manuela Silva

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Title: Extracorporeal membrane oxygenation support for postcardiotomy shock: single center experience

Abstract

Objectives: We aim to report our experience on venoarterial extracorporeal membrane oxygenation (VA-ECMO) for postcardiotomy shock (PCS). 

Methods: Single center, retrospective study of all patients on VA-ECMO for PCS, from November 2006 to July 2019. Pediatric and adult patients were analysed separately. Primary outcomes were survival to discharge and one-year survival. 

Results: Twenty-nine patients were included. Pediatric group (group PED) (62%, n=18): mean age 1,3±2,1 years and 39% male. Adults (group AD) (38%, n=11): mean age 55,6±15,9 years and 64% male. Indications in group PED were complex congenital heart surgery (94%) and heart transplant (6%), with 27% being reoperations; in group AD valvular surgery (45%), aortic surgery (21%), coronary artery bypass grafting (18%) and pulmonary endarterectomy (9%); 45% were reoperations. ECMO support was initiated intraoperatively due to failure to wean from cardiopulmonary bypass in 28% of group PED and 73% of group AD. Central cannulation was performed in all pediatric patients and 82% adults. Bleeding was the most common complication in both groups (group PED 39%, group AD 45%). Mean ECMO support time was respectively 6,2±4,9 and 6,2± 3,6 days for group PED and group AD. Weaning rate was 44% in group PED (with 2 patients bridged to LVAD) and 45% in group AD. Survival to discharge as well as oneyear survival were both 28% in group PED and 18% in group AD. 

Conclusion: Despite low survival and high complication rates, VA ECMO support provides a survival benefit in refractory cases, with poor prognosis, that would otherwise die.

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