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Ann Thorac Surg 2001;71:1421-1427
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

An extracorporeal membrane oxygenation–based approach to cardiogenic shock in an older population

Christopher Smith, FRACSa, Rinaldo Bellomo, MDb, Jai S. Raman, FRACSa, George Matalanis, FRACSa, Alexander Rosalion, FRACSa, Jonathan Buckmaster, MDb, Graeme Hart, MDb, William Silvester, MDb, Geoffrey A. Gutteridge, FANZCAb, Ben Smith, CCPc, Laurie Doolan, MDc, Brian F. Buxton, FRACSa

a Department of Cardiothoracic Surgery, Austin & Repatriation Medical Centre, Melbourne, Australia
b Department of Intensive Care, Austin & Repatriation Medical Centre, Melbourne, Australia
c Department of Anaesthesia, Austin & Repatriation Medical Centre, Melbourne, and Warringal Private Hospital, Melbourne, Australia

Accepted for publication October 17, 2000.

Address reprint requests to Dr Bellomo, Department of Intensive Care, Austin & Repatriation Medical Centre, Studley Rd, Heidelberg, Victoria 3084, Australia
e-mail: rb{at}austin.unimelb.edu.au

Background. We investigated the efficacy of an integrated system of advanced supportive care based on extracorporeal membrane oxygenation (ECMO) in older patients with an estimated mortality of more than 90% to establish whether its use is justifiable.

Methods. Treatment was provided by cardiac surgeons and critical care physicians and included the following key elements: (1) ECMO, (2) early application of continuous venovenous hemofiltration, (3) inhaled nitric oxide, (4) maintenance of perfusion pressure with norepinephrine, (5) maintenance of pulmonary blood flow by ventricular filling with intravenous colloids, (6) avoidance of early postoperative anticoagulation, (7) frequent use of transesophageal echocardiography, and (8) low tidal volume ventilation. Demographic features, intraoperative details, postoperative course, ECMO weaning rate, morbidity, survival to hospital discharge, and the quality of life of survivors were recorded.

Results. Seventeen consecutive patients (median age, 69 years) with refractory cardiogenic shock were studied. The median duration of ECMO was 86 hours (20 to 201 hours). Eleven patients (65%) were successfully weaned from ECMO. Seven patients (41%) survived to discharge. The major causes of morbidity were bleeding and leg ischemia. All patients who survived to discharge were alive and well at follow-up (median, 21 months) and reported a satisfactory quality of life.

Conclusions. An ECMO-based approach can be used with acceptable results in the treatment of refractory cardiogenic shock, even in older patients.




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