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Ann Thorac Surg 2007;83:145
© 2007 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Invited commentary

Department of Cardiothoracic & Vascular Surgery, Friedrich Schiller University, Erlanger Allee 101, Jena, 07747 Germany

(Email: ulrich.franke{at}med.uni-jena.de).

The article by Saito and colleagues [1] focuses on the very important topic of highly technological medicine. Their retrospective analysis of the results of extracorporeal life support (ECSL) using extracorporeal membrane oxygenation (ECMO) demonstrated the ability to save the life of almost half of these dangerously ill cardiac patients. The results for weaning patients from ECMO and for their discharge are superior compared with those of other groups. In comparison with the results of other groups, elderly patients also benefit from the use of ECMO. This is surprising because elderly patients have a higher incidence of cerebral, pulmonary, and intestinal complications after cardiac surgery. It is reasonable to conclude that ECMO should induce similar results. The comparatively small ratio of coronary vascular patients in this study (24 of 91 patients) may be the reason for this observation. Careful analysis of the data indicates that the discharge ratio of postcardiotomy cardiogenic shock patients is substantially lower than primary cardiac failure patients (odds ratio, 0.45). For surgical patients, the discharge rate decreases to about 25%. None of the 3 elderly patients survived the ECMO therapy after cardiac surgery. This finding correlates with my own experience that the results for postcardiotomy patients are worse compared with all other patients. Valve and aortic patients especially have a poor prognosis confirmed by Saito and colleagues [1].

Evaluation of long-term results is necessary for the assessment of the beneficial effects of ECMO therapy. The quality of life and development of exercise capacity after rehabilitation are especially important. Few studies address this issue. Furthermore there is limited knowledge about the predictors for successful ECMO support. Because of very high costs, resource consumption, and long intensive care unit and hospital stays, there is pressure to increase the effectiveness of ECMO therapy. Future studies must focus on the negative predictive factors of survival as well as long-term quality of life. Thus ECMO use in elderly patients should be recommended cautiously and eventually on available data.

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1. Saito S, Nakatani T, Kobayashi J, et al. Is extracorporeal life support contraindicated in elderly patients? Ann Thorac Surg 2006;83:140-145.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ulrich F.W. Franke Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Franke, U. F.W. Search for Related Content PubMed PubMed Citation Articles by Franke, U. F.W. Related Collections Extracorporeal circulation Related Article