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Heart Center, Clinic for Cardiac Surgery, Sana Heart Center Stuttgart, Strumpellstrasse 39, Leipzig 04289, Germany
(Email: n.doll{at}sana-herzchirurgie.de).
Wang and colleagues [1] have included an interesting group of patients in a rescue ECMO program postcardiac surgery. The authors have examined both early and intermediate results, as well as the quality of life of this specific ECMO group.
This article [1] reports a 30-day survival of 54.8% of the entire cohort (34 of 62 patients). The data of 62 patients of 12,644 were collected retrospectively during a 4-year period with a mean duration of ECMO support of 61 ± 37 hours. Furthermore, 40 patients (64.5%) were successfully weaned from ECMO. Thirty-four patients (54.8%) were discharged from the hospital after 44.3 ± 17.6 days. The in-hospital mortality rate was 45.2%, and the main cause of death was multiple organ failure. The overall results are comparable with those of the literature in terms of early, intermediate results and quality of life. However, this study has its limitations because of the retrospective nature of the study, which imposes a lack of baseline for the quality of life, inhomogeneous control groups to the ECMO group.
The incidence of postcardiotomy myocardial dysfunction is as high as 3% to 5% among patients receiving routine cardiac surgical procedures [2]. However, approximately 1% of these patients require prolonged postoperative circulatory support owing to refractory cardiac or pulmonary dysfunction, or both [3, 4].
In our experience, the majority of our patients who were weaned from ECMO and discharged from the hospital were on intra-aortic balloon pump (IABP). However, indications and timing of the implantation of an ECMO in patients who have received an IABP remain unclear. Therefore, The IABP score can predict survival early after IABP implantation. In patients with a high IABP score, implantation of an ECMO should be considered [5].
Furthermore, independent predictors of an in-hospital survival were younger in age, absent of preoperative myocardial infarction, absent of diabetes mellitus, and absent use of an intra-aortic balloon prior to ECMO support. Independent predictors of survival at 5 years were younger age and absence of diabetes [6].
On the other hand, high serum lactate above normal for 3 days post-institution of ECMO is a strong predictor against myocardial recovery.
We compliment Dr Wang and colleagues for their efforts to gain insight into the early, intermediate results and quality of life after ECMO institution postcardiac surgery. We believe that the quality of life after ECMO has an acceptable standard and will improve with time.
Consequently, we would encourage further prospective studies that will enlighten the ECMO benefits in terms of physical results and quality of life.
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