Abstract 144: Salvage Peripheral Cardiopulmonary Support as a Bridge to Decision for Acute Refractory Cardiogenic Shock
Objectives Acute refractory cardiogenic shock with early multisystem organ failure has a poor outcome without mechanical circulatory support. Emergent implantation of temporary or permanent central mechanical support has significant limitations when neurologic and end organ viability are unknown. We review our experience with emergent peripheral cardiopulmonary support as a bridge to decision in these patients.
Methods A retrospective review from January 2009 through December 2010 was conducted of 26 consecutive adult patients at a single institution with acute refractory cardiogenic shock who underwent salvage peripheral cardiopulmonary support.
Results There were 18 men and 8 women with a mean age of 54 years (range 18-76). Indications for support: acute myocardial infarction (n=16), decompensated chronic heart failure (n=2), refractory arrhythmic arrest (n=3) and acute valvular pathology (n=4) and unknown (n=1). Patients with primary post-cardiotomy shock were excluded. The types of support used were peripheral extracorporeal membrane oxygenation (ECMO) (n=22) and the Tandem Heart (CardiacAssist Inc., Pittsburgh, PA, USA) (n=4). Median duration of support was 3 days (range 1-14). Decisions included: withdraw of support (n=4), recovery (n=5) and bridge to a procedure (n=17). The procedures were percutaneous coronary intervention (n=4), left ventricular assist device (n=9), heart transplantation (n=1) and miscellaneous cardiac surgery (n=3). Overall survival was 65% (n=17). In the recovery and bridge to a procedure groups (n=22), 78% (n=17) were discharged from the hospital and survival at 3 months was 72% (n=16).
Conclusions Salvage peripheral cardiopulmonary support is a useful tool to rapidly stabilize acute refractory cardiogenic shock permitting an assessment of neurologic and end organ viability. We believe our midterm outcomes support this bridge to decision strategy.
- © 2011 by American Heart Association, Inc.