Abstract 13924: Outcome of Patients with Profound Cardiogenic Shock after Cardiopulmonary Resuscitation and Prompt Extracorporeal Membrane Oxygenation Support: A Single-Center Observational Study
Background: In-hospital outcome of patients with profound cardiogenic shock (CS) undergoing extracorporeal membrane oxygenation(ECMO) and prognostic predictors were analyzed.
Methods and Results: Between 2003 and 2010, 134 patients with profound CS undergoing 10-15 minutes of cardiopulmonary cerebral resuscitation (CPCR) and ECMO were prospectively recruited, including 27.6% (37)with ST-elevation myocardial infarction (STEMI), 11.9% (16) with non-STEMI, 22.4% (30) with post-surgery pump failure, 10.5% (14) with refractory congestive heart failure, 19.4% (26) with fulminant acute myocarditis, 2.2% (3) with pediatric congenital diaphragmatic hernia, and 6.0% (8) with percutaneous coronary intervention-related complications. Mean systolic pressure was 49.8 mmHg and 91.8% of patients required ventilatory support prior to ECMO. Post-ECMO Mean Acute Physiology and Chronic Health Evaluation (APACHE) II score and peak creatine phosphokinase (CPK) level were 26.2 and 5311 IU/L, respectively. In-hospital mortality was 57.5%. Sixty-eight patients (50.7%) were successfully weaned from ECMO and 57 (42.5%) were discharged alive. Univariate analysis identified APACHE II score as strongest predictor of in-hospital mortality (P<0.0001) with respiratory failure, smoking, and male gender also related (all P<0.03). Multivariate analysis identified APACHE II score≥22 and successful ECMO weaning as only independent predictor for in-hospital mortality and determinant of survival, respectively (P=0.0003).
Conclusions: Profound CS was associated with high mortality. Both successful weaning from ECMO and APACHE II score may serve as outcome predictors for risk stratification. Key words: Profound cardiogenic shock; Cardiopulmonary cerebral resuscitation; Extracorporeal membrane oxygenation support
- © 2012 by American Heart Association, Inc.