OBJECTIVE: To assess the outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation (ECMO) for refractory cardiogenic shock. DESIGN, SETTING, AND PATIENTS: Refractory cardiogenic shock is almost always lethal without emergency circulatory support, e.g., ECMO. ECMO-associated morbidity and mortality plead for identification of early predictors of its failure, and detailed analyses of short- and long-term outcomes to refine patient selection and improve results. Outcomes of 81 patients given ECMO support for medical (n = 55), postcardiotomy (n = 16), or posttransplantation (n = 10) cardiogenic shock were evaluated. MEASUREMENTS AND MAIN RESULTS: Thirty-four (42%) patients survived to hospital discharge; 57% suffered > or = 1 major ECMO-related complications. Independent predictors of intensive care unit death were: device insertion under cardiac massage (odds ratio [OR] = 20.68), 24 hr urine output < 500 mL (OR = 6.52), prothrombin activity < 50% (OR = 3.93), and female sex (OR = 3.89); myocarditides were associated with better outcomes (OR = .13). Sequelae and health-related quality-of-life were evaluated for 28 long-term survivors (median follow-up, 11 months), whose mean Short-Form 36 scores were significantly lower than matched healthy controls for physical role, general health, and social functioning, but higher than those reported for patients on chronic hemodialysis, with advanced heart failure, or after recovery from acute respiratory distress syndrome. CONCLUSIONS: ECMO support can rescue 40% of otherwise fatal cardiogenic shock patients but its initiation under cardiac massage or after renal or hepatic failure carried higher risks of intensive care unit death, while fulminant myocarditis had a better prognosis. Despite satisfactory mental health and vitality, long-term survivors' persistent physical and social problems might benefit from tailored medical or psychosocial interventions.
OBJECTIVE: To assess the outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation (ECMO) for refractory cardiogenic shock. DESIGN, SETTING, AND PATIENTS: Refractory cardiogenic shock is almost always lethal without emergency circulatory support, e.g., ECMO. ECMO-associated morbidity and mortality plead for identification of early predictors of its failure, and detailed analyses of short- and long-term outcomes to refine patient selection and improve results. Outcomes of 81 patients given ECMO support for medical (n = 55), postcardiotomy (n = 16), or posttransplantation (n = 10) cardiogenic shock were evaluated. MEASUREMENTS AND MAIN RESULTS: Thirty-four (42%) patients survived to hospital discharge; 57% suffered > or = 1 major ECMO-related complications. Independent predictors of intensive care unit death were: device insertion under cardiac massage (odds ratio [OR] = 20.68), 24 hr urine output < 500 mL (OR = 6.52), prothrombin activity < 50% (OR = 3.93), and female sex (OR = 3.89); myocarditides were associated with better outcomes (OR = .13). Sequelae and health-related quality-of-life were evaluated for 28 long-term survivors (median follow-up, 11 months), whose mean Short-Form 36 scores were significantly lower than matched healthy controls for physical role, general health, and social functioning, but higher than those reported for patients on chronic hemodialysis, with advanced heart failure, or after recovery from acute respiratory distress syndrome. CONCLUSIONS: ECMO support can rescue 40% of otherwise fatal cardiogenic shockpatients but its initiation under cardiac massage or after renal or hepatic failure carried higher risks of intensive care unit death, while fulminant myocarditis had a better prognosis. Despite satisfactory mental health and vitality, long-term survivors' persistent physical and social problems might benefit from tailored medical or psychosocial interventions.
Authors: Dierk H Endemann; Alois Philipp; Christian Hengstenberg; Andreas Luchner; Thomas Pühler; Michael Hilker; Christof Schmid; Günter A J Riegger; Thomas Müller; Markus Resch Journal: Intensive Care Med Date: 2011-10-13 Impact factor: 17.440
Authors: Philipp Pichler; Herwig Antretter; Martin Dünser; Stephan Eschertzhuber; Roman Gottardi; Gottfried Heinz; Gerhard Pölzl; Ingrid Pretsch; Angelika Rajek; Andrä Wasler; Daniel Zimpfer; Alexander Geppert Journal: Med Klin Intensivmed Notfmed Date: 2015-09 Impact factor: 0.840
Authors: Samuel Jacob; Juan C MacHannaford; Themistokles Chamogeorgakis; Gonzalo V Gonzalez-Stawinski; Joost Felius; Aldo E Rafael; Rajasekhar S Malyala; Brian Lima Journal: Proc (Bayl Univ Med Cent) Date: 2017-04
Authors: Stéphanie Ruiz; Emmanuelle Papy; Daniel Da Silva; Patrick Nataf; Laurent Massias; Michel Wolff; Lila Bouadma Journal: Intensive Care Med Date: 2008-09-16 Impact factor: 17.440
Authors: Klaus Distelmaier; Alexander Niessner; Dominik Haider; Irene M Lang; Gottfried Heinz; Gerald Maurer; Herbert Koinig; Barbara Steinlechner; Georg Goliasch Journal: Intensive Care Med Date: 2013-04-24 Impact factor: 17.440