Felix Schoenrath1, Dennis Hoch2, Francesco Maisano2, Christoph T Starck3, Burkhardt Seifert4, Urs Wenger5, Frank Ruschitzka6, Markus J Wilhelm2. 1. Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany. Electronic address: schoenrath@dhzb.de. 2. Clinic for Cardiovascular Surgery, University Heart Center, Rämistraße 100, 8091 Zurich, Switzerland. 3. Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. 4. Epidemiology, Biostatistics and Prevention Institute, Department of Biostatistics, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland. 5. Department for Intensive Care Medicine, University Hospital Zurich, Rämistraße 100, 8091 Zurich, Switzerland. 6. Department for Cardiology, University Heart Center, Rämistraße 100, 8091 Zurich, Switzerland.
Abstract
BACKGROUND: Mechanical circulatory support is increasingly used in acute cardiogenic shock. OBJECTIVE: To assess treatment strategies for cardiogenic shock. METHODS: Data of 57 patients in acute intrinsic cardiogenic shock treated with ECMO were analyzed. Different subsequent strategies (weaning, VAD, transplantation) were followed. RESULTS: Overall 1, 2, and 4-year survival was 36.8 ± 6.4%, 32.2 ± 6.4%, 29.8 ± 6.3%. Elevated lactate and hemorrhagic complications (all p in patients with right heart failure prior to ECMO implantation, BVAD therapy showed a trend (p=0.058) towards superior survival compared with LVAD therapy. Seven of the BVAD patients received successful transplantation, with a 1-year survival of 71%. Among survivors Short Form 36 reported significantly lower combined physical scores (p=0.004). CONCLUSIONS: Right heart assessment prior to ECMO implantation may be beneficial to provide tailored therapy if ECMO weaning fails. Survival after cardiogenic shock requiring ECMO seems to be associated with impaired long-term quality of life.
BACKGROUND: Mechanical circulatory support is increasingly used in acute cardiogenic shock. OBJECTIVE: To assess treatment strategies for cardiogenic shock. METHODS: Data of 57 patients in acute intrinsic cardiogenic shock treated with ECMO were analyzed. Different subsequent strategies (weaning, VAD, transplantation) were followed. RESULTS: Overall 1, 2, and 4-year survival was 36.8 ± 6.4%, 32.2 ± 6.4%, 29.8 ± 6.3%. Elevated lactate and hemorrhagic complications (all p in patients with right heart failure prior to ECMO implantation, BVAD therapy showed a trend (p=0.058) towards superior survival compared with LVAD therapy. Seven of the BVADpatients received successful transplantation, with a 1-year survival of 71%. Among survivors Short Form 36 reported significantly lower combined physical scores (p=0.004). CONCLUSIONS: Right heart assessment prior to ECMO implantation may be beneficial to provide tailored therapy if ECMO weaning fails. Survival after cardiogenic shock requiring ECMO seems to be associated with impaired long-term quality of life.