Guihaire Julien, Dang Van Simon, Rouze Simon, Rosier Sébastien, Roisne Antoine, Langanay Thierry, Corbineau Hervé, Verhoye Jean-Philippe, Flécher Erwan
Thoracic and Cardiovascular Surgery Department, Pontchaillou Hospital, University of Rennes 1, Rennes, France.
Interact Cardiovasc Thorac Surg. 2017 Sep 1;25(3):363-369. doi: 10.1093/icvts/ivx155.
Post-cardiotomy cardiogenic shock is a major concern in cardiac surgery. We reviewed our experience of extracorporeal membrane oxygenation (ECMO) as temporary circulatory support in post-cardiotomy cardiogenic shock.
Between January 2005 and December 2014, adult patients implanted with ECMO after cardiac surgical procedures were included. Indications for ECMO were failure to be withdrawn from cardiopulmonary bypass or refractory cardiogenic shock occurring during postoperative Days 1 and 2. Patients' characteristics and outcomes were prospectively collected in a local ECMO database.
Ninety-two patients, median age of 63 years (17-83 years), were supported by ECMO following valvular surgery (66%), acute aortic dissection (10%) and coronary artery bypass grafting (9%). A total of 37% were combined surgical procedures, 24% were redo procedures and 33% were emergent procedures. The median duration of ECMO support was 6 days (1-28 days). The weaning rate from mechanical support was 48%. Overall 1-month and 6-month survival rates were, respectively, 42% and 39%. Survivors were younger (57 vs 63 years old, P = 0.02) and had a higher preoperative left ventricular ejection fraction (52.5 vs 44.1%, P = 0.017). There was a trend for lower serum creatinine levels and total bilirubin rates in the survivors' group 24 h after initiation of ECMO (respectively, 162 vs 212 µmol/l, P = 0.06; 25.3 vs 54.2 mg/dl, P = 0.08). Valvular surgery and peak lactic acid serum level were associated with poor outcomes. The mean health-related quality of life EuroQoL scale was 68 ± 16/100 at 2 years.
Refractory cardiogenic shock requiring ECMO was most frequently observed after redo valvular surgery in the present study. The overall 6-month survival rate was 39% after ECMO support for post-cardiotomy cardiogenic shock with acceptable health-related quality of life. Improved kidney and liver functions after 24 h of support were associated with favourable outcomes.
心脏术后心源性休克是心脏手术中的一个主要问题。我们回顾了我们使用体外膜肺氧合（ECMO）作为心脏术后心源性休克临时循环支持的经验。
纳入2005年1月至2014年12月期间心脏手术后植入ECMO的成年患者。ECMO的指征为无法脱离体外循环或术后第1天和第2天出现的难治性心源性休克。患者的特征和结局前瞻性地收集于当地的ECMO数据库中。
92例患者，中位年龄63岁（17 - 83岁），在瓣膜手术（66%）、急性主动脉夹层（10%）和冠状动脉搭桥术（9%）后接受了ECMO支持。共有37%为联合手术，24%为再次手术，33%为急诊手术。ECMO支持的中位持续时间为6天（1 - 28天）。机械支持撤机率为48%。总体1个月和6个月生存率分别为42%和39%。幸存者更年轻（57岁对63岁，P = 0.02），术前左心室射血分数更高（52.5%对44.1%，P = 0.017）。在启动ECMO后24小时，幸存者组的血清肌酐水平和总胆红素率有降低趋势（分别为162对212 μmol/l，P = 0.06；25.3对54.2 mg/dl，P = 0.08）。瓣膜手术和血清乳酸峰值水平与不良结局相关。在2年时，与健康相关的生活质量欧洲五维度健康量表的平均评分为68 ± 16/100。
在本研究中，需要ECMO的难治性心源性休克最常出现在再次瓣膜手术后。对于心脏术后心源性休克，在接受ECMO支持后，总体6个月生存率为39%，且健康相关生活质量可接受。支持24小时后肾脏和肝脏功能改善与良好结局相关。
