Heart and Lung Center, Helsinki University Hospital, Haartmaninkatu 4 P.O. Box 340, 00029 Helsinki, Finland.
Research Unit of Surgery, Anesthesiology and Critical Care, Faculty of Medicine, University of Oulu, Oulu, Finland.
Eur Heart J Acute Cardiovasc Care. 2021 Aug 24;10(6):595-601. doi: 10.1093/ehjacc/zuaa039.
Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) support for post-cardiotomy cardiogenic shock (PCS) after adult cardiac surgery is associated with satisfactory hospital survival. However, data on long-term survival of these critically ill patients are scarce.
Between January 2010 and March 2018, 665 consecutive patients received VA-ECMO for PCS at 17 cardiac surgery centres and herein we evaluated their 5-year survival. The mean follow-up of this cohort was 1.7 ± 2.7 years (for hospital survivors, 4.6 ± 2.5 years). In this cohort, 240 (36.1%) patients survived to hospital discharge. Five-year survival of all patients was 27.7%. The PC-ECMO score was predictive of 5-year survival in these patients (0 point, 50.9%; 1 point, 44.9%; 2 points, 40.0%; 3 points, 34.7%; 4 points, 21.0%; 5 points, 17.6%; ≥6 points, 10.7%; P < 0.0001). Age was among factors independently associated with late survival, patients >70 years old having a remarkably poor 5-year survival (<60 years: 39.2%; 60-69 years: 29.9%; 70-79 years: 12.3%; ≥80 years: 13.0%, P < 0.0001). Implantation of a ventricular assist device or heart transplant was performed in 3.2% of patients and their 5-year survival was 42.9% (for heart transplant, 63.6%).
Veno-arterial extracorporeal membrane oxygenation for PCS is associated with satisfactory 5-year survival in young patients without critical pre-ECMO conditions. The use of VA-ECMO for PCS in patients >70 years should be considered only after a judicious scrutiny of patient's life expectancy. Future studies should evaluate whether satisfactory mid-term survival of these patients translates into a good functional outcome.
Clinicaltrials.gov-NCT03508505.
成人心脏手术后因心肌梗死后心原性休克（PCS）而接受静脉-动脉（VA）体外膜肺氧合（ECMO）支持与令人满意的医院存活率相关。然而，这些危重症患者的长期生存数据却很少。
2010 年 1 月至 2018 年 3 月，17 个心脏外科中心的 665 例连续患者因 PCS 接受 VA-ECMO，在此我们评估了他们 5 年的存活率。该队列的平均随访时间为 1.7±2.7 年（对于医院幸存者，为 4.6±2.5 年）。在本队列中，240（36.1%）例患者存活至出院。所有患者的 5 年生存率为 27.7%。在这些患者中，PC-ECMO 评分可预测 5 年生存率（0 分，50.9%；1 分，44.9%；2 分，40.0%；3 分，34.7%；4 分，21.0%；5 分，17.6%；≥6 分，10.7%；P<0.0001）。年龄是与晚期生存相关的因素之一，70 岁以上的患者 5 年生存率明显较差（<60 岁：39.2%；60-69 岁：29.9%；70-79 岁：12.3%；≥80 岁：13.0%，P<0.0001）。3.2%的患者植入心室辅助装置或心脏移植，其 5 年生存率为 42.9%（心脏移植为 63.6%）。
VA-ECMO 治疗 PCS 可使年轻患者获得令人满意的 5 年生存率，且无 ECMO 前关键条件。对于 70 岁以上的患者，只有在仔细审查患者预期寿命后，才应考虑使用 VA-ECMO 治疗 PCS。未来的研究应评估这些患者的中期生存是否能转化为良好的功能结局。
Clinicaltrials.gov-NCT03508505。
