Division of Cardiothoracic Surgery and Transplantation, Harefield Hospital, London, UK.
Division of Cardiothoracic Surgery, Hammersmith Hospital, London, UK.
Perfusion. 2022 Nov;37(8):825-834. doi: 10.1177/02676591211023304. Epub 2021 Jun 11.
Post-cardiotomy cardiogenic shock is an infrequent but important cause of death following cardiac surgery. Extra-corporeal membrane oxygenation offers the opportunity for temporary cardiovascular support and myocardial rest, with a view to recovery. We examine our results with our recently-implemented management algorithm.
We report our series of 15 consecutive patients out of 357 patients [4.2%] who required institution of veno-arterial extra-corporeal membrane oxygenation system support as treatment for Post-cardiotomy cardiogenic shock in the current era [January-2017 to January-2020].
The mean age was 64.3 ± 11.6 years (range: 40-82 years); there were 13 males (86.7%). Duration of veno-arterial extra-corporeal membrane oxygenation support was 6.7 ± 1.9 days. Duration of stay on intensive care unit [ICU] was 18.9 ± 17.1 days. Duration of hospital-stay was 28.3 ± 20.8 days. Survival to discharge and at 2.2 ± 0.9 years was 67%.
We have shown clearly that veno-arterial extra-corporeal membrane oxygenation is an important rescue option for patients who develop refractory post-cardiotomy cardiogenic shock, with improved survival of 67% at 2.2 ± 0.9 years in those placed on post-cardiotomy veno-arterial extra corporeal membrane oxygenation support, which is superior to that reported hitherto in literature. We have sought to highlight the successes of post cardiotomy veno-arterial extra corporeal membrane oxygenation support, with improved results, based on careful patient selection, as well as diligent management of these critically-ill patients in the postoperative period, prior to establishment of irreversible end-organ dysfunction. Our strategy has also helped us rationalize and optimize the use of this expensive treatment modality.
心脏手术后的心源性休克是心脏手术后罕见但重要的死亡原因。体外膜肺氧合（ECMO）提供了临时心血管支持和心肌休息的机会，以期恢复。我们检查了我们最近实施的管理算法的结果。
我们报告了我们的 15 例连续患者，他们是在当前时代（2017 年 1 月至 2020 年 1 月）因心脏手术后心源性休克而需要建立静脉-动脉体外膜肺氧合系统支持的 357 例患者中的一部分。
平均年龄为 64.3±11.6 岁（范围：40-82 岁）；男性 13 例（86.7%）。静脉-动脉体外膜肺氧合支持的持续时间为 6.7±1.9 天。重症监护病房（ICU）的住院时间为 18.9±17.1 天。住院时间为 28.3±20.8 天。出院时和 2.2±0.9 年的存活率为 67%。
我们清楚地表明，静脉-动脉体外膜肺氧合是治疗难治性心脏手术后心源性休克患者的重要挽救选择，在接受心脏手术后静脉-动脉体外膜肺氧合支持的患者中，2.2±0.9 年的存活率提高到 67%，优于文献报道的存活率。我们试图强调心脏手术后静脉-动脉体外膜肺氧合支持的成功，基于仔细的患者选择以及在术后期间对这些重症患者的精心管理，取得了更好的结果，在不可逆的终末器官功能障碍建立之前。我们的策略还帮助我们合理化和优化了这种昂贵的治疗方式的使用。
