Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, 72076 Tübingen, Germany.
Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, 66421 Homburg, Germany.
Medicina (Kaunas). 2022 Mar 15;58(3):427. doi: 10.3390/medicina58030427.
Cardiogenic shock (CS) is a medical emergency associated with a high mortality rate. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has become an accepted therapy for CS. Despite widely available data for short-term survival rates, there are only limited data available regarding long-term outcomes following successful VA-ECMO therapy. We analyzed the demographics, past medical history, adverse events, and outcomes of survivors who received VA-ECMO support for CS at our center from January 2012 to December 2019. Post-cardiotomy cases were excluded. A total of 578 VA-ECMO implantations on 564 consecutive patients due to CS were identified during the study period. Successful weaning was achieved in 207 (36.7%) patients. Among the survivors, 126 (63%) patients received VA-ECMO therapy without preceding cardiac surgery during their current admission. A follow-up exceeding 12 (mean: 36 ± 20.9) months was available in a total of 55 (43.7%) survivors. The mean VA-ECMO perfusion time was 10.9 (±7.7) days with a mean intensive care unit (ICU) stay of 38.2 (±29.9) days and a mean hospital stay of 49.9 (±30.5) days. A total of 3 deaths were recorded during long-term follow-up (mean survival of 26 ± 5.3 months). Despite the high mortality associated with VA-ECMO therapy, a long-term follow-up with an acceptably low rate of negative cardiac events can be achieved in many survivors. We observed an acceptable low rate of new cardiac events. Further evaluation, including a quality-of-life assessment and a close follow-up for rarer complications in these patients, is needed to elucidate the longer-term outcomes for survivors of invasive VA-ECMO therapy.
心源性休克（CS）是一种与高死亡率相关的医疗急症。静脉-动脉体外膜肺氧合（VA-ECMO）已成为 CS 的一种公认治疗方法。尽管有广泛的短期生存率数据，但关于成功接受 VA-ECMO 治疗后的长期结果的数据有限。我们分析了 2012 年 1 月至 2019 年 12 月期间在我们中心接受 VA-ECMO 支持治疗 CS 的幸存者的人口统计学、既往病史、不良事件和结局。排除了心脏手术后的病例。在研究期间，共确定了 564 例连续患者中有 578 例因 CS 进行的 VA-ECMO 植入。207 例（36.7%）患者成功脱机。在幸存者中，126 例（63%）幸存者在当前住院期间未接受先前的心脏手术接受了 VA-ECMO 治疗。共有 55 例（43.7%）幸存者的随访时间超过 12 个月（平均：36 ± 20.9 个月）。VA-ECMO 灌注时间的平均值为 10.9（±7.7）天，重症监护病房（ICU）停留时间的平均值为 38.2（±29.9）天，住院时间的平均值为 49.9（±30.5）天。长期随访中共有 3 例死亡（平均生存时间为 26 ± 5.3 个月）。尽管 VA-ECMO 治疗相关的死亡率很高，但许多幸存者都能实现长期随访，且心脏不良事件的发生率可接受地低。我们观察到新的心脏不良事件发生率较低。需要进一步评估，包括对这些患者进行生活质量评估和更罕见并发症的密切随访，以阐明接受侵入性 VA-ECMO 治疗的幸存者的长期结果。
