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Extracorporeal Membrane Oxygenation Uses in Refractory Cardiogenic Shock After Open-Heart Surgery

INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) is the first-line therapy for temporary mechanical circulatory support allowing cardiac and pulmonary recovery or as a bridge to further therapeutic alternatives. The aim of this study was to report clinical outcomes in adult patients with ref...

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Autores principales: Elizalde, Pablo Salazar, Chaud, German J., Gundelach, Joaquín, Gaete, Barbara, Durand, Marcos, Cuadra, Ignacio, Provoste, Sinthya, Yanten, Enrique, Tiznado, Marcelo, Alvarado, Cristóbal
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Sociedade Brasileira de Cirurgia Cardiovascular 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10611424/
https://www.ncbi.nlm.nih.gov/pubmed/37889232
http://dx.doi.org/10.21470/1678-9741-2022-0344
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author Elizalde, Pablo Salazar
Chaud, German J.
Gundelach, Joaquín
Gaete, Barbara
Durand, Marcos
Cuadra, Ignacio
Provoste, Sinthya
Yanten, Enrique
Tiznado, Marcelo
Alvarado, Cristóbal
author_facet Elizalde, Pablo Salazar
Chaud, German J.
Gundelach, Joaquín
Gaete, Barbara
Durand, Marcos
Cuadra, Ignacio
Provoste, Sinthya
Yanten, Enrique
Tiznado, Marcelo
Alvarado, Cristóbal
author_sort Elizalde, Pablo Salazar
collection PubMed
description INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) is the first-line therapy for temporary mechanical circulatory support allowing cardiac and pulmonary recovery or as a bridge to further therapeutic alternatives. The aim of this study was to report clinical outcomes in adult patients with refractory cardiac failure after open-heart surgery undergoing ECMO in a single center with an ECMO unit in Chile. METHODS: We retrospectively analyzed adults with refractory cardiac failure after open-heart surgery who required a venoarterial (VA) ECMO between 2016 and 2021. RESULTS: Of 16 patients with VA ECMO, 60% were men (n=10), 90% had hypertension (n=14), 69% had < 30% of left ventricular ejection fraction (n=11), and the mean European System for Cardiac Operative Risk Evaluation II score was 12 ± 11%. ECMO support with central cannulation accounts for 81% (n=13), and an intra-aortic balloon pump was used in nine patients (56%). The mean time of support was 4.7 ± 2.6 days (1.5 - 12 days). ECMO weaning was achieved in 88% of patients, and in-hospital mortality was 44% (n=7) after discharge. The freedom from all-cause mortality at one year of follow-up of the entire cohort was 38% (n=6). CONCLUSION: VA ECMO is now a well-known life-saving therapeutic option, but mortality and morbidity remain high. Implementation of an ECMO program with educational training is mandatory in order to find the proper balance between patient benefits, ethical considerations, and public health financial input in South America.
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spelling pubmed-106114242023-10-28 Extracorporeal Membrane Oxygenation Uses in Refractory Cardiogenic Shock After Open-Heart Surgery Elizalde, Pablo Salazar Chaud, German J. Gundelach, Joaquín Gaete, Barbara Durand, Marcos Cuadra, Ignacio Provoste, Sinthya Yanten, Enrique Tiznado, Marcelo Alvarado, Cristóbal Braz J Cardiovasc Surg Original Article INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) is the first-line therapy for temporary mechanical circulatory support allowing cardiac and pulmonary recovery or as a bridge to further therapeutic alternatives. The aim of this study was to report clinical outcomes in adult patients with refractory cardiac failure after open-heart surgery undergoing ECMO in a single center with an ECMO unit in Chile. METHODS: We retrospectively analyzed adults with refractory cardiac failure after open-heart surgery who required a venoarterial (VA) ECMO between 2016 and 2021. RESULTS: Of 16 patients with VA ECMO, 60% were men (n=10), 90% had hypertension (n=14), 69% had < 30% of left ventricular ejection fraction (n=11), and the mean European System for Cardiac Operative Risk Evaluation II score was 12 ± 11%. ECMO support with central cannulation accounts for 81% (n=13), and an intra-aortic balloon pump was used in nine patients (56%). The mean time of support was 4.7 ± 2.6 days (1.5 - 12 days). ECMO weaning was achieved in 88% of patients, and in-hospital mortality was 44% (n=7) after discharge. The freedom from all-cause mortality at one year of follow-up of the entire cohort was 38% (n=6). CONCLUSION: VA ECMO is now a well-known life-saving therapeutic option, but mortality and morbidity remain high. Implementation of an ECMO program with educational training is mandatory in order to find the proper balance between patient benefits, ethical considerations, and public health financial input in South America. Sociedade Brasileira de Cirurgia Cardiovascular 2023-10-23 /pmc/articles/PMC10611424/ /pubmed/37889232 http://dx.doi.org/10.21470/1678-9741-2022-0344 Text en https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Elizalde, Pablo Salazar
Chaud, German J.
Gundelach, Joaquín
Gaete, Barbara
Durand, Marcos
Cuadra, Ignacio
Provoste, Sinthya
Yanten, Enrique
Tiznado, Marcelo
Alvarado, Cristóbal
Extracorporeal Membrane Oxygenation Uses in Refractory Cardiogenic Shock After Open-Heart Surgery
title Extracorporeal Membrane Oxygenation Uses in Refractory Cardiogenic Shock After Open-Heart Surgery
title_full Extracorporeal Membrane Oxygenation Uses in Refractory Cardiogenic Shock After Open-Heart Surgery
title_fullStr Extracorporeal Membrane Oxygenation Uses in Refractory Cardiogenic Shock After Open-Heart Surgery
title_full_unstemmed Extracorporeal Membrane Oxygenation Uses in Refractory Cardiogenic Shock After Open-Heart Surgery
title_short Extracorporeal Membrane Oxygenation Uses in Refractory Cardiogenic Shock After Open-Heart Surgery
title_sort extracorporeal membrane oxygenation uses in refractory cardiogenic shock after open-heart surgery
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10611424/
https://www.ncbi.nlm.nih.gov/pubmed/37889232
http://dx.doi.org/10.21470/1678-9741-2022-0344
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