Prolonged extracorporeal membrane oxygenation (ECMO) in 231 patients after different indications with low cardiac output – a single-center experience

Aims: For ventricular and pulmonary support the extracorporeal membrane oxygenation (ECMO) system using the Bio-Medicus centrifugal pump (Medtronic®, Minneapolis, MN, USA) was applied in 231 patients with low cardiac output for a prolonged period of several days.

Methods: From December 1996 to May 2011 the ECMO was implanted in 231 patients (180 adult, mean age: 52.5±17.5 years and 51 children, mean age: 1.6±3.1 years) with mostly postcardiotomy low cardiac output. The surgical procedures included congenital heart surgery (n=38, 16.5%), heart transplantation (HTx) (n=38, 16.5%), coronary artery bypass operation (CABG) and/or valvular operation (n=67, 29.0%), other operations (n=26, 11.3%) and 62 (26.8%) patients with ECMO support for bridge-to-recovery.

Results: In contrast to other studies the mean supporting time was 4.7±4.5 days. Overall, 30-days-survival was 42.6%. Best survival rates were seen after congenital heart surgery (29 patients survived from 38, 76.3%) and after HTx (20/38, 52.6%); the worst survival rates were in the group of CABG and/or valvular operations (19/67, 28.4%), only ECMO support (24/62, 38.7%) and other operations (6/26, 23.1%). Altogether 96 patients died while supported by ECMO, 46 were weaned from ECMO but died in hospital, Overall 82 patients were weaned and survived, 7 patients were lost to follow up. Causes of death were multi-organ-failure (35.3%), persistent low cardiac output (21.8%), bleeding (10.9%), sepsis (7.1%), allograft failure (3.8%), others (12.2%) and not exactly known (9.0%).

Conclusions: Prolonged ECMO support showed best results in pediatric patients after congenital heart surgery and in patients after HTx in contrast to multi-morbid, older patients with often irreversible myocardial damage.