Mechanical Circulatory Support in Patients with Cardiogenic Shock after Surgical Revascularization

Background: Patients presenting with acute myocardial ischemia pose a risk at developing cardiogenic shock despite adequate medical or interventional treatment. A recent multicenter randomized clinical trial by Thiele et al showed no benefits in 30-day survival in patients on ECMO. Interestingly, patients were treated solely by interventional revascularization and no data was provided on patients unsuitable for intervention. Therefore, no clear data on survival in these patients on ECMO is available. In this abstract we evaluated survival in patients on ECMO presented in our center for surgical revascularization after cardiogenic shock due to myocardial ischemia.

Methods: All patients >18 years treated with va-ECMO due to cardiogenic shock after acute myocardial ischemia admitted between 2012 and 2020 to our intensive care unit (ICU) were included in this study. A retrospective analysis of patient characteristics, ECMO runtime, the need for vasoactive and inotropic medication and 30-day survival was done.

Results: In total, 32 patients were included in this study. All patients were in cardiogenic shock with isolated coronary artery disease at the time of presentation. In total, 24 (75%) patients were male with mean patient age of 63.5 ± 2.4 years. Patients were 6.4 ± 2.3 days on ECMO support. Postoperative mechanical ventilation time was 245 ± 41.6 hours. The mean hospital stay was 17.4 ± 2.3 days. 30 days-survival after was 53.1%. No significant difference in patient age, gender and ECMO runtime for survival was seen. The need for postoperative hemodynamic support was not significantly different. The use of vasopressin was significantly higher in the nonsurvival population (p = 0.025). Survival patients had significantly longer hospital stay time (p = 0.001).

Conclusion: Cardiogenic shock after acute myocardial infarction is a life-threatening situation and still poses challenges in interventional and surgical treatment. For patients not suitable for interventional revascularization, surgical treatment may be a last resort for survival. Although we describe an extremely high-risk population, our results are comparable with interventional patients. In our opinion, this warrants the use of ECMO-support in selected patients after surgical revascularization.

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Artikel online veröffentlicht:
13. Februar 2024