Outcome of patients with profound Cardiogenic shock after cardiopulmonary resuscitation and prompt extracorporeal membrane oxygenation support-a single-center observational study

Sheng Ying Chung, Jiunn Jye Sheu, Ying Jui Lin, Cheuk Kwan Sun, Li Teh Chang, Yung Lung Chen, Tzu Hsien Tsai, Chien Jen Chen, Cheng Hsu Yang, Chi Ling Hang, Steve Leu, Chiung Jen Wu, Fan Yen Lee, Hon Kan Yip*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

74 Scopus citations

Abstract

Background: The in-hospital outcome of patients with profound cardiogenic shock (CS) undergoing extracorporeal membrane oxygenation (ECMO) and prognostic predictors were analyzed. Methods and Results: Between 2003 and 2010, 134 patients with profound CS undergoing 10-15 min of cardiopulmonary cerebral resuscitation (CPCR) and ECMO were prospectively recruited, including 27.6% (37) with ST-elevation myocardial infarction (STEMI), 11.9% (16) with non-STEMI, 22.4% (30) with post-surgery pump failure, 10.5% (14) with refractory congestive heart failure, 19.4% (26) with fulminant acute myocarditis, 2.2% (3) with pediatric congenital diaphragmatic hernia, and 6.0% (8) with percutaneous coronary intervention-related complications. The mean systolic pressure was 49.8 mmHg and 91.8% of patients required ventilatory support prior to ECMO. The Post- ECMO Mean Acute Physiology and Chronic Health Evaluation (APACHE) II score and peak creatine kinase level were 26.2 and 5,311 IU/L, respectively. In-hospital mortality was 57.5%. Sixty-eight patients (50.7%) were successfully weaned from ECMO and 57 (42.5%) were discharged alive. Univariate analysis identified the APACHE II score as the strongest predictor of in-hospital mortality (P<0.0001) with respiratory failure, smoking, and male gender also related (all P<0.03). Multivariate analysis identified an APACHE II score ≥22 and successful ECMO weaning as the only independent predictor for in-hospital mortality and a determinant of survival, respectively (P=0.0003). Conclusions: Profound CS was associated with high mortality. Both successful weaning from ECMO and an APACHE II score might serve as outcome predictors for risk stratification.

Original languageEnglish
Pages (from-to)1385-1392
Number of pages8
JournalCirculation Journal
Volume76
Issue number6
DOIs
StatePublished - 06 2012

Keywords

  • Cardiopulmonary cerebral resuscitation
  • Extracorporeal membrane oxygenation support
  • Profound cardiogenic shock

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