Survival, quality of life and impact of right heart failure in patients with acute cardiogenic shock treated with ECMO

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• 作者：Felix Schoenrath ; MD^a ; ^f ; ^g ; ^{schoenrath@dhzb.de" class="auth_mail" title="E-mail the corresponding author} ; Dennis Hoch ; Medical student^b ; Francesco Maisano ; MD^b ; Christoph T. Starck ; MD ; PhD^a ; ^g ; Burkhardt Seifert ; PhD^c ; Urs Wenger ; MD^d ; Frank Ruschitzka ; MD ; PhD^e ; ^h ; Markus J. Wilhelm ; MD ; PhD^b ; ^h
• 关键词：Cardiogenic shock ; Extracorporeal membrane oxygenation ; Ventricular assist device ; Right heart failure ; Quality of life
• 刊名：Heart & Lung: The Journal of Acute and Critical Care
• 出版年：2016
• 出版时间：September-October 2016
• 年：2016
• 卷：45
• 期：5
• 页码：409-415
• 全文大小：709 K

文摘

Mechanical circulatory support is increasingly used in acute cardiogenic shock.

Objective

To assess treatment strategies for cardiogenic shock.

Methods

Data of 57 patients in acute intrinsic cardiogenic shock treated with ECMO were analyzed. Different subsequent strategies (weaning, VAD, transplantation) were followed.​

Results

Overall 1, 2, and 4-year survival was 36.8 ± 6.4%, 32.2 ± 6.4%, 29.8 ± 6.3%. Elevated lactate and hemorrhagic complications (all p in patients with right heart failure prior to ECMO implantation, BVAD therapy showed a trend (p=0.058) towards superior survival compared with LVAD therapy. Seven of the BVAD patients received successful transplantation, with a 1-year survival of 71%. Among survivors Short Form 36 reported significantly lower combined physical scores (p=0.004).

Conclusions

Right heart assessment prior to ECMO implantation may be beneficial to provide tailored therapy if ECMO weaning fails. Survival after cardiogenic shock requiring ECMO seems to be associated with impaired long-term quality of life.