Extracorporeal Life Support for Cardiogenic Shock in Octogenarians: Single Center Experience

BACKGROUND

The age limit for the use of extracorporeal membrane oxygenation (ECMO) support for post-cardiotomy cardiac failure is not defined. The aim of the study was to evaluate the outcomes of octogenarians supported with ECMO due to cardiogenic shock.

METHODS

A retrospective review of consecutive elderly patients supported with ECMO during a 13-year period in a tertiary care center. Patient's demographic variables, comorbidities, perioperative data and outcomes were collected from patient medical records. Data of octogenarian patients were compared with the septuagenarian group. The main outcomes of the study was in hospital mortality, 6-month survival and 1-year survival after hospital discharge and discharge options. Multivariate logistic regression analysis was performed to identify the factors associated with hospital survival.

RESULTS

Eleven patients (18.3%) in the elderly group were octogenarians (aged 80 years or above), and forty-nine (81.7%) were septuagenarians (aged 70-79 years). There were no differences except age in demographic and preoperative variables between groups. Pre ECMO SAVE, SOFA, SAPS-II and inotropic scores were significantly higher in septuagenarians than octogenarians. There was no statistically significant difference in hospital mortality, 6-month survival, 1 year survival or discharge options between groups.

CONCLUSIONS

ECMO could be successfully used in selected octogenarian patients undergoing cardiac surgery to support a failing heart. An early decision to initiate ECMO therapy in elderly post-cardiotomy shock patients is associated with favorable outcomes.

Evaluation of risk factors for adverse outcome in extracorporeal membrane oxygenation-supported elderly postcardiotomy patients

BACKGROUND

Recently extracorporeal membrane oxygenation is becoming the commonly used mechanical assist device for the treatment of severe cardiogenic shock in postcardiotomy patients. Evaluation of risk factors of negative outcome would be beneficial in decision-making in the elderly patient population.

METHODS

This was a retrospective single-centre analysis of elderly patients who underwent extracorporeal membrane oxygenation treatment for refractory cardiogenic shock in a tertiary care centre. Demographic data, comorbidities and perioperative parameters were collected to evaluate their impact on the outcome of extracorporeal membrane oxygenation treatment in this patient group. Logistic regression analysis of the variables was performed to identify factors predicting an adverse outcome.

RESULTS

Forty consecutive elderly patients underwent extracorporeal membrane oxygenation treatment during the study period. The mean age was 76.7 ± 3.8 years, 27 (68%) were male. The mean Survival after Veno-Arterial extracorporeal membrane oxygenation score before initiating extracorporeal membrane oxygenation support was - 11 ± 6. Intra-aortic counterpulsation was used as the first-line mechanical support in 31 (77%) patients. The mean duration of extracorporeal membrane oxygenation support was 172 ± 128 hours. Twenty-four patients (56%) were successfully weaned from extracorporeal membrane oxygenation, and 8 (20%) survived to hospital discharge. Lactate level before extracorporeal membrane oxygenation initiation was the only predictor of unfavourable outcome in multivariate analysis (p < 0.05).

CONCLUSION

High lactate level before initiation of extracorporeal membrane oxygenation was the most important prognostic values of an unfavourable outcome.

Long-term quality of life in patients treated with extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock

Objective:

The aim of our study was to explore long-term health-related quality of life (HRQOL) and incidence of post-traumatic stress disorder (PTSD) in extracorporeal membrane oxygenation (ECMO) survivors.

Methods:

Single-center prospective follow-up study. All patients in whom ECMO was initiated due to refractory cardiogenic shock between 2009 and 2014 were included in the study. We used Medical Outcomes Study 36-Item Short-Form Health Survey to evaluate HRQOL and IES-R questionnaire to assess incidence of PTSD.

Results:

Sixty-nine patients were treated with venoarterial (VA) ECMO during the study period. Nineteen patients survived until hospital discharge and 15 patients were alive at the study cut-off point in June 2017; mean follow-up time was 70.6 ± 10 months. The average Physical Component Summary and Mental Component Summary scores amongst long-term survivors were 46.1 ± 7 and 47.1 ± 8, respectively. PTSD was evident in 4 out of 15 participants.

Conclusions:

Despite the complex clinical course and prolonged recovery, ECMO survivors achieved satisfactory levels of both mental and physical recovery, which were comparable to the age- and pathology-adjusted population means.