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

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题名:	Outcome of patients with profound cardiogenic shock after cardiopulmonary resuscitation and prompt extracorporeal membrane oxygenation support. A single-center observational study.
作者:	Chung SY;Sheu JJ;Lin YJ;Sun CK;Chang LT;Chen YL;Tsai TH;Chen CJ;Yang CH;Hang CL;Leu S;Wu CJ;Lee FY;Yip HK
日期:	2012-03
上传时间:	2012-09-24T07:01:43Z (UTC)
摘要:	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.
關聯:	Circ J. 2012;76(6):1385-92. Epub 2012 Mar 13.
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