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

doi:10.1253/circj.CJ-11-1015

Critical Care

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

Author information

Sheng-Ying Chung
Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
Jiunn-Jye Sheu
Division of Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
Ying-Jui Lin
Department of Pediatric Cardiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
Cheuk-Kwan Sun
Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
Li-Teh Chang
Basic Science, Nursing Department, Meiho University
Yung-Lung Chen
Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
Tzu-Hsien Tsai
Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
Chien-Jen Chen
Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
Cheng-Hsu Yang
Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
Chi-Ling Hang
Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
Steve Leu
Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
Chiung-Jen Wu
Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
Fan-Yen Lee
Division of Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
Hon-Kan Yip
Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine

Keywords: Cardiopulmonary cerebral resuscitation, Extracorporeal membrane oxygenation support, Profound cardiogenic shock

JOURNAL FREE ACCESS

2012 Volume 76 Issue 6 Pages 1385-1392

DOI https://doi.org/10.1253/circj.CJ-11-1015

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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 10-15min 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 49.8mmHg 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 5,311IU/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. (Circ J 2012; 76: 1385-1392)

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