ECMO veno-arterial en pacientes adultos con choque cardiogénico refractario. Características clínicas y supervivencia en una serie de casos

Abstract

Objective: to describe the clinical characteristics and to determine the probability of survival of the patients treated with veno-arterial ECMO (VA ECMO) due to refractory cardiogenic indication in the Fundación Cardioinfantil (FCI-IC). Materials and methods: retrospective analysis of a series of 17 cases who required VA ECMO as a treatment for refractory cardiogenic shock secondary to multiple causes: postcardiotomy syndrome (PCS), acute myocardial infarction, acute decompensated heart failure (ADHF), primary graft dysfunction, among others. Demographic and characteristics were described with measures of central tendency. A survival analysis was made to establish the probability of these patients to be weaned off VA ECMO. Main results: 12 patients were succesfully weaned off VA ECMO (71%) and 9 survived to hospital discharge (53%). Median age of the deceased patients was 61 years. 100% of them were at least 50 years old. Diabetes mellitus, arterial hypertension, chronic pulmonary obstructive disease, and pulmonary hypertension were more frecuent in the non-survivors group of patients. PCS and ADHF were the two principal etiologies of cardiogenic shock requiring VA ECMO. Median duration of ECMO was 3 days. Non-survivors received more transfusions than survivors. Probability of survival was reduced to 66% after the fifth day of extracorporeal life support. Conclusions: VA ECMO mortality in FCI-IC is similar to that registered in most centers around the world, observing a significant reduction in survival probability after day 5 of extracorporeal life support.