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Outcome of patients with profound cardiogenic shock after cardiopulmonary resuscitation and prompt extracorporeal membrane oxygenation support. A single-center observational study.
Chung, Sheng-Ying; Sheu, Jiunn-Jye; Lin, Ying-Jui; Sun, Cheuk-Kwan; Chang, Li-Teh; Chen, Yung-Lung; Tsai, Tzu-Hsien; Chen, Chien-Jen; Yang, Cheng-Hsu; Hang, Chi-Ling; Leu, Steve; Wu, Chiung-Jen; Lee, Fan-Yen; Yip, Hon-Kan.
Afiliación
  • Chung SY; Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Circ J ; 76(6): 1385-92, 2012.
Article en En | MEDLINE | ID: mdl-22447007
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 10-15 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.
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Banco de datos: MEDLINE Asunto principal: Choque Cardiogénico / Oxigenación por Membrana Extracorpórea / Reanimación Cardiopulmonar Tipo de estudio: Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: Asia Idioma: En Revista: Circ J Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2012 Tipo del documento: Article País de afiliación: Taiwán
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Banco de datos: MEDLINE Asunto principal: Choque Cardiogénico / Oxigenación por Membrana Extracorpórea / Reanimación Cardiopulmonar Tipo de estudio: Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: Asia Idioma: En Revista: Circ J Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2012 Tipo del documento: Article País de afiliación: Taiwán