Mechanical support with venoarterial extracorporeal membrane oxygenation (ECMO-VA): Short-term and long-term prognosis after a successful weaning. / Soporte mecánico con membrana de oxigenación extracorpórea veno-arterial (ECMO-VA): evolución a corto y a largo plazo tras la retirada de la asistencia.
Med Intensiva
; 41(9): 513-522, 2017 Dec.
Article
en En, Es
| MEDLINE
| ID: mdl-28259366
ABSTRACT
OBJECTIVE:
Extracorporeal membrane oxygenation (ECMO) affords mechanical circulatory assistance associated to high mortality. However, weaning from such mechanical support may not imply improved short- or long-term survival. This study describes the characteristics and evolution of patients with refractory cardiogenic shock (RCS) subjected to venoarterial ECMO (VA-ECMO) in a hospital with a heart transplant program.DESIGN:
A single-center, retrospective cohort study was carried out.SETTING:
The cardiovascular ICU of a tertiary hospital. PATIENTS Forty-six patients consecutively subjected to VA-ECMO over 6 years.INTERVENTIONS:
Hospital mortality after weaning from ECMO and overall survival (OS) were analyzed.RESULTS:
Fifteen patients (33%) died with VA-ECMO and 31 (67%) were weaned after 8 days of support (IQR 5-15). Fourteen patients under went transplantation. Hospital mortality in these patients was 32% (10/31), and was associated to age (P=.001), SAPS II score (P=.009), cannulation bleeding (P=.01) and post-acute myocardial infarction RCS (P=.001). After a median follow-up of 27 months (IQR 11-49), 91% of the patients discharged from hospital were still alive. Overall survival after weaning from assistance was associated to the type of cardiac disease (P=.002). Patients with RCS after acute myocardial infarction had a poorer prognosis.CONCLUSIONS:
In our experience, VA-ECMO can be used as mechanical assistance in the management of RCS. The technique is associated to high early mortality, though the long-term survival rate after hospital discharge is good.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Choque Cardiogénico
/
Oxigenación por Membrana Extracorpórea
/
Desconexión del Ventilador
Tipo de estudio:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
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Risk_factors_studies
Límite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
/
Es
Año:
2017
Tipo del documento:
Article