PMID- 35371741
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220405
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 14
IP  - 2
DP  - 2022 Feb
TI  - The Early Introduction of Extracorporeal Membrane Oxygenation for Postcardiotomy 
      Cardiogenic Shock Does Not Improve 30-Day Mortality Rates in Low-Volume Centers.
PG  - e22474
LID - 10.7759/cureus.22474 [doi]
LID - e22474
AB  - Background and objective Postcardiotomy cardiogenic shock (PCS) is one of the 
      most critical conditions observed in cardiac surgery. Recently, the early 
      initiation of venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been 
      recommended for PCS patients to ensure end-organ perfusion, especially in 
      high-volume centers. In this study, we investigated the effectiveness of earlier 
      initiation of VA-ECMO for PCS in low-volume centers. Methods We retrospectively 
      assessed patients admitted in two of our related facilities from April 2014 to 
      March 2019. The patients who underwent VA-ECMO during peri- or post-cardiac 
      surgery (within 48 hours) were included. We divided the patients into two groups 
      according to the timing of VA-ECMO initiation. In the early initiation of VA-ECMO 
      group, the "early ECMO group," VA-ECMO was initiated when patients needed 
      high-dose inotropic support with high-dose catecholamines, such as epinephrine, 
      without waiting for PCS recovery. In the late initiation of VA-ECMO group, the 
      "late ECMO group," VA-ECMO was delayed until PCS was not controlled with 
      high-dose catecholamines, with the intent of avoiding severe bleeding 
      complications. Results A total of 30 patients were included in the analysis 
      (early ECMO group/late ECMO group: 19/11 patients). Thirty-day mortality in the 
      entire cohort was 60% (n=18), and there was no significant difference between the 
      two groups (early ECMO group/late ECMO group: 64%/55%, p=0.712). Thirteen and six 
      patients died without being weaned off in the early ECMO (43%) and late ECMO 
      groups (55%), respectively; there was no significant difference between the two 
      groups (p=0.696). The median duration of ECMO support was five days (IQR: 
      1.5-6.5). Conclusions The early initiation of ECMO did not contribute to 
      patients' 30-day outcomes in low-volume centers. To improve outcomes of ECMO 
      therapy in patients with PCS, centralization of low-volume centers may be 
      required.
CI  - Copyright (c) 2022, Kunioka et al.
FAU - Kunioka, Shingo
AU  - Kunioka S
AD  - Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, JPN.
FAU - Shirasaka, Tomonori
AU  - Shirasaka T
AD  - Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, JPN.
FAU - Miyamoto, Hiroyuki
AU  - Miyamoto H
AD  - Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, JPN.
FAU - Shibagaki, Keisuke
AU  - Shibagaki K
AD  - Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, JPN.
FAU - Kikuchi, Yuta
AU  - Kikuchi Y
AD  - Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, JPN.
FAU - Akasaka, Nobuyuki
AU  - Akasaka N
AD  - Department of Cardiovascular Surgery, Steel Memorial Muroran Hospital, Muroran, 
      JPN.
FAU - Kamiya, Hiroyuki
AU  - Kamiya H
AD  - Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, JPN.
LA  - eng
PT  - Journal Article
DEP - 20220221
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC8943440
OTO - NOTNLM
OT  - cardiac surgery
OT  - extracorporeal membrane oxygenation
OT  - low volume centers
OT  - mortality
OT  - postcardiotomy shock
COIS- The authors have declared that no competing interests exist.
EDAT- 2022/04/05 06:00
MHDA- 2022/04/05 06:01
PMCR- 2022/02/21
CRDT- 2022/04/04 05:31
PHST- 2022/02/21 00:00 [accepted]
PHST- 2022/04/04 05:31 [entrez]
PHST- 2022/04/05 06:00 [pubmed]
PHST- 2022/04/05 06:01 [medline]
PHST- 2022/02/21 00:00 [pmc-release]
AID - 10.7759/cureus.22474 [doi]
PST - epublish
SO  - Cureus. 2022 Feb 21;14(2):e22474. doi: 10.7759/cureus.22474. eCollection 2022 
      Feb.