Eastern Cardiothoracic Surgical Society

Is the Underlying Etiology of Cardiogenic Shock Associated with Myocardial Recovery in Patients on Veno-Arterial Extracorporeal Membrane Oxygenation?
Joshua K. Wong, Amber L. Melvin, Peter A. Knight. University of Rochester Medical Center, Rochester, NY USA.

Objectve: Myocardial recovery in patients with cardiogenic shock (CS), stabilized on Veno-Arterial (VA) Extracorporeal Membrane Oxygenation (ECMO) may be associated with the underlying etiology of CS. This study seeks to determine myocardial recovery patterns by CS etiology in patients on VA-ECMO.

Methods: This is a retrospective review of 103 adult patients supported on VA-ECMO for acute-CS from January 2010-2015. Myocardial recovery was estimated by serial left ventricular ejection fraction improvement (LVEF-I) measurements using echocardiography at a minimum of 48 hours apart. Patients with <2 LVEF measurements or a baseline LVEF >35% were excluded.

Results: Forty-two patients supported on VA-ECMO met criteria and were analyzed. Indications for support were CS secondary to ischemia, post-cardiotomy shock, malignant arrhythmia and cardiomyopathy in 15 (35.7%), 17 (40.5%), 5 (11.9%) and 5 (11.9%) patients while the mean baseline LVEF was 15.3%, 17.9%, 12.0% and 10.0% in CS-ischemia, CS-post-cardiotomy, CS-arrhythmia and CS-cardiomyopathy patients respectively (p=0.21) There was a trend towards a significant difference in mean LVEF-I between CS-ischemia (+25.6%), CS-post-cardiotomy (+15.3%), CS-arrhythmia (+4.2%) and CS-cardiomyopathy (+18.0%) patient groups (p=0.07). 18 patients (18/22, 81.8%) who had LVEF-I 15% successfully weaned to recovery versus 2 patients (2/20, 10.0%) with LVEF-I <15% (OR: 40.5, CI: 6.6-249.7, p<0.001). Overall survival was not different between patients by indication groups (p=0.39) (Table SA11-1).

Conclusions: Myocardial recovery for acute CS patients stabilized on VA-ECMO may be associated with the underlying etiology of CS. Our data suggests patients with LVEF-I 15% have a significantly higher likelihood of weaning from VA-ECMO without the need for further mechanical support.