Survival, quality of life and impact of right heart failure in patients with acute cardiogenic shock treated with ECMO

Abstract

Background: Mechanical circulatory support is increasingly used in acute cardiogenic shock.

Objective: To assess treatment strategies for cardiogenic shock.

Methods: Data of 57 patients in acute intrinsic cardiogenic shock treated with ECMO were analyzed. Different subsequent strategies (weaning, VAD, transplantation) were followed.​

Results: Overall 1, 2, and 4-year survival was 36.8 ± 6.4%, 32.2 ± 6.4%, 29.8 ± 6.3%. Elevated lactate and hemorrhagic complications (all p in patients with right heart failure prior to ECMO implantation, BVAD therapy showed a trend (p=0.058) towards superior survival compared with LVAD therapy. Seven of the BVAD patients received successful transplantation, with a 1-year survival of 71%. Among survivors Short Form 36 reported significantly lower combined physical scores (p=0.004).

Conclusions: Right heart assessment prior to ECMO implantation may be beneficial to provide tailored therapy if ECMO weaning fails. Survival after cardiogenic shock requiring ECMO seems to be associated with impaired long-term quality of life.

Keywords: Cardiogenic shock; Extracorporeal membrane oxygenation; Quality of life; Right heart failure; Ventricular assist device.