Extracorporeal Membrane Oxygenation Support in Refractory Cardiogenic Shock: Treatment Strategies and Analysis of Risk Factors

Abstract: Two centrifugal pumps, the RotaFlow (Maquet,Jostra Medizintechnik AG, Hirrlingen, Germany) andLevitronix CentriMag (Levitronix LCC, Waltham, MA,USA), used in central or peripheral veno-arterial extra-corporeal membrane oxygenation (ECMO) supportsystems have been investigated, in terms of double-centerexperience, as treatment for patients with refractorycardiogenic shock (CS). Between January 2006 andDecember 2012, 228 consecutive adult patients were sup-ported on RotaFlow ( n= 213) or CentriMag ( n= 15)ECMO, at our institutions (155 men; age 58.3 ± 10.5 years,range: 19–84 years). Indications for support were: failure towean from cardiopulmonary bypass in the setting ofpostcardiotomy ( n= 118) and primary donor graft failure( n= 37); postacute myocardial infarction CS ( n= 27);acute myocarditis ( n= 6); and CS on chronic heart failure( n= 40). A peripheral ECMO setting was established in126 (55.2%) patients while it was established centrally in102 (44.7%). Overall mean support time was 10.9 ± 9.7days (range: 1–43 days). Eighty-four (36.8%) patients diedon ECMO. Overall success rate, in terms of survival onECMO (