Objective

Post-cardiotomy cardiogenic shock (PCCS) occurs in 2-6% of patients undergoing cardiac surgery. 0.5-1.5% of patients are refractory to maximal inotropic and intra-aortic balloon pump support. PCCS leads to multi-organ dysfunction syndrome and is invariably fatal without extra-corporeal membrane oxygenation (ECMO) or ventricular assist devices (VAD). We retrospectively analysed outcomes of salvage VAD and ECMO for refractory PCCS in the 3 cardiothoracic centres in Scotland over a 20 year period.

Methods

The data was obtained through Edinburgh, Glasgow and Aberdeen cardiac surgery databases. Our inclusion criteria included any patient from April 1995 to April 2015 who had received salvage VA ECMO or VAD for PCCS refractory to IABP and maximal inotropic support following adult cardiac surgery.

Results

27 patients met the inclusion criteria. Age range was 34-83 years (Median 75). 23 (85%) were male. 23 (85%) received VA ECMO (13 (56%) central and 10 (44%) peripheral). 4 (15%) had a VAD (BiVAD=1, RVAD=1 and LVAD=2). Most common procedural related complication was major haemorrhage (n=10). Renal failure (n=7), CVA (n=5), septic shock (n=2), and Femoral artery cannulation site pseudo-aneurysm (n=1) also occurred. Overall survival was 40.7%. All survivors had NYHA class I-II on 12 months follow-up.

Conclusion

AMCS for refractory PCCS carries a survival benefit and achieves acceptable functional recovery despite a significant complication rate.