Comparative Analysis of Therapeutic Strategies in Post-Cardiotomy Cardiogenic Shock: Insight into a High-Volume Cardiac Surgery Center

: Post-cardiotomy cardiogenic shock (PCCS), which is defined as severe low cardiac output syndrome after cardiac surgery, has a mortality rate of up to 90%. No study has yet been performed to compare patients with PCCS treated by conservative means to patients receiving additional mechanical circula...

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Bibliographic Details
Published in:Journal of clinical medicine 2024-04, Vol.13 (7), p.2118
Main Authors: Baldan, B Ufuk, Hegeman, Romy R M J J, Bos, Nelleke M J P, Smeenk, Hans G, Klautz, Robert J M, Klein, Patrick
Format: Article
Language:English
Subjects:
Biomarkers
Blood oxygenation, Extracorporeal
Cardiogenic shock
Care and treatment
Classification
Comparative analysis
Extracorporeal membrane oxygenation
Heart
Heart attacks
Heart surgery
Hemodynamics
Hospitals
Ischemia
Medical prognosis
Mortality
Patient outcomes
Patients
Plasma
Risk factors
Surgery
Thoracic surgery
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Summary:: Post-cardiotomy cardiogenic shock (PCCS), which is defined as severe low cardiac output syndrome after cardiac surgery, has a mortality rate of up to 90%. No study has yet been performed to compare patients with PCCS treated by conservative means to patients receiving additional mechanical circulatory support with veno-arterial extracorporeal membrane oxygenation (ECMO). : A single-center retrospective analysis from January 2018 to June 2022 was performed. : Out of 7028 patients who underwent cardiac surgery during this time period, 220 patients (3%) developed PCCS. The patients were stratified according to their severity of shock based on the Stage Classification Expert Consensus (SCAI) group. Known risk factors for shock-related mortality, including the vasoactive-inotropic score (VIS) and plasma lactate levels, were assessed at structured intervals. In patients treated additionally with ECMO ( = 73), the in-hospital mortality rate was 60%, compared to an in-hospital mortality rate of 85% in patients treated by conservative means (non-ECMO; = 52). In 18/73 (25%) ECMO patients, the plasma lactate level normalized within 48 h, compared to 2/52 (4%) in non-ECMO patients. The morbidity of non-ECMO patients compared to ECMO patients included a need for dialysis (42% vs. 60%), myocardial infarction (19% vs. 27%), and cerebrovascular accident (17% vs. 12%). : In conclusion, the additional use of ECMO in PCCS holds promise for enhancing outcomes in these critically ill patients, more rapid improvement of end-organ perfusion, and the normalization of plasma lactate levels.
ISSN:2077-0383
2077-0383
DOI:10.3390/jcm13072118