Extracorporeal membrane oxygenation for refractory cardiogenic shock: patient survival and health-related quality of life

Salla Jäämaa-Holmberg, Birgitta Salmela, Raili Suojaranta, Janne J. Jokinen, Karl B. Lemström, Jyri Lommi

Forskningsoutput: TidskriftsbidragArtikelVetenskapligPeer review

Sammanfattning

OBJECTIVES Our goal was to study the outcome of patients with cardiogenic shock who were treated with venoarterial extracorporeal membrane oxygenation (VA ECMO), including the subsequent long-term health-related quality of life (HRQoL).

METHODS We conducted a retrospective study of 133 consecutive patients treated in a single centre from 2007 to 2016. The HRQoL was studied using the EuroQuol-5 dimensions-3 level questionnaire and the RAND 36-Item Short Form Health Survey at a minimum of 1year after VA ECMO.

RESULTS Of all patients, 66 (49.6%) were weaned from VA ECMO and 16 (12.0%) patients were bridged directly to a transplant, 15 (11.3%) to a ventricular assist device and 1 (0.8%) to a total artificial heart. Survival to discharge was 63.9% and to 1year, 60.9%. A higher in-hospital mortality rate was independently associated with lower HCO3 at VA ECMO implantation [odds ratio (OR) 1.2/decrease of 1mmol/l in HCO3 (95% confidence interval 1.1-1.3, P <0.001)] and with increased need of red blood cells transfused during intensive care [OR 1.9/unit of red blood cells needed/day (95% confidence interval 1.4-2.6, P <0.001)]. HRQoL measured with the EuroQuol-5 dimensions-3 level questionnaire was equal to the HRQoL of the general population. In the 36-Item Short Form questionnaire, patients reported better emotional well-being and equal energy, pain and general health perception compared to the general population. Limitations were experienced only in physical health. In total, 56% of the patients 60years had returned to work.

CONCLUSIONS VA ECMO can provide acceptable long-term survival with good HRQoL for selected patients with refractory cardiogenic shock. Timing of patient assessment and of VA ECMO implantation is essential because deeper acidosis is associated with a higher in-hospital mortality rate.

Originalspråkengelska
TidskriftEuropean Journal of Cardio-Thoracic Surgery
Volym55
Utgåva4
Sidor (från-till)780-787
Antal sidor8
ISSN1010-7940
DOI
StatusPublicerad - apr 2019
MoE-publikationstypA1 Tidskriftsartikel-refererad

Vetenskapsgrenar

  • 3126 Kirurgi, anestesiologi, intensivvård, radiologi

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