• F W Bowen, A F Carboni, M L O'Hara, A Pochettino, B R Rosengard, R J Morris, R C Gorman, J H Gorman, and M A Acker.
• Department of Surgery, School of Medicine, University of Pennsylvania, Philadelphia, USA.
• Ann. Thorac. Surg. 2001 Jul 1; 72 (1): 86-90.

BackgroundIn patients with acute profound cardiogenic circulatory failure unresponsive to conventional resuscitation, we instituted immediate aggressive application of extracorporeal membrane oxygenation (ECMO) to restore circulatory stability. Long-term hemodynamic support was accomplished with an early "bridge" to ventricular assist device (VAD) before definitive treatment with cardiac transplantation.MethodsA respective review of ECMO and VAD data registries was instituted.ResultsFrom May 1996 to July 2000, 23 patients were placed on ECMO support for profound cardiogenic circulatory failure. Eleven patients (47%) were withdrawn from support due to severe neurologic injury or multisystem organ failure. Three patients (13%) were weaned off ECMO with good outcome. Nine patients (39%) were transferred to a VAD. Two patients expired while on VAD support, and 7 of the VAD-supported patients (78%) survived to transplantation. Overall survival was 43%.ConclusionsEmergent ECMO support is a salvage approach for cardiac resuscitation once conventional measures have failed. In neurologically intact patients, the early transfer to a VAD quickly stabilizes hemodynamics, avoids complications, and is essential for long-term circulatory support before definitive treatment with cardiac transplantation.

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