• R García-Gigorro, E Renes-Carreño, J L Pérez-Vela, H Marín-Mateos, J Gutiérrez, M A Corrés-Peiretti, J F Delgado, E Pérez-de la Sota, J M Cortina-Romero, and J C Montejo-González.
• UCI Cardiológica, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España. Electronic address: rennygg@hotmail.com.
• Med Intensiva. 2017 Dec 1; 41 (9): 513-522.

ObjectiveExtracorporeal membrane oxygenation (ECMO) affords mechanical circulatory assistance associated to high mortality. However, weaning from such mechanical support may not imply improved short- or long-term survival. This study describes the characteristics and evolution of patients with refractory cardiogenic shock (RCS) subjected to venoarterial ECMO (VA-ECMO) in a hospital with a heart transplant program.DesignA single-center, retrospective cohort study was carried out.SettingThe cardiovascular ICU of a tertiary hospital.PatientsForty-six patients consecutively subjected to VA-ECMO over 6 years.InterventionsHospital mortality after weaning from ECMO and overall survival (OS) were analyzed.ResultsFifteen patients (33%) died with VA-ECMO and 31 (67%) were weaned after 8 days of support (IQR: 5-15). Fourteen patients under went transplantation. Hospital mortality in these patients was 32% (10/31), and was associated to age (P=.001), SAPS II score (P=.009), cannulation bleeding (P=.01) and post-acute myocardial infarction RCS (P=.001). After a median follow-up of 27 months (IQR: 11-49), 91% of the patients discharged from hospital were still alive. Overall survival after weaning from assistance was associated to the type of cardiac disease (P=.002). Patients with RCS after acute myocardial infarction had a poorer prognosis.ConclusionsIn our experience, VA-ECMO can be used as mechanical assistance in the management of RCS. The technique is associated to high early mortality, though the long-term survival rate after hospital discharge is good.Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

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