Mid-Term Outcomes and Characteristics of Veno-Arterial ECMO in the Management of Refractory Post-Cardiotomy Cardiogenic Shock: Experience of the Cardiac Surgery Department at CHU Ibn Sina

Objectives: Post-cardiotomy cardiogenic shock remains a critical and life-threatening complication in cardiac surgery. This study aims to review and analyze our department's experience with the use of extracorporeal membrane oxygenation (ECMO) as a temporary mechanical circulatory support strategy in managing refractory post-cardiotomy cardiogenic shock. Methods: This is a retrospective study of veno-arterial ECMOs (V-A ECMO) implanted between 2013 and 2022 at the Ibn Sina University Hospital, following cardiac surgery. All adult patients who received a V-A ECMO implantation after cardiac surgery were included. The indications for ECMO were failure to wean from extracorporeal circulation or refractory cardiogenic shock occurring within the first or second postoperative day. Intra-aortic balloon pump (IABP) counter pulsation was systematically associated, either preoperatively or postoperatively. Results: Nine veno-arterial ECMOs were implanted for refractory cardiogenic shock following 5,438 cardiac surgeries, with an incidence of 0.16%. The overall survival rate was 55.5%, with a mean patient age of 61.9 ± 10.5 years. ECMO was implemented after valvular surgery (44.4%), coronary artery bypass grafting (44.4%), acute aortic dissection (11.1%), and post-infarction ventricular septal defect (33.3%). A third of the interventions were combined surgeries. The median ECMO support duration was 89 ± 11 hours, with a weaning rate of 44.4%. Survival rates at 1 month, 1 year, and 3 years were 55.5%, 44.4%, and 33.3%, respectively. Poor prognostic factors included age >65 years, EuroSCORE >8, and post-cardiotomy cardiogenic shock due to right or biventricular failure. Under ECMO, all patients had persistent hyperlactatemia (>10 mmol/L), myocardial and muscular lysis, and multivisceral organ failure (hepatic cytolysis, hyperbilirubinemia, renal dysfunction). They required maximal doses of vasopressors and inotropes, with ECMO duration >72 hours, mechanical ventilation >80 hours,