Emergency Medicine Resident University Medical Center Maribor Maribor, Maribor, Slovenia
Disclosure(s):
Jerica Zaloznik Djordjevic, MD: No financial relationships to disclose
Background: In the last decades there has been an exponential rise of the implementation of ECMO in various clinical settings, one of them being the postcardiotomy cardiogenic shock. Despite important technological advances the survival of these patients has not improved dramatically and only a third of patients survive until hospital discharge.
Methods: We present a case of a 67-year-old male patient who presented to the ED with acute biventricular heart failure. He was diagnosed with severe coronary disease, reduced LV ejection fraction 30%, moderate mitral regurgitation and severe tricuspid regurgitation. Additionally, hemodynamic significant stenoses were found in both carotid arteries. After CABG, left carotid endarterectomy, tricuspid annuloplasty, LAA exclusion and surgical ablation for paroxysmal AFib, he developed postcardiotomy cardiogenic shock and was treated with venoarterial ECMO for 72 hours. After weaning and extubation, he developed pneumonia and C. difficile enterocolitis. Nevertheless, he was successfully discharged from hospital on postoperative day 36.
Outcome: Patients with severe ischemic cardiomyopathy remain difficult to diagnose and treat both at the ED as well as in the OR and ICU. An aggressive approach should be utilized to achieve successful outcomes.
Conclusion: Prolonged venoarterial ECMO support is associated with poor outcome in adult patients after cardiovascular surgery. Patient age < 70 years and ECMO duration < 7 days is in our experience associated with increased in-hospital survival.
