Early Implantation of Extracorporeal Membrane Oxygenator After Open-Heart Surgery

Extracorporeal membrane oxygenator (ECMO) is effective for maintaining oxygenation and hemodynamic support in patients with post-cardiotomy cardiogenic shock (PCCS). Researchers, led by Ahmed Abdeljawad, sought to compare the effect of early ECMO implantation in emergency patients versus elective patients who developed univentricular or biventricular pump failure. After their trial, they suggested that “early use of ECMO in high-risk emergency cardiac surgery should be taken into consideration when possible, without hesitance.”

Their article, published in The Heart Surgery Forum, also reported that “emergency and elective patients benefit equally from ECMO implantation and show comparable complication rates,” further supporting the value of early ECMO implantation for patients with refractory PCCS.

The trial included 35 patients who received ECMO between 2019 and 2021 after developing refractory PCCS. Patients were categorized into two groups; Group A was comprised of 18 patients who were urgently operated on, while group B was comprised of 17 patients who were operated on electively. ECMO was implanted through central cannulation (right atrium and ascending aorta) or through peripheral cannulation (femoral vessels or axillary artery).

Abdeljawad and colleagues reported no statistically significant differences between the two ECMO groups among preoperative patient characteristics, complication rates, duration of mechanical ventilation, post-ECMO weaning hospital stay, duration of ICU stay, in-hospital mortality, number of patients discharged from the hospital, or one-year survival during follow-up.

The high degree of similarity in ECMO implantation outcomes between the emergency patients and elective patients led the study’s authors to strongly recommend the early application of ECMO to treat refractory PCCS in cardiac surgery patients.