Does an Early Implantation of Extracorporeal Membrane Oxygenator in High-Risk Emergency Open Heart Surgery Patients Improve the Outcome in Comparison with Elective Patients? A Prospective Cohort Comparative Study.

Abstract

BACKGROUND Extracorporeal membrane oxygenator (ECMO) has been implemented in refractory postcardiotomy cardiogenic shock (PCCS) patients to maintain excellent oxygenation and hemodynamic support. The aim of this study is to compare the results of early ECMO implantation to treat refractory PCCS in emergency versus elective patients who developed univentricular or biventricular pump failure. PATIENTS AND METHODS Between January 2019 and June 2021, 35 patients received ECMO after refractory PCCS. Patients have been categorized into two groups: Group A contains 18 patients who were urgently operated on and Group B, which includes 17 patients who were electively operated on. ECMO was implanted through central cannulation (right atrium and ascending aorta), or through peripheral cannulation (femoral vessels or through axillary artery). RESULTS There was no statistically significant difference between the two ECMO groups in the preoperative patient's characteristics, complication rate, duration of mechanical ventilation, post-ECMO weaning hospital stay, duration of ICU stay, in-hospital mortality, and number of patients discharged from the hospital or in 1-year survival on follow up. CONCLUSION Early use of ECMO in high-risk emergency cardiac surgery should be taken into consideration when possible, without hesitance. Emergency and elective patients benefit equally from ECMO implantation and show comparable complication rates.