ExtraCorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock

Inclusion criteria

Patients must fulfil criteria for rapidly deteriorating (A) or severe (B) cardiogenic shock:

A. Rapidly deteriorating cardiogenic shock is defined as progressive hemodynamic instability necessitating repeated bolus administration of vasopressors to maintain mean arterial pressure > 50 mmHg + impaired left ventricle systolic function (Left ventricle ejection fraction (LVEF) < 35% or LVEF 35-55% in case of severe mitral regurgitation or aortic stenosis) or

B. In severe cardiogenic shock all following criteria should be met:

• Hemodynamic:

Cardiac Index (CI) < 2.2 L/min/m2 + norepinephrine dose > 0.1 μg/kg/min + dobutamin dose > 5 μg/kg/min or Systolic blood pressure < 100 mmHg + norepinephrine dose > 0.2 μg/kg/min + dobutamin dose > 5 μg/kg/min + (LVEF < 35% or LVEF 35-55% + severe mitral regurgitation or aortic stenosis)

• Metabolic:

Lactate - two consecutive values ≥ 3 mmol/L (with at least 30 min between samples), with non-decreasing trend on steady doses of inotropes and/or vasopressors or SvO2 - two consecutive values < 50% (with at least 30 min between measurements), with non-increasing trend on steady doses of inotropes and/or vasopressors

• Hypovolemia must be excluded:

Central venous pressure > 7 mmHg or pulmonary capillary wedge pressure > 12 mmHg

Exclusion criteria

• Age < 18 years
• Life expectancy lower than 1 year
• High suspicion of pulmonary emboli or cardiac tamponade as a cause of shock
• Significant bradycardia or tachycardia which might be responsible for hemodynamic instability and not treated by pacing or cardioversion
• Cardiac arrest survivors remaining comatose
• Hypertrophic obstructive cardiomyopathy
• Peripheral artery disease disabling insertion of outflow cannula to femoral artery
• Moderate to severe aortic regurgitation
• Aortic dissection
• Uncontrolled bleeding or TIMI major bleeding within last 6 months
• Known encephalopathy