Postcardiotomy cardiogenic shock occurs in 3 to 5% of contemporary cardiac operations. Furthermore, refractory shock after cardiac surgery occurs in 0.5% of these procedures; the rate of patient survival to discharge is 25 to 44%. Hence, early aggressive management with extracorporeal membrane oxygenation (ECMO) can offer a survival advantage. Overall criteria for using ECMO include failure to wean off cardiopulmonary bypass (CPB) in patients receiving maximum inotropic and vasopressor support with or without an intra-aortic balloon pump, postoperative cardiac arrest, and refractory cardiogenic shock (systolic blood pressure less than 80 mmHg, pulmonary capillary wedge pressure greater than 20 mmHg, and cardiac index less than 1.8 l · min–1 · m–2).

ECMO initiated in the operating room or the perioperative period after cardiac surgery is referred to as postcardiotomy ECMO. Its most common indications are...

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