{"doi":"10.1016/j.xjon.2021.10.020","title":"Postcardiotomy shock extracorporeal membrane oxygenation: Peripheral or central?","abstract":"Central MessageOn the basis of available evidence, peripheral cannulation should be considered if there is no clear reason for central cannulation, but multi-institutional, prospective data are needed to strengthen this recommendation. On the basis of available evidence, peripheral cannulation should be considered if there is no clear reason for central cannulation, but multi-institutional, prospective data are needed to strengthen this recommendation. Postcardiotomy shock (PCS) is poorly defined in the literature, but is broadly understood to mean circulatory failure after cardiac surgery necessitating mechanical circulatory support and high-dose inotropes. PCS occurs in 0.5% to 1.5% of all cardiac surgeries and is important to better understand because it has an in-hospital mortality rate >50%.1Rastan A.J. Dege A. Mohr M. Doll N. Falk V. Walther T. et al.Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock.J Thorac Cardiovasc Surg. 2010; 139: 302-311.e1https://doi.org/10.1016/j.jtcvs.2009.10.043Abstract Full Text Full Text PDF PubMed Scopus (380) Google Scholar,2Fukuhara S. Takeda K. Garan A. Kurlansky P. Hastie J. Naka Y. et al.Contemporary mechanical circulatory support therapy for postcardiotomy shock.Gen Thorac Cardiovasc Surg. 2016; 64: 183-191https://doi.org/10.1007/s11748-016-0625-4Crossref PubMed Scopus (0) Google Scholar In the past there were a limited number of ways to support a patient in such profound cardiogenic shock, but today there are multiple mechanical circulatory support devices available. These include extracorporeal membrane oxygenation (ECMO), and several distinct technologies that fall into the category of ventricular assist device (VAD). VADs can be further classified by whether they provide short-term or long-term support, and percutaneous versus open insertion.2Fukuhara S. Takeda K. Garan A. Kurlansky P. Hastie J. Naka Y. et al.Contemporary mechanical circulatory support therapy for postcardiotomy shock.Gen Thorac Cardiovasc Surg. 2016; 64: 183-191https://doi.org/10.1007/s11748-016-0625-4Crossref PubMed Scopus (0) Google Scholar ECMO has become the most widely used support system for PCS.3Lorusso R. Raffa G. Alenizy K. Sluijpers N. Makhoul M. Brodie D. et al.Structured review of post-cardiotomy extracorporeal membrane oxygenation: part 1—adult patients.J Heart Lung Transplant. 2019; 38: 1125-1143https://doi.org/10.1016/j.healun.2019.08.014Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar Relative ease of ECMO cannulation and ability to deploy ECMO quickly in an emergency likely contribute to widespread use. Over the past 2 decades there has been a large increase in use of ECMO for all underlying etiologies, and a fivefold increase in the use of ECMO specifically for PCS. Unfortunately, the increase in use has not been paralleled by improved survival for patients in whom it is used.3Lorusso R. Raffa G. Alenizy K. Sluijpers N. Makhoul M. Brodie D. et al.Structured review of post-cardiotomy extracorporeal membrane oxygenation: part 1—adult patients.J Heart Lung Transplant. 2019; 38: 1125-1143https://doi.org/10.1016/j.healun.2019.08.014Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar,4McCarthy F.H. McDermott K.M. Kini V. Gutsche J.T. Wald J.W. Xie D. et al.Trends in U.S. extracorporeal membrane oxygenation use and outcomes: 2002-2012.Semin Thorac Cardiovasc Surg. 2015; 27: 81-88https://doi.org/10.1053/j.semtcvs.2015.07.005Abstract Full Text Full Text PDF PubMed Scopus (135) Google Scholar The percentage of PCS patients treated with ECMO who survive to hospital discharge varies on the basis of source, but ranges from approximately 30% to 60%.4McCarthy F.H. McDermott K.M. Kini V. Gutsche J.T. Wald J.W. Xie D. et al.Trends in U.S. extracorporeal membrane oxygenation use and outcomes: 2002-2012.Semin Thorac Cardiovasc Surg. 2015; 27: 81-88https://doi.org/10.1053/j.semtcvs.","journal":"JTCVS Open","year":2021,"id":195810,"datarank":0.668359652062391,"base_score":2.1972245773362196,"endowment":2.1972245773362196,"self_citation_contribution":0.32958368660043297,"citation_network_contribution":0.33877596546195804,"self_endowment_contribution":0.32958368660043297,"citer_contribution":0.33877596546195804,"corpus_percentile":null,"corpus_rank":null,"citation_count":8,"citer_count":8,"citers_with_citation_signal":6,"citers_with_endowment":6,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9491,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":763669,"name":"William Hiesinger","orcid":"0000-0002-3548-2578","position":1,"is_corresponding":false},{"id":767744,"name":"Cayley Bowles","orcid":null,"position":0,"is_corresponding":true}],"reference_count":21,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T23:50:07.691929Z","pmid":"36004095","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}