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. 2016 Mar;49(3):802-9.
doi: 10.1093/ejcts/ezv212. Epub 2015 Jun 23.

When all else fails: extracorporeal life support in therapy-refractory cardiogenic shock

Sabina P W Guenther  1 , Stefan Brunner  2 , Frank Born  3 , Matthias Fischer  3 , René Schramm  3 , Maximilian Pichlmaier  3 , Steffen Massberg  2 , Christian Hagl  3 , Nawid Khaladj  3
Affiliations

When all else fails: extracorporeal life support in therapy-refractory cardiogenic shock

Sabina P W Guenther et al. Eur J Cardiothorac Surg. 2016 Mar.

Abstract

Objectives: No guidelines for mechanical circulatory support in patients with therapy-refractory cardiogenic shock and multiorgan failure including ongoing cardiopulmonary resuscitation (CPR) exist. To achieve immediate cardiopulmonary stabilization, we established an interdisciplinary concept with on-site percutaneous extracorporeal life support (ECLS) implantation.

Methods: From February 2012 to November 2014, 96 patients were deemed eligible for ECLS implantation. Establishing ECLS was successful in 87 patients (mean age 54 ± 13 years, 16% female, initial flow 4.4 ± 0.9 l/min). Aetiologies included acute coronary syndromes (n = 52, 60%), cardiomyopathies (n = 25, 29%) and other pathologies. Fifty-nine patients (68%) had been resuscitated, and in 27 (31%), implantation was performed during CPR; 11 patients (13%) were awake at implantation and 20 (23%) underwent implantation in the referring hospital.

Results: Metabolic parameters differed in non-survivors versus survivors before ECLS implantation (pH 7.15 ± 0.23 vs. 7.27 ± 0.18, P = 0.007; lactate levels 10.90 ± 6.00 mmol/l vs. 8.79 ± 5.78 mmol/l, P = 0.091) and 6 h postimplantation (pH 7.27 ± 0.11 vs. 7.37 ± 0.11, P < 0.001; lactate levels 10.19 ± 5.52 mmol/l vs. 5.52 ± 4.17 mmol/l, P < 0.001). Altogether 44 patients could be weaned, and 9 were bridged to assist device implantation and 1 to heart transplantation. The mean time of support was 6 days, and the 30-day survival rate was 47% (n = 41).

Conclusions: ECLS serves as a bridge-to-decision and bridge-to-treatment device. Our interdisciplinary ECLS programme achieved acceptable survival of critically ill patients despite a substantial percentage of patients having been resuscitated and no absolute exclusion criteria. Further studies defining inclusion- and exclusion criteria might additionally improve outcome.

Keywords: Cardiogenic shock; Cardiomyopathy; Cardiopulmonary resuscitation; Extracorporeal life support; Myocardial infarction.

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