Experience with Extracorporeal Life Support for Cardiogenic Shock in the Older Population more than 70 Years of Age

Abstract

The two main objectives of this single-center, retrospective study were to analyze the outcomes and to identify the independent predictors of 30 day and long-term mortality in case of cardiopulmonary resuscitation requiring extracorporeal life support (ECLS) in the elderly patients. From October 2004 to May 2014, 163 patients with a mean age of 75.5 years (range 70-91) required veno-arterial ECLS. The main indication was postcardiotomy cardiogenic shock (79.6%). Extracorporeal life support duration averaged 5.6 ± 4.3 days. Thirty-day mortality was 72% (n = 117) and follow-up survival rate was 14.1% with a median follow-up of 23.7 months (range 1.5-102.3). Lactatemia was identified as an independent risk factor of 30 day mortality. Previous stroke, lactatemia, bilirubinemia, and ECLS implantation under cardiac massage were identified as independent risk factors for long-term mortality. Extracorporeal life support after TAVI procedure and intra-aortic balloon pump support were identified as protective factors for both 30 day and long-term survival. The 23 patients, still alive at last follow up, have a good quality of life, doing well, and self-catering. Although mortality rate at 30 days is more than 70% in elderly patients requiring circulatory support with ECLS, survivors can pretend to an acceptable long-term survival with a good quality of life. Extracorporeal life support implantation in the elderly patients should remain scarce, but should still be considered as a therapeutic option in well-selected patients.

Periprocedural Cardiopulmonary Bypass or Venoarterial Extracorporeal Membrane Oxygenation During Transcatheter Aortic Valve Replacement: A Systematic Review

“…Of those, 9 studies representing a total of 5191 patients met the inclusion criteria (Figure and Table 1). 8, 10, 11, 12, 13, 14, 15, 16, 17 All studies except the study by Seco et al15 were retrospective studies of institutional or national databases. All studies were published from 2012 to 2017, with 7 out of 9 studies published from the United States and Europe.…”

“…The substudy of the PARTNER trial registry by Shreenivas et al was the largest study, contributing 109/203 (53.7%) patients, all of whom needed CPB 8. Commonly noted indications for CPB/VA‐ECMO included left ventricular (LV) or aortic annular rupture, rapid hemodynamic deterioration, severe aortic regurgitation, cardiac arrest from ventricular tachycardia or fibrillation, and obstruction of the left main coronary artery 8, 10, 11, 12, 13, 14, 15, 16, 17. The definition of hemodynamic deterioration varied across studies and included low cardiac output, need for high‐dose vasopressors and inotropes, prolonged pacing sequence, and severe LV dysfunction on echocardiography.…”

Extracorporeal Membrane Oxygenation Use in Cardiogenic Shock: Impact of Age on In-Hospital Mortality, Length of Stay, and Costs

“…Sixth, time trend analyses could not be accomplished secondary to low cell counts. Seventh, while results from this study are broadly applicable to patients in general, subgroups with heterogeneous outcomes may exist including myocarditis, congenital heart disease, (5,12,29,32,43) cardiac arrest, (11,40,(43)(44)(45) postcardiotomy, (11,37,(45)(46)(47)(48) and patients with certain comorbidities or organ dysfunction. (11,27,29,31,34,35,43,44,49,50) Finally, we did not compare our findings in the NIS with those that might be found in ELSO given the use of self-reported data increasing the concern for selection bias and lack of data regarding hospital LOS, disposition, and costs.…”

The dilemma of patient age in decision-making for extracorporeal life support in cardiopulmonary resuscitation

“…The findings of Yu and associates confirm the ominous prognosis of ECPR in the very old patients when a certain time to mechanical support (60 min) has been passed. Age, as negative determinant of ECLS outcome, has been highlighted by previous investigations [1][2][3][4][5][6][7][8], although overall outcomes have never been sufficiently dismal to disqualify the very old patients of access to ECLS, particularly in a cardiac arrest scenario [4]. Indeed, an unfavourable prognosis when ECPR is started after an hour of resuscitation has been previously reported [13,14] and the study of Yu and associates confirms previous investigations, underlining the strict association of ECPR timing and patient age with regards to ultimate outcome.…”

“…Consideration of patient age in the decision-making for starting extracorporeal life support (ECLS) has long been recognised as a dilemma and remains controversial [1][2][3][4][5][6][7][8]. Providing ECLS is resource intensive and a complicated post-implementation course, or eventually proven to be futile, is not uncommon.…”