Extracorporeal Life Support for Refractory Cardiac Arrest or Shock

Abstract

We aimed to identify factors associated with hospital mortality among patients receiving extracorporeal life support (ECLS). All consecutive patients treated with ECLS for refractory cardiac arrest or shock in the Caen University Hospital in northwestern France during the last decade were included in a retrospective cohort study. Sixty-four patients were included: 29 with refractory cardiac arrest and 35 with refractory shock. The main reasons for ECLS were acute coronary syndrome (n = 23) and severe poisoning caused by drug intoxication (n = 19). At ECLS initiation, the left ventricular ejection fraction was 16% (±11). Initial blood test results were arterial pH = 7.19 (±0.20) and plasma lactate = 8.02 (±5.88) mmol/L. Forty (63%) patients died including 33 under ECLS. In a multivariate analysis, two factors were independently associated with survival: drug intoxication as the reason for ECLS (adjusted odds ratio [AOR], 0.07; 95% confidence intervals [CI], 0.01-0.28; p < 0.001) and arterial pH (an increase of 0.1 point [AOR, 0.013; 95% CI, <0.001-0.27; p < 0.01]). This study supports early ECLS as a last resort therapeutic option in a highly selected group of patients with refractory cardiac arrest or shock, in particular before profound acidosis occurs and when the cause is reversible.

Management of pharmaceutical and recreational drug poisoning

“…It showed better survival in the group treated by VA-ECMO and multivariate analyses identified VA-ECMO as one of the independent factors of survival [24]. Other non-controlled retrospective studies have reported a survival of between 25 and 75% in patients with cardiotoxicant poisonings treated by VA-ECMO [240][241][242][243][244][245]. A registry study showed improvement of haemodynamic and metabolic parameters of cardiotoxicant-poisoned patients treated by VA-ECMO [246].…”

Predicting Survival After Extracorporeal Membrane Oxygenation for ARDS: An External Validation of RESP and PRESERVE Scores

“…ECMO was performed only after admission into the Caen University Hospital, where medical teams and nurses have extensive experience with emergency extracorporeal life support. [15][16][17] The hardware consisted of a Biomedicus (Medtronic, Minneapolis, Minnesota) or Maquet (Rotaflow, Jostra-Maquet, France) portable system incorporat-ing a centrifugal pump console. The closed ECMO circuit consisted of preconnected polyvinyl chloride tubing (Medtronic or PLS 20-50 [Maquet]) having a hollow-fiber membrane oxygenator with an integrated heat exchanger.…”

Predicting factors for the need of extracorporeal membrane oxygenation for suicide attempts by cardiac medication: a single-center cohort study

“…These two patients presented with local bleeding complications. The time between ingestion was 4 [2][3][4][5][6][7] h and the duration of ECMO was 4 [2-5] d. ECMO was started 3 [(-1)-5] h after the theoretical peak plasma level. The mean of the SAVE-score was -6, the mean survival predicted by the SAVE-score was 30%, but the observed survival was 70%.…”

“…Sometimes intoxication requires more aggressive treatment, such as venous-arterial extracorporeal membrane oxygenation (VA-ECMO). [3,4] For refractory cardiac arrest or shock, drug intoxication is independently associated with survival, [5] and treatment with VA-ECMO could improve survival. [6] Prompt implementations of ECMO could improve the prognosis.…”