Extracorporeal life support with left ventricular decompression—improved survival in severe cardiogenic shock: results from a retrospective study

PeerJ

article

Bastian Schmack¹  Philipp Seppelt¹  Alexander Weymann³  Christina Alt¹  Mina Farag¹  Rawa Arif¹  Andreas O. Doesch⁴  Philip W. Raake⁴  Klaus Kallenbach⁵  Ashham Mansur⁶  Aron-Frederik Popov⁷  Matthias Karck¹  Arjang Ruhparwar¹ 

[1] Department of Cardiac Surgery, University Hospital Heidelberg;Medical Clinic III, Department of Cardiology, University Hospital Frankfurt;Department of Cardiac Surgery, University Hospital Oldenburg;Department of Cardiology, University Hospital Heidelberg;Department of Cardiac Surgery, INCCI National Heart Institute;Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen;Division of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt

关键词: Acute heart failure;    Cardiogenic shock;    Extracorporeal circulation;    ECLS;    ECMO;   

DOI  :  10.7717/peerj.3813

学科分类：社会科学、人文和艺术（综合）

来源: Inra

【 摘 要 】

ObjectiveExtracorporeal life support (ECLS) is a life-saving procedure used in the treatment of severe cardiogenic shock. Within this retrospective single centre study, we examined our experience in this critically ill patient cohort to assess outcomes and clinical parameters by comparison of ECLS with or without selective left ventricular decompression.MethodsBetween 2004 and 2014 we evaluated 48 adult patients with INTERMACS level 1 heart failure (age 49.7 ± 19.5 years), who received either central ECLS with (n = 20, 41.7%) or ECLS without (n = 28, 58.3%, including 10 peripheral ECLS) integrated left ventricular vent in our retrospective single centre trial.ResultsFollow up was 100% with a mean of 0.83 ± 1.85 years. Bridge to ventricular assist device was feasible in 29.2% (n = 14), bridge to transplant in 10.4% (n = 5) and bridge to recovery in 8.3% (n = 4). Overall 30-day survival was 37.5%, 6-month survival 27.1% and 1-year survival 25.0%. ECLS support with left ventricular decompression showed favourable 30-day survival compared to ECLS without left ventricular decompression (p = 0.034). Thirty-day as well as long-term survival did not differ between the subgroups (central ECLS with vent, ECLS without vent and peripheral ECLS without vent). Multivariate logistic regression adjusted for age and gender revealed ECLS without vent as independent factor influencing 30-day survival.ConclusionECLS is an established therapy for patients in severe cardiogenic shock. Independent of the ECLS approach, 30-day mortality is still high but with superior 30-day survival for patients with ECLS and left ventricular venting. Moreover, by unloading the ventricle, left ventricular decompression may provide an important time window for recovery or further treatment, such as bridge to bridge or bridge to transplant.

【 授权许可】

CC BY