Clinical outcomes of venoarterial extracorporeal life support in 462 patients: Single‐center experience

Abstract

This study aims to investigate the outcomes of venoarterial extracorporeal life support (VA-ECLS) in a large single-center patient cohort regarding survival and adverse events. Between June 2009 and March 2019, 462 consecutive patients received VA-ECLS. The mean age was 66.2 ± 11.9 years. Two patient groups were identified: Group 1-patients with ECLS due to postcardiotomy shock (PCS) after cardiac surgery (PCS, n = 357); Group 2-patients with ECLS due to cardiogenic shock (CS) without previous surgery (nonPCS, n = 105). The primary end point was overall in-hospital survival, while secondary end points were adverse events during the study period. Overall, the in-hospital survival rate was 26%. There was no statistically significant difference between the groups: 26.3% for PCS and 24.8% for nonPCS, respectively (P > .05). Weaning from VA-ECLS was possible in 44.3% for PCS and in 29.5% for nonPCS (P = .004). The strong predictors of overall mortality were postoperative hepatic dysfunction (OR = 14.362, 95%CI = 1.948-105.858), cardiopulmonary resuscitation > 30 minutes (OR = 6.301, 95%CI = 1.488-26.673), bleeding with a need for revision (OR = 2.123, 95%CI = 1.343-3.355), and previous sternotomy (OR = 2.077, 95%CI = 1.021-4.223). Despite its low survival rates, VA-ECLS therapy is the last resort and the only lifesaving option for patients in refractory CS. In contrast, there is still a lack of evidence for VA-ECLS in PCS patients. Future studies are warranted to evaluate the outcomes of VA-ECLS therapy after cardiac surgery. K E Y W O R D S cardiogenic shock, cardiopulmonary resuscitation, postcardiotomy shock, venoarterial extracorporeal life support How to cite this article: Zhigalov K, Sá MPBO, Safonov D, et al; on behalf of ITCVR. Clinical outcomes of venoarterial extracorporeal life support in 462 patients: Single-center experience.

Outcomes of patients suffering unwitnessed hypothermic cardiac arrest rewarmed with extracorporeal life support: A systematic review

“…Unwitnessed cardiac arrest patients are, therefore, often deemed ineligible for ECPR clinical protocols when the no‐flow duration is unknown 19‐21 . The duration of CPR corresponding to a low‐flow prolonged to the extent that brain recovery is doubtful (about 60‐80 min), is also considered as a contraindication to ECPR 19‐22 . The median low‐flow duration of 105 minutes for neurologically intact survivors in our study is much longer than median CPR durations of normothermic CA patients undergoing ECPR 23 .…”

The impact of obesity on outcomes in patients receiving extracorporeal life support

“…The reduced complication and resource utilization rates observed in obese patients may be in part related to the higher proportion of such patients receiving ECLS for respiratory failure. Venoarterial extracorporeal life support (VA ECLS) for cardiogenic shock is associated with higher complication rates and in‐hospital mortality owing to the patient’s underlying condition, the presence of end‐organ injury secondary to malperfusion, and the complexities of arterial cannulation 13,34,35 . Previous single‐center studies endorsing similar or improved outcomes in obese patients have primarily focused on the administration of venovenous (VV) ECLS 15,19,20 .…”

“…Venoarterial ECLS requires closer monitoring and flow adjustment than VV ECLS and is associated with greater complication rates secondary to more technically challenging cannulation technique, as it requires both venous and arterial access. 11,13,34,35 . Furthermore, patients receiving VV ECLS are generally hemodynamically stable, while VA ECLS is often administered in the setting of profound circulatory failure 11,12,34 .…”

“… 11,13,34,35 . Furthermore, patients receiving VV ECLS are generally hemodynamically stable, while VA ECLS is often administered in the setting of profound circulatory failure 11,12,34 . Greater complication rates have been reported for VA support modalities compared to VV, with unique risks including cardiac thrombosis and elevated risk of coronary and cerebral hypoxia 13 .…”

Predictors of in‐hospital mortality during extracorporeal life support

“…We have read with great interest the Letter to the Editor by Imamura. 1 He referred to our study, which was published previously. 2 We investigated the outcomes of venoarterial extracorporeal life support (VA-ECLS) in a single-center cohort of 462 patients regarding survival and adverse events.…”