Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock in Elderly Patients: Trends in Application and Outcome From the Extracorporeal Life Support Organization (ELSO) Registry

Abstract

Based on the acceptable survival to hospital discharge in our study, older age alone should not represent an absolute contraindication when considering VA-ECMO support for RCS.

Extracorporeal life support in the multidisciplinary management of cardiogenic shock complicating acute myocardial infarction

“…Muller et al identified pre‐ECLS age >60 years as an independent predictor of intensive care unit death in one of the largest published series of ECLS support for cardiogenic shock in the setting of AMI . Nevertheless, Lorusso et al found an overall increased use of ECLS support in elderly patients in recent years with acceptable mortality rate . However, ECLS support in elderly patients with refractory cardiogenic shock complicating AMI needs an individualized careful evaluation in order to avoid inappropriate resource utilization and excessive hospital costs.…”

“…13 Nevertheless, Lorusso et al found an overall increased use of ECLS support in elderly patients in recent years with acceptable mortality rate. 29 However, ECLS support in elderly patients with refractory cardiogenic shock complicating AMI needs an individualized careful evaluation in order to avoid inappropriate resource utilization and excessive hospital costs. Although not statistically significant, nonsurvivors exhibited in our series a trend towards higher incidence of left main trunk disease.…”

Time is your best friend, but it soon becomes your worst enemy: The conflict of venoarterial extracorporeal membrane oxygenation in cardiac surgery

“…3 Cardiac surgical patients are usually characterized by substantial pre-ECMO comorbidities and more advanced age. 7 All these factors, individually or in association, may influence the capability of the myocardium to recover or hamper favorable body response to prolonged extracorporeal mechanical assistance. In some patients, the mechanical support does not prompt to improved cardiac function or organ integrity, and clinicians may therefore be forced to bridge the patient toward more advanced treatments, such as HTx or long-lasting VADs.…”

Recommendations for extracorporeal cardiopulmonary resuscitation (eCPR)

“…Zudem ist zu berücksichtigen, dass ältere und gebrechliche Patienten mit OHCA eine niedrige Überlebenswahrscheinlichkeit zeigen [41]. Das Alter alleine scheint dennoch die Überlebensrate nicht negativ zu beeinflussen und sollte daher nicht als absolute Kontraindikation aufgeführt werden [22,42,43]. Zusammenfassend existieren aus Beobachtungsstudien eine Reihe von Parametern mit prognostischer Bedeutung, wobei keiner dieser Marker im Sinne einer "No-go-Entscheidungshilfe" herangezogen werden kann.…”