BACKGROUND: Few data are available on the clinical outcome of patients with acute coronary syndrome (ACS) complicated by refractory cardiogenic shock or cardiac arrest who receive percutaneous extracorporeal life support (ECLS). We investigated the in-hospital outcome and predictors of mortality in these patients. METHODS: The investigation was a single-center, retrospective cohort study of 98 ACS patients who received ECLS to reverse hemodynamic collapse refractory to conventional treatment. RESULTS: Circulatory status before ECLS introduction was cardiogenic shock in 34, ventricular fibrillation or pulseless ventricular tachycardia in 23, and asystole or pulseless electrical activity in 41. Ninety-four patients (95.9%) underwent emergency revascularization, including 92 who received percutaneous coronary intervention and 2 who received isolated coronary artery bypass grafting. Successful angioplasty was achieved in 65 of 92 patients (70.7%). Fifty-four patients (55.1%) were weaned from ECLS, and ECLS-related complications occurred in 35 (35.7%). All-cause in-hospital mortality rate was 67.3%, and the survival rate to hospital discharge was 32.7%. Multivariate analysis revealed that independent predictors of in-hospital mortality were unsuccessful angioplasty, asystole or pulseless electrical activity before ECLS introduction, and ECLS-related complications. CONCLUSIONS: Despite hemodynamic support with ECLS, patients with ACS complicated by cardiogenic shock or cardiac arrest refractory to conventional treatment had high mortality. However, the higher than 30% in-hospital survival rate in this extremely critical population indicates that ECLS might improve outcomes in ACS by saving the lives of patients in this specialized category. Unsuccessful angioplasty, asystole or pulseless electrical activity before ECLS introduction, and ECLS-related complications were predictors of in-hospital mortality.
BACKGROUND: Few data are available on the clinical outcome of patients with acute coronary syndrome (ACS) complicated by refractory cardiogenic shock or cardiac arrest who receive percutaneous extracorporeal life support (ECLS). We investigated the in-hospital outcome and predictors of mortality in these patients. METHODS: The investigation was a single-center, retrospective cohort study of 98 ACS patients who received ECLS to reverse hemodynamic collapse refractory to conventional treatment. RESULTS: Circulatory status before ECLS introduction was cardiogenic shock in 34, ventricular fibrillation or pulseless ventricular tachycardia in 23, and asystole or pulseless electrical activity in 41. Ninety-four patients (95.9%) underwent emergency revascularization, including 92 who received percutaneous coronary intervention and 2 who received isolated coronary artery bypass grafting. Successful angioplasty was achieved in 65 of 92 patients (70.7%). Fifty-four patients (55.1%) were weaned from ECLS, and ECLS-related complications occurred in 35 (35.7%). All-cause in-hospital mortality rate was 67.3%, and the survival rate to hospital discharge was 32.7%. Multivariate analysis revealed that independent predictors of in-hospital mortality were unsuccessful angioplasty, asystole or pulseless electrical activity before ECLS introduction, and ECLS-related complications. CONCLUSIONS: Despite hemodynamic support with ECLS, patients with ACS complicated by cardiogenic shock or cardiac arrest refractory to conventional treatment had high mortality. However, the higher than 30% in-hospital survival rate in this extremely critical population indicates that ECLS might improve outcomes in ACS by saving the lives of patients in this specialized category. Unsuccessful angioplasty, asystole or pulseless electrical activity before ECLS introduction, and ECLS-related complications were predictors of in-hospital mortality.
Authors: Sabina Guenther; Hans D Theiss; Matthias Fischer; Stefan Sattler; Sven Peterss; Frank Born; Maximilian Pichlmaier; Steffen Massberg; Christian Hagl; Nawid Khaladj Journal: Interact Cardiovasc Thorac Surg Date: 2013-12-13
Authors: Philipp Pichler; Herwig Antretter; Martin Dünser; Stephan Eschertzhuber; Roman Gottardi; Gottfried Heinz; Gerhard Pölzl; Ingrid Pretsch; Angelika Rajek; Andrä Wasler; Daniel Zimpfer; Alexander Geppert Journal: Wien Klin Wochenschr Date: 2015-03-28 Impact factor: 1.704
Authors: Jürgen Leick; Christoph Liebetrau; Sebastian Szardien; Ulrich Fischer-Rasokat; Matthias Willmer; Arnaud van Linden; Johannes Blumenstein; Holger Nef; Andreas Rolf; Matthias Arlt; Thomas Walther; Christian Hamm; Helge Möllmann Journal: Clin Res Cardiol Date: 2013-05-09 Impact factor: 5.460
Authors: Darryl Abrams; A Reshad Garan; Akram Abdelbary; Matthew Bacchetta; Robert H Bartlett; James Beck; Jan Belohlavek; Yih-Sharng Chen; Eddy Fan; Niall D Ferguson; Jo-Anne Fowles; John Fraser; Michelle Gong; Ibrahim F Hassan; Carol Hodgson; Xiaotong Hou; Katarzyna Hryniewicz; Shingo Ichiba; William A Jakobleff; Roberto Lorusso; Graeme MacLaren; Shay McGuinness; Thomas Mueller; Pauline K Park; Giles Peek; Vin Pellegrino; Susanna Price; Erika B Rosenzweig; Tetsuya Sakamoto; Leonardo Salazar; Matthieu Schmidt; Arthur S Slutsky; Christian Spaulding; Hiroo Takayama; Koji Takeda; Alain Vuylsteke; Alain Combes; Daniel Brodie Journal: Intensive Care Med Date: 2018-02-15 Impact factor: 17.440