A S Sharma1, P W Weerwind2, Y M Ganushchak1, D W Donker3, J G Maessen1. 1. Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands. 2. Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands P.Weerwind@maastrichtuniversity.nl. 3. Department of Intensive Care, Maastricht University Medical Centre, Maastricht, the Netherlands Department of Cardiology - Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands.
Abstract
BACKGROUND: We describe a single-centre experience of extracorporeal life support (ELS) for patients with severe and refractory cardiogenic shock, refractory cardiac arrest and severe respiratory failure. METHODS: Between September 2007 and September 2012, 56 intra-hospital and 10 inter-hospital adult patients were supported. RESULTS: The median ELS duration was 3 (0.9 - 6) days in venoarterial and 9.2 (7.4 - 24.4) days in venovenous supported patients. At hospital discharge and follow-up (12 and 40 months), survival among the respiratory (venovenous) patients and cardiac (venoarterial) patients was 84% and 38%, respectively. Survival in severe refractory cardiogenic shock patients was related to early initiation of ELS (<8 hours of onset of failure). A delay in initiating venoarterial ELS (>8 hours) and increased pre-ELS pH and lactate levels were associated with death in all cardiomyopathy patients, independent of infarct size. CONCLUSIONS: Our results exemplify the benefits of ELS as a bridge to initial stabilization of critically ill patients. Potentially, the early application of ELS technology can lower mortality and morbidity in patients with a regressive pathology.
BACKGROUND: We describe a single-centre experience of extracorporeal life support (ELS) for patients with severe and refractory cardiogenic shock, refractory cardiac arrest and severe respiratory failure. METHODS: Between September 2007 and September 2012, 56 intra-hospital and 10 inter-hospital adult patients were supported. RESULTS: The median ELS duration was 3 (0.9 - 6) days in venoarterial and 9.2 (7.4 - 24.4) days in venovenous supported patients. At hospital discharge and follow-up (12 and 40 months), survival among the respiratory (venovenous) patients and cardiac (venoarterial) patients was 84% and 38%, respectively. Survival in severe refractory cardiogenic shockpatients was related to early initiation of ELS (<8 hours of onset of failure). A delay in initiating venoarterial ELS (>8 hours) and increased pre-ELS pH and lactate levels were associated with death in all cardiomyopathypatients, independent of infarct size. CONCLUSIONS: Our results exemplify the benefits of ELS as a bridge to initial stabilization of critically illpatients. Potentially, the early application of ELS technology can lower mortality and morbidity in patients with a regressive pathology.
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