N Rousse1, F Juthier1, C Pinçon2, I Hysi3, C Banfi3, E Robin4, G Fayad3, B Jegou3, A Prat3, A Vincentelli5. 1. Department of Cardiovascular Surgery, Centre Hospitalier Régional et Universitaire de Lille, Lille 59035, France; Université Lille Nord de France, Lille 59000, UDSL, France; Inserm, UMR1011, Lille 59035, France. 2. Université Lille Nord de France, Lille 59000, UDSL, EA2694, Department of Biostatistics. 3. Department of Cardiovascular Surgery, Centre Hospitalier Régional et Universitaire de Lille, Lille 59035, France. 4. Department of Anesthesiology, Centre Hospitalier Régional et Universitaire de Lille, Lille 59035, France. 5. Department of Cardiovascular Surgery, Centre Hospitalier Régional et Universitaire de Lille, Lille 59035, France; Université Lille Nord de France, Lille 59000, UDSL, France; Inserm, UMR1011, Lille 59035, France. Electronic address: andre.vincentelli@chru-lille.fr.
Abstract
BACKGROUND: Our 8-year experience with ECMO support as a bridge to decision was reviewed. METHODS: A cohort of 124 consecutive patients received ECMO for refractory cardiogenic shock in our institution. Twenty-six of these were out of hospital cardiac arrests and were excluded from this analysis. The median age was 43 years, in the range of 11 to 73 years. RESULTS: The median duration of ECMO support was 4.5 days. Mortality while supported by ECMO was 50% with a median support time of 2 days. Weaning from ECMO was achieved for 49 patients with the following outcomes: cardiac recovery (60%), heart transplantation (26%), and VAD implantation (14%). Median duration of support before weaning was 8 days. Hospital survival was 83%, 61.5% and 71% for cardiac recovery, heart transplantation and VAD implantation, respectively. ECMO weaning was significantly improved in all patients who had normalized their renal function, and when duration of support>6 days (HR: 4.255 [1.255-14.493], p=0.02 and HR: 2.164 [1.152-4.082], p=0.02, respectively). A creatinine level>14 mg/l the day of weaning was a significant predictor of death (HR: 5.807 [1.089-30.953]; p=0.04). Median follow up was 2.4 years; one-year survival rate was 78%, 51% and 75% for cardiac recovery, heart transplantation and VAD implantation, respectively. CONCLUSION: With at least 6 days of support, ECMO allowed a better patient selection for myocardial recovery, VAD implantation or heart transplantation. Whether VAD implantation or heart transplant in those patients is a better indication remains to be evaluated.
BACKGROUND: Our 8-year experience with ECMO support as a bridge to decision was reviewed. METHODS: A cohort of 124 consecutive patients received ECMO for refractory cardiogenic shock in our institution. Twenty-six of these were out of hospital cardiac arrests and were excluded from this analysis. The median age was 43 years, in the range of 11 to 73 years. RESULTS: The median duration of ECMO support was 4.5 days. Mortality while supported by ECMO was 50% with a median support time of 2 days. Weaning from ECMO was achieved for 49 patients with the following outcomes: cardiac recovery (60%), heart transplantation (26%), and VAD implantation (14%). Median duration of support before weaning was 8 days. Hospital survival was 83%, 61.5% and 71% for cardiac recovery, heart transplantation and VAD implantation, respectively. ECMO weaning was significantly improved in all patients who had normalized their renal function, and when duration of support>6 days (HR: 4.255 [1.255-14.493], p=0.02 and HR: 2.164 [1.152-4.082], p=0.02, respectively). A creatinine level>14 mg/l the day of weaning was a significant predictor of death (HR: 5.807 [1.089-30.953]; p=0.04). Median follow up was 2.4 years; one-year survival rate was 78%, 51% and 75% for cardiac recovery, heart transplantation and VAD implantation, respectively. CONCLUSION: With at least 6 days of support, ECMO allowed a better patient selection for myocardial recovery, VAD implantation or heart transplantation. Whether VAD implantation or heart transplant in those patients is a better indication remains to be evaluated.
Authors: Ravi Vuthoori; Cassandra Heaney; Brian Lima; Alexis Knisel; Ed Miller; Kevin Kennedy; David Majure; Gerin Stevens; Karl Bocchieri; Hugh Cassiere; Harold Fernandez; Simon Maybaum Journal: ESC Heart Fail Date: 2022-04-22
Authors: Jeffrey DellaVolpe; Ryan P Barbaro; Jeremy W Cannon; Eddy Fan; Wendy R Greene; Kyle J Gunnerson; Lena M Napolitano; Ace Ovil; Jeremy C Pamplin; Matthieu Schmidt; Lauren R Sorce; Daniel Brodie Journal: Crit Care Med Date: 2020-06 Impact factor: 7.598
Authors: Clément Delmas; Jean-Marie Conil; Simon Sztajnic; Bernard Georges; Caroline Biendel; Camille Dambrin; Michel Galinier; Vincent Minville; Olivier Fourcade; Stein Silva; Bertrand Marcheix Journal: Indian J Crit Care Med Date: 2017-03