Adrien Bouglé1, Arthur Le Gall2, Florence Dumas3, Guillaume Geri4, Isabelle Malissin5, Sebastian Voicu5, Bruno Mégarbane5, Alain Cariou4, Nicolas Deye5. 1. Medical Intensive Care Unit, Cochin University Hospital, AP-HP, 75014 Paris, France; Paris V University, 75006 Paris, France. Electronic address: adrien.bougle@aphp.fr. 2. Medical Intensive Care Unit, Cochin University Hospital, AP-HP, 75014 Paris, France; Paris V University, 75006 Paris, France. 3. Paris V University, 75006 Paris, France; Emergency Department, Cochin University Hospital, AP-HP, 75014 Paris, France; Inserm UMR-S970, Paris Cardiovascular Research Centre, 75908 Paris, France. 4. Medical Intensive Care Unit, Cochin University Hospital, AP-HP, 75014 Paris, France; Paris V University, 75006 Paris, France; Inserm UMR-S970, Paris Cardiovascular Research Centre, 75908 Paris, France. 5. Medical and Toxicologic Intensive Care Unit, Lariboisière University Hospital, AP-HP, 75010 Paris, France; Paris VII University, 75013 Paris, France.
Abstract
BACKGROUND: Post cardiac arrest shock (PCAS) occurring after resuscitated cardiac arrest (CA) is a main cause of early death. Extracorporeal life support (ECLS) could be useful pending recovery from myocardial failure. AIM: To describe our PCAS population, and the factors associated with initiation of ECLS. METHODS: This analysis included 921 patients admitted to two intensive care units between 2005 and 2014 for CA and PCAS; 43 of these patients had ECLS initiated. Neurological and ECLS-related outcomes were gathered retrospectively. RESULTS: The 43 patients treated with ECLS were predominantly (70%) young males with evidence of myocardial infarction on coronary angiography. ECLS was initiated in patients with severe cardiovascular dysfunction (median left ventricular ejection fraction 15% [interquartile range 10-25%]), a median of 9hours [interquartile range 6-16hours] after the CA. At 1 year, eight patients (19%) had survived without neurological disability. Blood lactate and coronary aetiology were associated with neurological outcomes. Logistic regression conducted using 878 controls with PCAS identified age>62 years, location of CA, use of a high dose of adrenaline (>3mg) and blood lactate and serum creatinine concentrations (>5mmol/L and>109μmol/L, respectively) as risk factors for initiation of ECLS. CONCLUSIONS: ECLS, as a salvage therapy for PCAS, could be an acceptable alternative for highly-selected patients.
BACKGROUND: Post cardiac arrest shock (PCAS) occurring after resuscitated cardiac arrest (CA) is a main cause of early death. Extracorporeal life support (ECLS) could be useful pending recovery from myocardial failure. AIM: To describe our PCAS population, and the factors associated with initiation of ECLS. METHODS: This analysis included 921 patients admitted to two intensive care units between 2005 and 2014 for CA and PCAS; 43 of these patients had ECLS initiated. Neurological and ECLS-related outcomes were gathered retrospectively. RESULTS: The 43 patients treated with ECLS were predominantly (70%) young males with evidence of myocardial infarction on coronary angiography. ECLS was initiated in patients with severe cardiovascular dysfunction (median left ventricular ejection fraction 15% [interquartile range 10-25%]), a median of 9hours [interquartile range 6-16hours] after the CA. At 1 year, eight patients (19%) had survived without neurological disability. Blood lactate and coronary aetiology were associated with neurological outcomes. Logistic regression conducted using 878 controls with PCAS identified age>62 years, location of CA, use of a high dose of adrenaline (>3mg) and blood lactate and serum creatinine concentrations (>5mmol/L and>109μmol/L, respectively) as risk factors for initiation of ECLS. CONCLUSIONS: ECLS, as a salvage therapy for PCAS, could be an acceptable alternative for highly-selected patients.