Prolonged veno-arterial extracorporeal life support for cardiac failure

Abstract

Objectives:

In intractable cardiogenic shock, extracorporeal life support frequently is the last treatment option. Outcomes of prolonged veno-arterial extracorporeal life support for cardiac failure are poorly defined.

Methods:

We retrospectively analyzed 10 patients (4 females, age = 36 ± 16 years) who underwent prolonged extracorporeal life support (≥7 days) from December 2015 to March 2017 for cardiogenic shock. The primary endpoint was survival to hospital discharge.

Results:

Etiologies included ischemic cardiomyopathy with non ST-segment elevation myocardial infarction (n = 1), dilated (n = 3), hypertrophic (n = 1), postpartum cardiomyopathy (n = 1), and others (n = 4). Heart failure was left or biventricular in 80.0% (left ventricular ejection fraction = 15.6 ± 5.5%). Among the 10 patients, 80.0% underwent femoral and 20.0% central cannulation, 40.0% required changes in the cannulation strategy, and 80.0% underwent left ventricular venting. No technical malfunctions occurred, but 50.0% required circuit exchanges for thrombus formation. 80.0% suffered from infections. 60.0% could be decannulated after 717 ± 830 (168–2301) h of support, and survival to hospital discharge was 40.0%. Longest follow-up available is 160 ± 175 (12–409) days after discharge, with 30.0% alive and in satisfying functional condition.

Conclusion:

Prolonged veno-arterial extracorporeal life support for cardiac failure is feasible with low technical complication rates. Survival rates are acceptable, yet inferior to short-term support. We observed a shift from initial shock-related complications to infections during prolonged support. Since recovery and thus weaning is rather unlikely after a prolonged need for extracorporeal life support, this form of support should be limited to centers offering the full spectrum of interdisciplinary cardiac care including ventricular assist device implantation and transplantation.

Keywords

Cardiogenic shock extracorporeal life support outcome prolonged duration

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References

Abrams

Combes

Brodie

Extracorporeal membrane oxygenation in cardiopulmonary disease in adults. J Am Coll Cardiol 2014; 63(25 Pt A): 2769–2778.

Werdan

Gielen

Ebelt

et al . Mechanical circulatory support in cardiogenic shock. Eur Heart J 2014; 35(3): 156–167.

Aubin

Petrov

Dalyanoglu

et al . A suprainstitutional network for remote extracorporeal life support: a retrospective cohort study. JACC Heart Fail 2016; 4(9): 698–708.

Guenther

Brunner

Born

et al . When all else fails: extracorporeal life support in therapy-refractory cardiogenic shock. Eur J Cardiothorac Surg 2016; 49(3): 802–809.

Schmidt

Burrell

Roberts

et al . Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE)-score. Eur Heart J 2015; 36(33): 2246–2256.

Thiagarajan

Barbaro

Rycus

et al . Extracorporeal life support organization registry international report 2016. ASAIO J 2017; 63(1): 60–67.

Merrill

Schoeneberg

Sandesara

et al . Outcomes after prolonged extracorporeal membrane oxygenation support in children with cardiac disease—extracorporeal life support organization registry study. J Thorac Cardiovasc Surg 2014; 148(2): 582–588.

Posluszny

Rycus

Bartlett

et al . Outcome of adult respiratory failure patients receiving prolonged (≥14 days) ECMO. Ann Surg 2016; 263(3): 573–581.

Gupta

McDonald

Chipman

et al . 20-year experience of prolonged extracorporeal membrane oxygenation in critically ill children with cardiac or pulmonary failure. Ann Thorac Surg 2012; 93(5): 1584–1590.

10.

Abnousi

Yong

Fearon

et al . The evolution of temporary percutaneous mechanical circulatory support devices: a review of the options and evidence in cardiogenic shock. Curr Cardiol Rep 2015; 17(6): 40.

11.

Camboni

Philipp

Hirt

et al . Possibilities and limitations of a miniaturized long-term extracorporeal life support system as bridge to transplantation in a case with biventricular heart failure. Interact Cardiovasc Thorac Surg 2009; 8(1): 168–170.

12.

Glater-Welt

Schneider

Zinger

et al . Nosocomial bloodstream infections in patients receiving extracorporeal life support: variability in prevention practices: a survey of the extracorporeal life support organization members. J Intensive Care Med 2015; 31(10): 654–659.

13.

Sommer

Marsch

Kaufeld

et al . Cardiac awake extracorporeal life support-bridge to decision? Artif Organs 2015; 39(5): 400–408.

14.

Keenan

Schechter

Bonadonna

et al . Early experience with a novel cannulation strategy for left ventricular decompression during nonpostcardiotomy venoarterial ECMO. ASAIO J 2016; 62(3): e30–e34.

15.

Smith

Vukomanovic

Brodie

et al . Duration of veno-arterial extracorporeal life support (VA ECMO) and outcome: an analysis of the extracorporeal life support organization (ELSO) registry. Crit Care 2017; 21(1): 45–53.

16.

Schibilsky

Haller

Lange

et al . Extracorporeal life support prior to left ventricular assist device implantation leads to improvement of the patients INTERMACS levels and outcome. PLoS ONE 2017; 12(3): e0174262.