Prolonged veno-arterial extracorporeal life support for cardiac failure

Günther, Sabina P. W.; Shudo, Yasuhiro; Hiesinger, William und Banerjee, Dipanjan (2018): Prolonged veno-arterial extracorporeal life support for cardiac failure. In: International Journal of Artificial Organs, Bd. 41, Nr. 8: S. 437-444

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.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0391-3988
• Sprache: Englisch