Prolonged veno-arterial extracorporeal life support for cardiac failure

Int J Artif Organs. 2018 Aug;41(8):437-444. doi: 10.1177/0391398818777359. Epub 2018 Jun 13.

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.

MeSH terms

  • Adult
  • Extracorporeal Membrane Oxygenation / methods*
  • Female
  • Heart Failure / complications
  • Heart Failure / mortality
  • Heart Failure / physiopathology
  • Heart Failure / therapy*
  • Heart Ventricles / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Shock, Cardiogenic / etiology
  • Shock, Cardiogenic / mortality
  • Shock, Cardiogenic / physiopathology
  • Shock, Cardiogenic / therapy*
  • Survival Rate
  • Treatment Outcome
  • Young Adult