Are There Contraindications for Percutaneous Extracorporal Life Support (ECLS) in Critical Patients with Therapy-Refractory Cardiogenic Shock?

• Published in: The Thoracic and Cardiovascular Surgeon
• Main Authors: Günther, S., Born, F., Sattler, S., Brunner, S., Peterss, S., Pichlmaier, M., Massberg, S., Hagl, C., Khaladj, N.
• Format: Conference Proceeding
• Language: English
• Published: 20.01.2015
• ISSN: 0171-6425; 1439-1902
• DOI: 10.1055/s-0035-1544533

Objectives: ECLS transport-systems made percutaneous femoral implantation on-scene possible. Implantation is feasible in the emergency department, cathlab or referring hospital, while cardiopulmonary resuscitation (CPR) but also in conscious patients. So far, indication and contraindication criteria are debated and rare data concerning risk factors of mortality exist. Methods: From 02/2012 until 04/2014 66 patients (9 female (14%), age 53.7 ± 13.5years) underwent percutaneous ECLS-implantation for therapy-refractory cardiogenic shock (due to acute coronary syndrome (ACS) in 64%, cardiomyopathy (CM) in 24%, other pathologies in 12%). 45 (68%) had been resuscitated, in 23 (35%) implantation was performed under ongoing CPR. 13 (20%) were implanted in the referring hospital, 6 (9%) were conscious. Mean pH and lactate levels before implantation were 7.18 ± 0.24 and 10.42 ± 6.29 mmol/l, values after 6 hours of support 7.30 ± 0.13 and 8.35 ± 5.36 mmol/l, respectively. Results: 28 patients died while on ECLS (42%). Overall 30-day mortality was 59% (39 patients, multi-organ failure: 23, neurological complications: 10, cardiac failure: 5, bleeding: 1). Logistic regression analysis identified 6-hour pH values as the only independent risk factor of 30-day mortality ( p  < 0.001, OR=0.000, 95%-CI 0.000–0.018). There was no difference in survival of ACS- and CM-patients. In 38 (58%) the system could be explanted after 151 ± 64hours of support, 10 received cardiac surgery. Conclusions: Percutaneous ECLS achieves immediate cardiopulmonary stabilization and serves as a bridging device. Controlling shock, normalizing acid-base metabolism and achieving sufficient perfusion of vital organs is crucial. We could not identify pre-implantation parameters excluding for ECLS-implantation in critical patients that otherwise most likely would have died. However, thorough evaluation by an interdisciplinary team is mandatory.