337 Extra Corporeal Life Support: A hope in refractory cardiac cardiac arrest?

BackgroundExtracorporeal life support (ECLS) using the percutaneous femoral approach has been proposed as a resuscitative tool in patients (pts) with refractory cardiac arrest (CA) or refractory cardiogenic shock. Little is known however about medium term outcome in this setting.PurposeAccordingly, we aimed to analyse the feasibility, complications, short- and medium-term outcome of emergency ECLS implanted during or after CA.MethodRetrospective analysis of in-hospital data and prospective follow-up of 50 consecutive patients (pts) successfully implanted with ECLS between 2005-2007.ResultsCA was secondary to ST+ acute coronary syndrome, non ischemic heart disease, poisoning, and pulmonary embolism in 27 (54%), 17 (34%), 4 (8%), and 2 pts (4%) respectively (33 males, mean age 47±14 years). Mean delay between CA and ECLS was 48±50 min. Percutaneous femoral implantation of ECLS was attempted in 56 pts, and was successful in 50 (feasibility 89%): In- and out of- hospital CA occurred in 43 and 7 pts respectively. 40 pts had recovered spontaneous circulation at the time of ECLS implantation but had persistent cardiogenic shock, while 10 pts were still under cardiopulmonary resuscitation. Mean duration of ECLS was 38±48 hours. 38 patients died in ICU, mainly from multiple organ failure or brain death. Twelve patients (24%) were explanted and 10 patients (20%) were discharge from hospital after a median stay of 29 days. All discharged patients were alive at a median follow-up of 16.8 months. None had neurological disability, one underwent heart transplantation, and all were in NYHA class I or II.ConlusionIn our initial experience, 20% of the treated patients were discharged, and were alive at 16 months with a good quality of life. Results of the following patients who have benefited from ECLS after these 50 initial patients will be also presented. ECLS should therefore be considered in selected pts with persistent hemodynamics failure after CA