292 * PERCUTANEOUS EXTRACORPORAL LIFE SUPPORT FOR PATIENTS IN THERAPY-REFRACTORY CARDIOGENIC SHOCK

Abstract

Objectives: Therapy-refractory cardiogenic shock is associated with a dismal outcome. Temporary circulatory support using an extracorporal life support (ECLS) system may reduce mortality by providing sufficient organ perfusion and therefore reduction of subsequent multiorgan failure (MOF). Methods: Between August 2012 and March 2013, 25 patients (9 female, median age 45 [17-84] years) were supported with a miniaturized ECLS system because of therapy-refractory cardiogenic shock due to various underlying pathologies (excluding postcardiotomy syndromes). Ten had been resuscitated or were under ongoing cardiopulmonary resuscitation (CPR). Twelve patients (48%) underwent immediate percutaneous coronary intervention. Upon implantation, serum lactate levels were 15 (7-22) mmol/l. Systems were implanted either in the referring hospital, emergency department, cathlab or intensive care unit via the groin vessels by a team comprising a board-certified cardiac surgeon and a trained perfusionist. Results: Thirty-day mortality was 32% (eight patients, six due to cerebral ischaemia). Support was necessary for six (1-12) days 14 patients could be weaned successfully. Interventional atrioseptostomy for additional ventricular unloading was necessary in two patients. In two other patients, the implantation of an assist device was necessary; another received heart transplantation. Patients who died had higher lactate levels (19 ± 3 mmol/l vs 12 ± 5 mmol/l, P = 0.001) and shorter support times (3 ± 1 days vs 8 ± 3 days, P < 0.001). Conclusions: Transportable ECLS systems provide sufficient circulatory support for patients in therapy-refractory shock and with early MOF. Despite the substantial mortality, ECLS implantation in selected patients by an experienced team offers additional support to CPR and conventional therapy. This concept has to be implemented in cardiac survival networks in the future.