Long-Term prognosis after extracorporeal life support in refractory cardiogenic shock: Results from a real-world cohort

Abstract

Aims: The current study presents data from a real-world cohort of patients with refractory cardiogenic shock (CS) undergoing extracorporeal life support (ECLS) with the aims of reporting clinical experience, objectifying complications as well as survival, and identifying predictors of mortality. Methods and results: Eighty-Three patients with refractory CS underwent percutaneous ECLS implantation performed by interventional cardiologists. Follow-up was performed at hospital discharge as well as at 18 months (IQR 15-36). Good clinical outcome was defined as survival with a Cerebral Performance Category (CPC) of 1-2. Median age was 61 years (IQR 50-72) and cardiopulmonary resuscitation prior to ECLS implantation was performed in 46 patients (55.4%). Aetiologies of CS were acute myocardial infarction (63.9%), acute deterioration of ischaemic cardiomyopathy (6.0%) or non-ischaemic acute heart failure (16.9%), valvular heart disease (9.6%), and interventional complications (3.6%). Although initial ECLS weaning was successful in 47 patients (56.6%), in-hospital mortality was 68.7%. Of all 83 patients initially undergoing ECLS implantation, only 15 patients (18.1%) were alive at follow-up, 13 (15.7%) with a CPC of 1-2. Age was identified as an independent predictor of mortality (p=0.04). Conclusions: Despite ECLS support, the long-Term prognosis of patients with CS refractory to standard treatment remains poor.