Abstract 20398: Cardiac Recovery after Extra-institutional Salvage Circulatory support Using Extra Corporeal Membrane Oxygenation: the Cardiac RESCUE program.
Background: Patients with refractory cardiogenic shock (RCS) benefit from temporary circulatory support with Extra Corporeal Membrane Oxygenation (ECMO). For patients hospitalized in centres with non cardiac surgery department, we set the cardiac Recovery after Extra-institutional Salvage Circulatory support Using ECMO (RESCUE) program. To establish its efficacy and refine its indication, we analysed in-hospital mortality and prognostic factor of this innovative program.
Methods and results: The program is based on a mobile medical team, carrying and initiating peripheral veno-arterial ECMO in hospitals around Paris and its region. From January 2005 to December 2009, 87 patients (sex ratio 2/1, mean age 46.1 ± 14.8 yrs) with RCS hospitalized in 36 institutions in Paris area have been supported by an ECMO in the frame of the cardiac RESCUE program. Main diagnosis was acute myocardial infarction (40, 46%), dilated cardiomyopathy (14, 16%), and no-ischemic non-dilated acute cardiopathy (33, 38%). 13 patients were implanted during CPR. After ECMO initiation, 71 patients (81%) have been transferred under ECMO, 32 (37%) were alive at hospital discharge, and 28(32%) were long-term survivors after a median follow up of 26 months. Using multivariate analyse, in-hospital mortality prognostic factors included cardiac arrest (HR=2.09, p=0.006), oligoanuria (RR=2.48, p=0.006), inotrope score > 20 (HR=1.91, p=0.017), and dilated cardiomyopathy (HR=2.30, p=0.035).
Conclusions: Cardiac recovery after extra institutional salvage circulatory support using ECMO is achieved in one third of patients with RCS who otherwise would die without being referred.
- © 2010 by American Heart Association, Inc.