Abstract 16062: Extracorporeal Life Support in Cardiogenic Shock: Impact of Microinvasive Approach on Outcome
Introduction: Extracorporeal Life Support (ECLS) is a well-established treatment of Refractory Cardiogenic Shock (RCS). A correct timing is the key to the prevention of MultiOrgan Dysfunction Syndrome (MODS). The ideal device should be rapidly and easily deployable, especially in emergent/urgent scenarios.
Hypothesis: we evaluate the non-inferiority of percutaneous approach of ECLS implantation compared to conventional surgical approach.
Methods: Between January 2009 and December 2015, 506 patients were treated with ECLS in our centre; we selected 126 patients treated for primary RCS (acute onset or exacerbation of chronic heart failure). 70 cases (56%) were implanted through percutaneous approach (PA); 56 cases (44%) were implanted with surgical approach (SA). Among the patients treated with PA, 65 implantation (93%) were performed bedside, 36 (51%) on awake patients and 33 (47%) under cardio-pulmonary resuscitation.
Results: Regarding the etiology of RCS, in the PA group, 49 patients were acute and 21 were chronic, whereas in the SA group 20 patients were acute and 36 were chronic (p<0.001). Average duration of the support was 7 ± 8 days in the PA group and 10 ± 9 days in the SA group (p=0.057), while mean rate support of the maximal theoretic flow was 68±21% and 63±15% (p=0.155), respectively. 13 patients of PA group and 8 patients of SA group died during ECLS support; 30-days survival was 73% and 75% (p=0.787) and discharge rate from hospital was 56% and 59% (p=0.591), respectively. In the PA group, limb ischemia occurred in 19 cases (27%), of whom 5 treated with implantation of accessorial femoral cannula of reperfusion and 14 switched to SA; no leg amputation was needed. Logistic regression for 30-days mortality and recovery of ventricular function showed no significant effect of PA versus SA.
Conclusions: RCS is a life-threatening condition that often requires urgent or emergent care, where the ECLS can be considered the ideal “bridge to life” treatment. Percutaneous technique of ECLS implantation represents a microinvasive and quickly available approach. Moreover, PA has proved to be non-inferior respect SA, providing full hemodynamic support and bearing acceptable complication rate.
- Extracorporeal circulation
- Shock, cardiogenic
- Artificial heart/Cardiac support devices
- Cardiopulmonary resuscitation
Author Disclosures: V. Tarzia: None. L. Bagozzi: None. G. Bortolussi: None. R. Bianco: None. J. Bejko: None. F. Zanella: None. T. Bottio: None. G. Gerosa: None.
- © 2016 by American Heart Association, Inc.