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The Journal of Cardiovascular Surgery 2019 February;60(1):128-35

DOI: 10.23736/S0021-9509.18.10283-7


lingua: Inglese

Further options and survival results after failure following extracorporeal life support implantation

Leopold RUPPRECHT, Daniele CAMBONI, Alois PHILIPP, Dirk LUNZ, Thomas MÜLLER, Christof SCHMID , Andreas KEYSER

Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany

BACKGROUND: A retrospective study was designed to analyze the outcome of patients with extracorporeal life support (ECLS) who needed a consecutive cardiac or pulmonary support system.
METHODS: From 2006 to 2016, 93 out of 587 patients with their age ranging from 2.4 to 77.3 years required an exchange of an ECLS by another mechanical support system. Sixty-one patients were inhospital cases, 39 patients were referred with ECLS from other institutions by ambulance car (N.=15) or helicopter (N.=24). Sixty-five patients came from internal medicine wards, of which 38 patients had CPR, whereas 24 patients suffered postcardiotomy failure with CPR in 11 cases. Ten patients were referred from other hospitals for failure to wean from ECLS.
RESULTS: Leading symptoms were continuing cardiac failure in 43 patients (46%) and ongoing respiratory failure after cardiac recovery in 50 patients (54%). Patients with cardiac failure underwent implantation of a ventricular assist device (N.=36) or remained on long-term ECLS (N.=7) until a donor organ for heart transplantation was available (mean waiting time 43 days). Respiratory failure was treated by veno-venous ECMO (N.=34) or vav-ECMO (N.=16). Overall inhouse survival was 50.5% (N.=47). Only 22.6% of patients (N.=21) died during ongoing support. In contrast, 26.9% of patients (N.=25) deceased 35+/-51 days after weaning from vv- or vav-ECMO. Major reasons of death were multi-organ failure in 16 patients, cerebral hypoxia in 12 patients, sepsis in 10 patients, and intractable ow output in 5 patients.
CONCLUSIONS: Despite a switch from ECLS to another mechanical support system, survival remains limited as irreversible multi-organ failure and sepsis still jeopardize the patients’ life.

KEY WORDS: Heart failure - Extracorporeal membrane oxygenation - Resuscitation - Heart-assist devices

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