Citation Information :
Delmas C, Conil J, Sztajnic S, Georges B, Biendel C, Dambrin C, Galinier M, Minville V, Fourcade O, Silva S, Marcheix B. Early Prediction of 3.month Survival of Patients in Refractory Cardiogenic Shock and Cardiac Arrest on Extracorporeal Life Support. Indian J Crit Care Med 2017; 21 (3):138-145.
Background: Extracorporeal life support (ECLS) holds the promise of significant improvement of the survival of patient in refractory cardiogenic shock (CS) or cardiac arrest (CA). Nevertheless, it remains to be shown to which extent these highly invasive supportive techniques could improve long-term patient\'s outcome. Methods: The outcomes of 82 adult ECLS patients at our institution between January 2012 and December 2013 were retrospectively analyzed.
Results: Patients were essentially men (64.7%) and are 54 years old. Preexisting ischemic (53.7%) and dilated cardiomyopathy (14.6%) were frequent. ECLS indications were shared equally between CA and CS. ECLS-specific adverse effects as hemorrhage (30%) and infection (50%) were frequent. ECLS was effective for 43 patients (54%) with recovery for 35 (43%), 5 (6%) heart transplant, and 3 (4%) left ventricular assist device support. Mortality rate at 30 days was 59.8%, but long-term and 3-month survival rates were similar of 31.7%. Initial plasma lactate levels >5.3 mmol/L and glomerular filtration rate <43 ml/min/1.73 m2 were significantly associated with 3-month mortality (risk ratio [RR] 2.58 [1.21–5.48]; P = 0.014; RR 2.10 [1.1–4]; P = 0.024, respectively). Long-term follow-up had shown patients paucisymptomatic (64% New York Heart Association 1–2) and autonomic (activities of daily living [ADL] score 6 ± 1.5).
Conclusion: In case of refractory CA or CS, lactates and renal function at ECLS initiation could serve as outcome predictor for risk stratification and ECLS indication.
Thiele H, Ohman EM, Desch S, Eitel I, de Waha S. Management of cardiogenic shock. Eur Heart J 2015;36:1223-30.
Goldberg RJ, Spencer FA, Gore JM, Lessard D, Yarzebski J. Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: A population-based perspective. Circulation 2009;119:1211-9.
Aissaoui N, Puymirat E, Tabone X, Charbonnier B, Schiele F, Lefèvre T, et al. Improved outcome of cardiogenic shock at the acute stage of myocardial infarction: A report from the USIK 1995, USIC 2000, and FAST-MI French nationwide registries. Eur Heart J 2012;33:2535-43.
Strömsöe A, Svensson L, Axelsson ÅB, Claesson A, Göransson KE, Nordberg P, et al. Improved outcome in Sweden after out-of-hospital cardiac arrest and possible association with improvements in every link in the chain of survival. Eur Heart J 2015;36:863-71.
Abraham WT, Adams KF, Fonarow GC, Costanzo MR, Berkowitz RL, LeJemtel TH, et al. In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications: An analysis from the acute decompensated heart failure national registry (ADHERE). J Am Coll Cardiol 2005;46:57-64.
Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J; 35:2541-619.
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr., et al. 2013 ACCF/AHA guideline for the management of heart failure: A report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 2013;128:e240-327.
McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012;33:1787-847.
Levy B, Bastien O, Karim B, Cariou A, Chouihed T, Combes A, et al. Experts' recommendations for the management of adult patients with cardiogenic shock. Ann Intensive Care 2015;5:52.
Extracorporeal Life Support Organization, editor. ELSO Guidelines for Cardiopulmonary Extracorporeal Life Support. Version 1. 3rd ed. Ann Arbor, MI, USA; 2013.
Riu B, Adnet F, Baud F, Cariou A, Carli P, Combes A, et al. Guidelines for indications for the use of extracorporeal life support in refractory cardiac arrest. French ministry of health. Ann Fr Anesth Reanim 2009;28:182-90.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985;13:818-29.
Cannesson M, Le Manach Y, Hofer CK, Goarin JP, Lehot JJ, Vallet B, et al. Assessing the diagnostic accuracy of pulse pressure variations for the prediction of fluid responsiveness: A “gray zone” approach. Anesthesiology 2011;115:231-41.
Combes A, Leprince P, Luyt CE, Bonnet N, Trouillet JL, Léger P, et al. Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Crit Care Med 2008;36:1404-11.
Mégarbane B, Deye N, Aout M, Malissin I, Résière D, Haouache H, et al. Usefulness of routine laboratory parameters in the decision to treat refractory cardiac arrest with extracorporeal life support. Resuscitation 2011;82:1154-61.
Rousse N, Juthier F, Pinçon C, Hysi I, Banfi C, Robin E, et al. ECMO as a bridge to decision: Recovery, VAD, or heart transplantation? Int J Cardiol 2015;187:620-7.
Pappalardo F, Pieri M, Arnaez Corada B, Ajello S, Melisurgo G, De Bonis M, et al. Timing and strategy for weaning from venoarterial ECMO are complex issues. J Cardiothorac Vasc Anesth 2015;29:906-11.
Demondion P, Fournel L, Golmard JL, Niculescu M, Pavie A, Leprince P. Predictors of 30-day mortality and outcome in cases of myocardial infarction with cardiogenic shock treated by extracorporeal life support. Eur J Cardiothorac Surg 2014;45:47-54.
Chung SY, Sheu JJ, Lin YJ, Sun CK, Chang LT, Chen YL, et al. Outcome of patients with profound cardiogenic shock after cardiopulmonary resuscitation and prompt extracorporeal membrane oxygenation support. A single-center observational study. Circ J 2012;76:1385-92.
Lin CY, Tsai FC, Tian YC, Jenq CC, Chen YC, Fang JT, et al. Evaluation of outcome scoring systems for patients on extracorporeal membrane oxygenation. Ann Thorac Surg 2007;84:1256-62.
Hsu PS, Chen JL, Hong GJ, Tsai YT, Lin CY, Lee CY, et al. Extracorporeal membrane oxygenation for refractory cardiogenic shock after cardiac surgery: Predictors of early mortality and outcome from 51 adult patients. Eur J Cardiothorac Surg 2010;37:328-33.
Guttendorf J, Boujoukos AJ, Ren D, Rosenzweig MQ, Hravnak M. Discharge outcome in adults treated with extracorporeal membrane oxygenation. Am J Crit Care 2014;23:365-77.
Burrell AJ, Pellegrino VA, Wolfe R, Wong WK, Cooper DJ, Kaye DM, et al. Long-term survival of adults with cardiogenic shock after venoarterial extracorporeal membrane oxygenation. J Crit Care 2015;30:949-56.
Chen JS, Ko WJ, Yu HY, Lai LP, Huang SC, Chi NH, et al. Analysis of the outcome for patients experiencing myocardial infarction and cardiopulmonary resuscitation refractory to conventional therapies necessitating extracorporeal life support rescue. Crit Care Med 2006;34:950-7.
Schmidt M, Burrell A, Roberts L, Bailey M, Sheldrake J, Rycus PT, et al. Predicting survival after ECMO for refractory cardiogenic shock: The survival after veno-arterial-ECMO (SAVE)-score. Eur Heart J 2015;36:2246-56.
Peigh G, Cavarocchi N, Keith SW, Hirose H. Simple new risk score model for adult cardiac extracorporeal membrane oxygenation: Simple cardiac ECMO score. J Surg Res 2015;198:273-9.
Mehra MR, Kobashigawa J, Starling R, Russell S, Uber PA, Parameshwar J, et al. Listing criteria for heart transplantation: International Society for Heart and Lung transplantation guidelines for the care of cardiac transplant candidates-2006. J Heart Lung Transplant 2006;25:1024-42.
Le Gall JR, Lemeshow S, Saulnier F. A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 1993;270:2957-63.
Shirakabe A, Nozaki A, Hata N, Kobayashi N, Shinada T, Tomita K, et al. Predictive score for survival after percutaneous cardiopulmonary support in cardiovascular disease patients- evaluation of pre-procedural information. Circ J 2013;77:2064-72.
Schmidt M, Zogheib E, Rozé H, Repesse X, Lebreton G, Luyt CE, et al. The PRESERVE mortality risk score and analysis of long-term outcomes after extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. Intensive Care Med 2013;39:1704-13.
Pappalardo F, Pieri M, Greco T, Patroniti N, Pesenti A, Arcadipane A, et al. Predicting mortality risk in patients undergoing venovenous ECMO for ARDS due to influenza A (H1N1) pneumonia: The ECMOnet score. Intensive Care Med 2013;39:275-81.
Park SB, Yang JH, Park TK, Cho YH, Sung K, Chung CR, et al. Developing a risk prediction model for survival to discharge in cardiac arrest patients who undergo extracorporeal membrane oxygenation. Int J Cardiol 2014;177:1031-5.
Aissaoui N, Luyt CE, Leprince P, Trouillet JL, Léger P, Pavie A, et al. Predictors of successful extracorporeal membrane oxygenation (ECMO) weaning after assistance for refractory cardiogenic shock. Intensive Care Med 2011;37:1738-45.
Chang WW, Tsai FC, Tsai TY, Chang CH, Jenq CC, Chang MY, et al. Predictors of mortality in patients successfully weaned from extracorporeal membrane oxygenation. PLoS One 2012;7:e42687.
Platts DG, Sedgwick JF, Burstow DJ, Mullany DV, Fraser JF. The role of echocardiography in the management of patients supported by extracorporeal membrane oxygenation. J Am Soc Echocardiogr 2012;25:131-41.
Cavarocchi NC, Pitcher HT, Yang Q, Karbowski P, Miessau J, Hastings HM, et al. Weaning of extracorporeal membrane oxygenation using continuous hemodynamic transesophageal echocardiography. J Thorac Cardiovasc Surg 2013;146:1474-9.
Distelmaier K, Niessner A, Haider D, Lang IM, Heinz G, Maurer G, et al. Long-term mortality in patients with chronic obstructive pulmonary disease following extracorporeal membrane oxygenation for cardiac assist after cardiovascular surgery. Intensive Care Med 2013;39:1444-51.