Emergency feasibility in medical intensive care unit of extracorporeal life support for refractory cardiac arrest

To report the feasibility, complications, and outcomes of emergency extracorporeal life support (ECLS) in refractory cardiac arrests in medical intensive care unit (ICU). Prospective cohort study in the medical ICU in a university hospital in collaboration with the cardiosurgical team of a neighbori...

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Bibliographic Details
Published in:Intensive care medicine 2007-05, Vol.33 (5), p.758-764
Main Authors: MEGARBANE, Bruno, LEPRINCE, Pascal, DEYE, Nicolas, RESIERE, Dabor, GUERRIER, Gilles, RETTAB, Samia, THEODORE, Jonathan, KARYO, Souheil, GANDJBAKHCH, Iradj, BAUD, Frédéric J
Format: Article
Language:English
Subjects:
Adult
Advanced Cardiac Life Support - methods
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
APACHE
Biological and medical sciences
Cardiac arrest
Cardiology and cardiovascular system
Cardiopulmonary bypass
Care and treatment
Clinical death. Palliative care. Organ gift and preservation
Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care
Emerging diseases
Extracorporeal Membrane Oxygenation
Feasibility Studies
Female
Health aspects
Heart Arrest - etiology
Heart Arrest - mortality
Heart Arrest - therapy
Human health and pathology
Humans
Infectious diseases
Intensive care medicine
Intensive care units
Intensive Care Units - statistics & numerical data
Life Sciences
Male
Medical sciences
Middle Aged
Poisoning - complications
Pulmonology and respiratory tract
Survival Analysis
Toxicology
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Description
Summary:To report the feasibility, complications, and outcomes of emergency extracorporeal life support (ECLS) in refractory cardiac arrests in medical intensive care unit (ICU). Prospective cohort study in the medical ICU in a university hospital in collaboration with the cardiosurgical team of a neighboring hospital. Seventeen patients (poisonings: 12/17) admitted over a 2-year period for cardiac arrest unresponsive to cardiopulmonary resuscitation (CPR) and advanced cardiac life support, without return of spontaneous circulation. ECLS femoral implantation under continuous cardiac massage, using a centrifugal pump connected to a hollow-fiber membrane oxygenator. Stable ECLS was achieved in 14 of 17 patients. Early complications included massive transfusions (n=8) and the need for surgical revision at the cannulation site for bleeding (n=1). Four patients (24%) survived at medical ICU discharge. Deaths resulted from multiorgan failure (n=8), thoracic bleeding(n=2), severe sepsis (n=2), and brain death (n=1). Massive hemorrhagic pulmonary edema during CPR (n=5) and major capillary leak syndrome (n=6) were observed. Three cardiotoxic-poisoned patients (18%, CPR duration: 30, 100, and 180 min) were alive at 1-year follow-up without sequelae. Two of these patients survived despite elevated plasma lactate concentrations before cannulation (39.0 and 20.0 mmol/l). ECLS was associated with a significantly lower ICU mortality rate than that expected from the Simplified Acute Physiology Score II (91.9%) and lower than the maximum Sequential Organ Failure Assessment score (>90%). Emergency ECLS is feasible in medical ICU and should be considered as a resuscitative tool for selected patients suffering from refractory cardiac arrest.
ISSN:0342-4642
1432-1238
DOI:10.1007/s00134-007-0568-4