Intensive Care Medicine

, Volume 33, Issue 5, pp 758–764

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

  • Bruno Mégarbane
  • Pascal Leprince
  • Nicolas Deye
  • Dabor Résière
  • Gilles Guerrier
  • Samia Rettab
  • Jonathan Théodore
  • Souheil Karyo
  • Iradj Gandjbakhch
  • Frédéric J. Baud
Original

DOI: 10.1007/s00134-007-0568-4

Cite this article as:
Mégarbane, B., Leprince, P., Deye, N. et al. Intensive Care Med (2007) 33: 758. doi:10.1007/s00134-007-0568-4

Abstract

Objective

To report the feasibility, complications, and outcomes of emergency extracorporeal life support (ECLS) in refractory cardiac arrests in medical intensive care unit (ICU).

Design and setting

Prospective cohort study in the medical ICU in a university hospital in collaboration with the cardiosurgical team of a neighboring hospital.

Patients

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.

Interventions

ECLS femoral implantation under continuous cardiac massage, using a centrifugal pump connected to a hollow-fiber membrane oxygenator.

Measurements and results

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%).

Conclusions

Emergency ECLS is feasible in medical ICU and should be considered as a resuscitative tool for selected patients suffering from refractory cardiac arrest.

Keywords

Cardiac arrest Cardiopulmonary resuscitation Extracorporeal life support Feasibility Poisoning Medical intensive care unit 

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Bruno Mégarbane
    • 1
  • Pascal Leprince
    • 2
  • Nicolas Deye
    • 1
  • Dabor Résière
    • 1
  • Gilles Guerrier
    • 1
  • Samia Rettab
    • 1
  • Jonathan Théodore
    • 1
  • Souheil Karyo
    • 1
  • Iradj Gandjbakhch
    • 2
  • Frédéric J. Baud
    • 1
  1. 1.Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Medical and Toxicological Critical Care DepartmentUniversity of Paris 7ParisFrance
  2. 2.Pitié Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris, Department of Cardiothoracic SurgeryUniversity of Paris 6ParisFrance

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