, Volume 33, Issue 5, pp 758-764
Date: 07 Mar 2007

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

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

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.

This article is discussed in the editorial available at: http://dx.doi.org/10.1007/s00134-006-0569-3