ExtraCorporeal life support for Cardiac ARrest in patients with post cardiac arrest syndrome: The ECCAR study
Adrien Bouglé1, Arthur Le Gall1, Florence Dumas2
1Medical Intensive Care Unit, Cochin University Hospital, AP-HP, 75014 Paris, France; Paris V University, 75006 Paris, France.
Background:
Post cardiac arrest shock (PCAS) occurring after resuscitated cardiac arrest (CA) is a main cause of early death. Extracorporeal life support (ECLS) could be useful pending recovery from myocardial failure.
Aim:
To describe our PCAS population, and the factors associated with initiation of ECLS.
Methods:
This analysis included 921 patients admitted to two intensive care units between 2005 and 2014 for CA and PCAS; 43 of these patients had ECLS initiated. Neurological and ECLS-related outcomes were gathered retrospectively.
Results:
The 43 patients treated with ECLS were predominantly (70%) young males with evidence of myocardial infarction on coronary angiography. ECLS was initiated in patients with severe cardiovascular dysfunction (median left ventricular ejection fraction 15% [interquartile range 10-25%]), a median of 9hours [interquartile range 6-16hours] after the CA. At 1 year, eight patients (19%) had survived without neurological disability. Blood lactate and coronary aetiology were associated with neurological outcomes. Logistic regression conducted using 878 controls with PCAS identified age>62 years, location of CA, use of a high dose of adrenaline (>3mg) and blood lactate and serum creatinine concentrations (>5mmol/L and>109μmol/L, respectively) as risk factors for initiation of ECLS.
Conclusions:
ECLS, as a salvage therapy for PCAS, could be an acceptable alternative for highly-selected patients.
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