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Analysis of clinical trends in a program of emergent ECLS for cardiovascular collapse
D C Willms1, P J Atkins, W P Dembitsky
1Department of Critical Care, Sharp Memorial Hospital, San Diego, California, USA.
Insights
Extracorporeal life support (ECLS) can be initiated by intensive care unit nurses for emergent resuscitation. Survival rates were 24.7% long-term, with surgically remediable conditions improving outcomes.
Area of Science:
- Cardiovascular Medicine
- Critical Care Medicine
- Medical Technology
Background:
- Emergent resuscitation often requires advanced life support.
- Extracorporeal life support (ECLS) offers a bridge to recovery or definitive treatment.
- Standardized protocols for ECLS initiation and management are crucial.
Purpose of the Study:
- To analyze survival rates and influencing factors in patients undergoing emergent extracorporeal life support (ECLS).
- To evaluate the impact of evolving technology and accumulated experience on ECLS outcomes.
- To assess the role of ECLS in facilitating subsequent therapeutic surgical interventions.
Main Methods:
- Retrospective review of clinical data from 81 patients resuscitated with a portable ECLS system (June 1986-October 1995).
- Venoarterial perfusion utilized centrifugal pumps and hollow fiber oxygenators.
- ECLS setup, priming, and perfusion initiation performed by trained ICU nurses.
Main Results:
- Overall survival > 24 hours was 43.2% (35/81), with long-term survival (> 30 days) at 24.7% (20/81).
- ECLS enabled therapeutic surgery in 45 patients; those with surgically remediable conditions had higher survival rates.
- Prolonged cardiopulmonary resuscitation (> 30 minutes) prior to ECLS initiation was associated with decreased survival.
Conclusions:
- Portable ECLS systems can be effectively managed by ICU nurses in various hospital settings.
- Patient survival on ECLS is influenced by the underlying condition, particularly the presence of surgically remediable problems.
- Timely initiation of ECLS is critical, as prolonged resuscitation efforts before its application negatively impact survival.
Abstract:
Between June 1986 and October 1995, 81 patients were emergently resuscitated with a portable extracorporeal life support (ECLS) system. Venoarterial perfusion was achieved using a centrifugal pump (BioMedicus; Medtronic, Anaheim, CA) and a hollow fiber oxygenator (BARD in 56 patients; Medtronic heparin-bonded MAXIMA, [MAXIMA, Medtronic, Minneapolis, MN] in the last 25 patients. The ECLS system was used at various locations in the hospital with the setup, priming, and initiation of perfusion done by ECLS trained intensive care unit nurses. Clinical data in these patients were reviewed to analyze variables influencing survival and trends that develop as the authors' experience accumulated and the technology evolved. The indication for ECLS was cardiac arrest in 68 patients and refractory cardiogenic shock in 13 patients. Thirty-five patients (43.2%) survived > 24 hrs after termination of ECLS, whereas 20 patients (24.7%) are long-term survivors (> 30 days). The ECLS system permitted an additional therapeutic surgical intervention in 45 cases. Patients who had a surgically remediable problem were more likely to survive. Prolongation of cardiopulmonary resuscitation beyond 30 mins before initiation of ECLS correlated with a decreased likelihood of survival.