Original article
Adult cardiac
Extracorporeal Life Support for Cardiogenic Shock or Cardiac Arrest Due to Acute Coronary Syndrome

https://doi.org/10.1016/j.athoracsur.2012.01.032Get rights and content

Background

Few data are available on the clinical outcome of patients with acute coronary syndrome (ACS) complicated by refractory cardiogenic shock or cardiac arrest who receive percutaneous extracorporeal life support (ECLS). We investigated the in-hospital outcome and predictors of mortality in these patients.

Methods

The investigation was a single-center, retrospective cohort study of 98 ACS patients who received ECLS to reverse hemodynamic collapse refractory to conventional treatment.

Results

Circulatory status before ECLS introduction was cardiogenic shock in 34, ventricular fibrillation or pulseless ventricular tachycardia in 23, and asystole or pulseless electrical activity in 41. Ninety-four patients (95.9%) underwent emergency revascularization, including 92 who received percutaneous coronary intervention and 2 who received isolated coronary artery bypass grafting. Successful angioplasty was achieved in 65 of 92 patients (70.7%). Fifty-four patients (55.1%) were weaned from ECLS, and ECLS-related complications occurred in 35 (35.7%). All-cause in-hospital mortality rate was 67.3%, and the survival rate to hospital discharge was 32.7%. Multivariate analysis revealed that independent predictors of in-hospital mortality were unsuccessful angioplasty, asystole or pulseless electrical activity before ECLS introduction, and ECLS-related complications.

Conclusions

Despite hemodynamic support with ECLS, patients with ACS complicated by cardiogenic shock or cardiac arrest refractory to conventional treatment had high mortality. However, the higher than 30% in-hospital survival rate in this extremely critical population indicates that ECLS might improve outcomes in ACS by saving the lives of patients in this specialized category. Unsuccessful angioplasty, asystole or pulseless electrical activity before ECLS introduction, and ECLS-related complications were predictors of in-hospital mortality.

Section snippets

Patients and Methods

The Institutional Review Board of the Sakurakai Takahashi Hospital approved this study and informed consent was waived because the patients had life-threatening emergencies. Between January 2000 and December 2010, a total of 256 patients received ECLS at our hospital. From this cohort, patients who presented with ACS were included in the study. The following conditions excluded patients from the analysis: (1) ECLS was initiated more than 48 hours after admission; and (2) the reason for

Patient Characteristics

During the period selected for study, 98 patients were eligible for inclusion. Baseline characteristics are shown in Table 1. Mean age was 72 ± 12 years. On hospital arrival, 28 patients (28.6%) had cardiogenic shock, and 36 (36.7%) had cardiac arrest. Emergency PCI was performed in 92 patients and isolated emergency CABG in 2. The remaining 4 patients did not undergo revascularization because 1 had AMI caused by refractory coronary spasm, 1 died of left ventricular free wall rupture before

Comment

This retrospective analysis of data from 98 patients with ACS complicated by cardiogenic shock or cardiac arrest refractory to conventional therapy who received ECLS support and mostly underwent early revascularization revealed high in-hospital mortality; however, it also showed a higher than 30% in-hospital survival in an extremely critical population of patients. Additionally, the data show that unsuccessful angioplasty, asystole or PEA before ECLS introduction, and ECLS-related complications

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