Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5 |
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Central extracorporeal circulatory life support (c-ECLS) in patients with critical cardiogenic shock | ||
L. Schmack1, B. Schmack2, M. Papathanasiou1, T. Müller1, M. Riebisch1, A. Weymann2, N. Pizanis3, A. Ruhparwar2, T. Rassaf1, P. Lüdike1 | ||
1Klinik für Kardiologie und Angiologie, Universitätsklinikum Essen, Essen; 2Klinik für Thorax- und Kardiovaskuläre Chirurgie, Universitätsklinikum Essen, Essen; 3Thorakale Transplantation, Universitätsklinikum Essen, Essen; | ||
Background:
Percutaneously placement of veno-arterial extracorporeal circulatory life support (p-ECLS) by peripheral cannulation of femoral artery and vein are the widely preferred approach in critical cardiogenic shock (CS), despite prospective data are lacking. In-hospital mortality of patients treated with p-ECLS still reaches up to 60% and vascular access complications remain a shortcoming of this therapy. Central cannulation by different surgical approaches (c-ECLS) has emerged as an alternative, albeit more invasive, option in selected patients. To date, neither systematic approaches exist that allow for definitions of inclusion criteria for c-ECLS, nor standardized technical recommendations for the preferred vascular access strategy. We here aim to define patient characteristics and inclusion criteria that identify high-risk patients with critical CS that might benefit from this last resort therapy. Methods:
This is a single-center, retrospective, case-control study, including all patients fulfilling criteria of critical CS at the West German Heart and Vascular center Essen between 2015 and 2020 who underwent c-ECLS (n=58), excluding post cardiotomy patients. Results:
15 patients received c-ECLS (25.9%) as first-line strategy, including five patients with surgical preparation and cannulation of the subclavian artery (8.62%). Switch to c-ECLS as second-line strategy due to p-ECLS failure was applied in 43 patients (74.1%). Average time to switch was 2 days. Main complications leading to second-line strategy were limb ischemia after femoral cannulation (32.8%) and ongoing haemodynamic instability despite p-ECLS (27.6%). 30-days mortality of secondary c-ECLS candidates was 69.8% and mortality at 3-and 6-months was 79.1% respectively. In comparison, primary c-ECLS cohort revealed a 30-days mortality of 53.3 % that was constant during follow-up. Average age at time of death was 56 years, while age of survivors was 49 years, respectively. Conclusion:
Surgical cannulation for ECLS in critical CS is a feasible therapy for selected patients with insufficient hemodynamic stabilization under p-ECLS or severe vascular complications. Especially younger patients with vascular complications or ongoing haemodynamic instability might benefit from early switch to c-ECLS. |
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https://dgk.org/kongress_programme/jt2022/aP1189.html |