Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

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. 
 

https://dgk.org/kongress_programme/jt2022/aP1189.html