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Venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock post-cardiac arrest

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A Correction to this article was published on 17 October 2017

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Abstract

Purpose

To describe the characteristics, outcomes, and risk factors associated with poor outcome of venoarterial extracorporeal membrane oxygenation (VA-ECMO)-treated patients with refractory shock post-cardiac arrest.

Methods

We retrospectively analyzed data collected prospectively (March 2007–January 2015) in a 26-bed tertiary hospital intensive care unit. All patients implanted with VA-ECMO for refractory cardiogenic shock after successful resuscitation from cardiac arrest were included. Refractory cardiac arrest patients, given VA-ECMO under cardiopulmonary resuscitation, were excluded.

Results

Ninety-four patients received VA-ECMO for refractory shock post-cardiac arrest. Their hospital and 12-month survival rates were 28 and 27 %, respectively. All 1-year survivors were cerebral performance category 1. Multivariable analysis retained INR >2.4 (OR 4.9; 95 % CI 1.4–17.2), admission SOFA score >14 (OR 5.3; 95 % CI 1.7–16.5), and shockable rhythm (OR 0.3; 95 % CI 0.1–0.9) as independent predictors of hospital mortality, but not SAPS II, out-of-hospital cardiac arrest score, or other cardiac arrest variables. Only 10 % of patients with an admission SOFA score >14 survived, whereas 50 % of those with scores ≤14 were alive at 1 year. Restricting the analysis to the 67 patients with out-of-hospital cardiac arrest of coronary cause yielded similar results.

Conclusion

Among 94 patients implanted with VA-ECMO for refractory cardiogenic shock post-cardiac arrest resuscitation, the 24 (27 %) 1-year survivors had good neurological outcomes, but survival was significantly better for patients with admission SOFA scores <14, shockable rhythm, and INR ≤2.4. VA-ECMO might be considered a rescue therapy for patients with refractory cardiogenic shock post-cardiac arrest resuscitation.

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Change history

  • 17 October 2017

    The second element of the first author’s name was misinterpreted as a given name, whereas in fact it is part of his family name. The correct version of his name for indexing purposes is therefore M. Pineton de Chambrun (not M. P. de Chambrun).

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Author information

Authors and Affiliations

  1. Service de Réanimation Médicale, iCAN, Groupe Hospitalier La Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, 47–83, Boulevard de l’Hôpital, 75651, Paris Cedex 13, France

    Marc Pineton de Chambrun, Nicolas Bréchot, Matthieu Schmidt, Guillaume Hekimian, Jean-Louis Trouillet, Jean Chastre, Alain Combes & Charles-Edouard Luyt

  2. Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France

    Marc Pineton de Chambrun, Nicolas Bréchot, Matthieu Schmidt, Guillaume Hekimian, Jean-Louis Trouillet, Jean Chastre, Alain Combes & Charles-Edouard Luyt

  3. Service de Chirurgie Thoracique et Cardiovasculaire, Groupe Hospitalier La Pitié–Salpêtrière, Assistance Publique Hôpitaux de Paris, Paris, France

    Guillaume Lebreton, Pierre Demondion & Pascal Leprince

Authors
  1. Marc Pineton de Chambrun
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  2. Nicolas Bréchot
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  3. Guillaume Lebreton
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  4. Matthieu Schmidt
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  8. Pascal Leprince
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  11. Charles-Edouard Luyt
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Corresponding author

Correspondence to Charles-Edouard Luyt.

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Conflicts of interest

Dr. Combes is the primary investigator of the EOLIA trial (NCT01470703), a randomized trial of VV-ECMO, supported in part by MAQUET. Drs. Bréchot, Lebreton, and Combes have received honoraria for lectures from MAQUET. The other authors declare that they have no conflicts of interest related to the purpose of this manuscript.

Additional information

Take-home message: Refractory cardiogenic shock is one of the leading causes of early death after successful cardiac arrest resuscitation. In this setting, venoarterial extracorporeal membrane oxygenation is associated with 27 % 1-year survival. Patients with SOFA scores >14 have poorer outcomes than the others (respective survival 10 vs. 50 %), raising the question of futility in these patients.

A correction to this article is available online at https://doi.org/10.1007/s00134-017-4963-1.

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de Chambrun, M.P., Bréchot, N., Lebreton, G. et al. Venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock post-cardiac arrest. Intensive Care Med 42, 1999–2007 (2016). https://doi.org/10.1007/s00134-016-4541-y

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