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28.09.2016 | Original | Ausgabe 12/2016

Intensive Care Medicine 12/2016

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

Zeitschrift:
Intensive Care Medicine > Ausgabe 12/2016
Autoren:
Marc Pineton de Chambrun, Nicolas Bréchot, Guillaume Lebreton, Matthieu Schmidt, Guillaume Hekimian, Pierre Demondion, Jean-Louis Trouillet, Pascal Leprince, Jean Chastre, Alain Combes, Charles-Edouard Luyt
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s00134-016-4541-y) contains supplementary material, which is available to authorized users.
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.

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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