Back from irreversibility: extracorporeal life support for prolonged cardiac arrest.
BACKGROUND
The survival of patients after prolonged cardiac arrest is still inadequate. Extracorporeal life support (ECLS) represents an alternative therapeutic method for patients who do not respond to conventional cardiopulmonary cerebral resuscitation. This technology is used to support the circulation of a patient with severe cardiac failure.


METHODS
Between June 1997 and January 2003, 40 ECLS procedures were performed in patients who presented with refractory cardiac arrest. During external cardiac massage, the patient was connected to an extracorporeal circuit by the insertion of an arterial and venous cannula through the femoral vessels. The extracorporeal circuit included a centrifugal pump and an oxygenator. Mean age was 42 +/- 15 years; the average time of external cardiac massage was 105 +/- 44 minutes.


RESULTS
Once the circulation was restored, 22 patients were disconnected from the extracorporeal circulation because of brain death or multiorgan failure; after 24 hours, among the 18 survivors, 6 were weaned off the pump, 9 were bridged to a ventricular assist device, and 2 patients were directly bridged to cardiac transplantation. Eight patients are alive and without any sequelae at 18 month's follow-up.


CONCLUSIONS
In prolonged cardiac arrest with failing conventional measures, rescue by extracorporeal support provides an ultimate therapeutic option with a good outcome in survivors. Our results encourage the wider application of ECLS for refractory cardiocirculatory arrest in selected patients. The high rate of neurologic death needs further improvements in the early phase of resuscitation maneuvers.
Massetti
Massimo
M
Department of Thoracic and Cardiovascular Surgery, University Hospital, Caen France. massetti-m@chu-caen.fr
Tasle
Marine
M
Le Page
Olivier
O
Deredec
Ronan
R
Babatasi
Gerard
G
Buklas
Dimitrios
D
Thuaudet
Sylvain
S
Charbonneau
Pierre
P
Hamon
Martial
M
Grollier
Gilles
G
Gerard
Jean Louis
JL
Khayat
André
A
D000328:Adult; D022561:Advanced Cardiac Life Support / Q000379:methods*; D001926:Brain Death; D002404:Catheterization; D003422:Critical Care / Q000379:methods; D005066:Euthanasia, Passive; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006336:Heart Massage; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D018579:Patient Selection; D016879:Salvage Therapy; D015996:Survival Rate; D016896:Treatment Outcome