Emergency feasibility in medical intensive care unit of extracorporeal life support for refractory cardiac arrest.
OBJECTIVE
To report the feasibility, complications, and outcomes of emergency extracorporeal life support (ECLS) in refractory cardiac arrests in medical intensive care unit (ICU).


METHODS
Prospective cohort study in the medical ICU in a university hospital in collaboration with the cardiosurgical team of a neighboring hospital.


METHODS
Seventeen patients (poisonings: 12/17) admitted over a 2-year period for cardiac arrest unresponsive to cardiopulmonary resuscitation (CPR) and advanced cardiac life support, without return of spontaneous circulation.


METHODS
ECLS femoral implantation under continuous cardiac massage, using a centrifugal pump connected to a hollow-fiber membrane oxygenator.


RESULTS
Stable ECLS was achieved in 14 of 17 patients. Early complications included massive transfusions (n=8) and the need for surgical revision at the cannulation site for bleeding (n=1). Four patients (24%) survived at medical ICU discharge. Deaths resulted from multiorgan failure (n=8), thoracic bleeding(n=2), severe sepsis (n=2), and brain death (n=1). Massive hemorrhagic pulmonary edema during CPR (n=5) and major capillary leak syndrome (n=6) were observed. Three cardiotoxic-poisoned patients (18%, CPR duration: 30, 100, and 180 min) were alive at 1-year follow-up without sequelae. Two of these patients survived despite elevated plasma lactate concentrations before cannulation (39.0 and 20.0 mmol/l). ECLS was associated with a significantly lower ICU mortality rate than that expected from the Simplified Acute Physiology Score II (91.9%) and lower than the maximum Sequential Organ Failure Assessment score (>90%).


CONCLUSIONS
Emergency ECLS is feasible in medical ICU and should be considered as a resuscitative tool for selected patients suffering from refractory cardiac arrest.
Mégarbane
Bruno
B
Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Medical and Toxicological Critical Care Department, University of Paris 7, 2 rue Ambroise Paré, 75010, Paris, France.
Leprince
Pascal
P
Pitié Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris, Department of Cardiothoracic Surgery, University of Paris 6, 75013, Paris, France.
Deye
Nicolas
N
Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Medical and Toxicological Critical Care Department, University of Paris 7, 2 rue Ambroise Paré, 75010, Paris, France.
Résière
Dabor
D
Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Medical and Toxicological Critical Care Department, University of Paris 7, 2 rue Ambroise Paré, 75010, Paris, France.
Guerrier
Gilles
G
Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Medical and Toxicological Critical Care Department, University of Paris 7, 2 rue Ambroise Paré, 75010, Paris, France.
Rettab
Samia
S
Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Medical and Toxicological Critical Care Department, University of Paris 7, 2 rue Ambroise Paré, 75010, Paris, France.
Théodore
Jonathan
J
Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Medical and Toxicological Critical Care Department, University of Paris 7, 2 rue Ambroise Paré, 75010, Paris, France.
Karyo
Souheil
S
Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Medical and Toxicological Critical Care Department, University of Paris 7, 2 rue Ambroise Paré, 75010, Paris, France.
Gandjbakhch
Iradj
I
Pitié Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris, Department of Cardiothoracic Surgery, University of Paris 6, 75013, Paris, France.
Baud
Frédéric J
FJ
Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Medical and Toxicological Critical Care Department, University of Paris 7, 2 rue Ambroise Paré, 75010, Paris, France. baud.frederic@wanadoo.fr.
D018806:APACHE; D000328:Adult; D022561:Advanced Cardiac Life Support / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation; D005240:Feasibility Studies; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011041:Poisoning / Q000150:complications; D016019:Survival Analysis