title: Emergency feasibility in medical intensive care unit of extracorporeal life support for refractory cardiac arrest.
abstract: 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.
authors.affiliation: Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Medical and Toxicological Critical Care Department, University of Paris 7, 2 rue Ambroise Paré, 75010, Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Mégarbane
authors.affiliation: Pitié Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris, Department of Cardiothoracic Surgery, University of Paris 6, 75013, Paris, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.affiliation: Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Medical and Toxicological Critical Care Department, University of Paris 7, 2 rue Ambroise Paré, 75010, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Deye
authors.affiliation: Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Medical and Toxicological Critical Care Department, University of Paris 7, 2 rue Ambroise Paré, 75010, Paris, France.
authors.forename: Dabor
authors.initials: D
authors.lastname: Résière
authors.affiliation: Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Medical and Toxicological Critical Care Department, University of Paris 7, 2 rue Ambroise Paré, 75010, Paris, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Guerrier
authors.affiliation: Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Medical and Toxicological Critical Care Department, University of Paris 7, 2 rue Ambroise Paré, 75010, Paris, France.
authors.forename: Samia
authors.initials: S
authors.lastname: Rettab
authors.affiliation: Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Medical and Toxicological Critical Care Department, University of Paris 7, 2 rue Ambroise Paré, 75010, Paris, France.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Théodore
authors.affiliation: Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Medical and Toxicological Critical Care Department, University of Paris 7, 2 rue Ambroise Paré, 75010, Paris, France.
authors.forename: Souheil
authors.initials: S
authors.lastname: Karyo
authors.affiliation: Pitié Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris, Department of Cardiothoracic Surgery, University of Paris 6, 75013, Paris, France.
authors.forename: Iradj
authors.initials: I
authors.lastname: Gandjbakhch
authors.affiliation: 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.
authors.forename: Frédéric J
authors.initials: FJ
authors.lastname: Baud
mesh_terms: 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