title: Resuscitation of non-postcardiotomy cardiogenic shock or cardiac arrest with extracorporeal life support: the role of bridging to intervention.
abstract: BACKGROUND
  To investigate the predictors of adverse outcomes of extracorporeal life support (ECLS) in rescuing adult non-postcardiotomy cardiogenic shock or cardiac arrest (non-PC CS/CA).
  
  
  METHODS
  This retrospective study included 60 adult patients receiving ECLS for non-PC CS/CA in a single institution between June 2003 and June 2010. The exclusion criteria were (1) pre-ECLS cardiac surgeries in the same admission and (2) age<18 years. Pre-ECLS and ECLS characteristics were compared in patients surviving to hospital discharge and those who did not. Mortalities after hospital discharge were also investigated.
  
  
  RESULTS
  Of the 38 patients weaned from ECLS, 32 survived to discharge. Acute myocardial infarction (AMI) and myocarditis were the most common aetiologies in this study. Forty patients experienced pre-ECLS conventional cardiopulmonary resuscitation (C-CPR) and 29 required an ECLS-assisted CPR (E-CPR). Thirteen patients who received E-CPR had profound anoxic encephalopathy later. In-hospital mortality was similar in AMI patients who underwent emergent coronary artery bypass grafting (CABG) after a failed percutaneous coronary intervention (PCI, 43%, 5/11) and those who underwent PCI only (58%, 7/12). Aetiologies other than myocarditis (odds ratio (OR) 11.0, 95% confidence interval (CI) 1.5-78.5), requirement for E-CPR (OR 5.6, 95% CI 1.5-22.0) and profound anoxic encephalopathy (OR 8.9, 95% CI 2.0-40.5) were predictors of in-hospital mortality. No risk factors of mortality after hospital discharge were identified.
  
  
  CONCLUSIONS
  ECLS was effective in bridging adults with non-PC CS/CA to definite treatments. Their prognosis depended on the cause of collapse and the severity of the post-cardiac arrest syndrome.
authors.affiliation: Department of Cardiovascular Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Meng-Yu
authors.initials: MY
authors.lastname: Wu
authors.forename: Ming-Yih
authors.initials: MY
authors.lastname: Lee
authors.forename: Chien-Chao
authors.initials: CC
authors.lastname: Lin
authors.forename: Yu-Sheng
authors.initials: YS
authors.lastname: Chang
authors.forename: Feng-Chun
authors.initials: FC
authors.lastname: Tsai
authors.forename: Pyng-Jing
authors.initials: PJ
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects* / Q000379:methods; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D008020:Life Support Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D015996:Survival Rate; D055815:Young Adult