title: Venoarterial extracorporeal membrane oxygenation support for refractory cardiovascular dysfunction during severe bacterial septic shock.
abstract: OBJECTIVE
  Profound myocardial depression can occur during severe septic shock. Although good outcomes of venoarterial extracorporeal membrane oxygenation-treated children with refractory septic shock have been reported, little is known about adults' outcomes. This study was designed to assess the outcomes and long-term health-related quality-of-life of patients supported by venoarterial extracorporeal membrane oxygenation for refractory cardiac and hemodynamic failure during severe septic shock.
  
  
  METHODS
  A retrospective, single-center, observational study and a cross-sectional survey to assess health-related quality of life by the Short Form-36 questionnaire and frequencies of anxiety, depression and posttraumatic stress disorder symptoms by the Hospital Anxiety and Depression Scale and the Impact of Event Scale, respectively.
  
  
  METHODS
  A 26-bed tertiary intensive care unit in a university hospital.
  
  
  METHODS
  We evaluated the outcomes of patients who received venoarterial extracorporeal membrane oxygenation rescue therapy for refractory cardiovascular failure during bacterial septic shock. Results are expressed as medians (range).
  
  
  RESULTS
  From January 2008 to September 2011, 14 patients, 45 years old (28-66), seven males, none with a history of left ventricular dysfunction, received venoarterial extracorporeal membrane oxygenation for septic shock refractory to conventional treatment, 24 hours (3-108) after shock onset. All exhibited severe myocardial dysfunction at extracorporeal membrane oxygenation implantation. Left ventricular ejection fraction was 16% (10% to 30%), cardiac index was 1.3 L/min/m (0.7-2.2 ) and systemic resistance vascular index was 3162 (2047-7685). All were receiving high-dose catecholamines and had signs of multiple organ failure: pH 7.16 (6.68-7.39), blood lactate 9 (2-17) mmol/L, PaO2/FIO2 87 (28-364), Simplified Acute Physiology Score III 84 (75-106) and Sepsis-Related Organ Failure Assessment score 18 (8-21). Twelve patients (86%) could be weaned off venoarterial extracorporeal membrane oxygenation after 5.5 days (2-12) days of support and 10 patients (71%) were discharged to home and were alive after a median follow-up of 13 months (3-43). All 10 survivors had normal left ventricular ejection fraction and reported good health-related quality of life at long-term follow-up.
  
  
  CONCLUSIONS
  Venoarterial extracorporeal membrane oxygenation rescued more than 70% of the patients who developed refractory cardiovascular dysfunction during severe bacterial septic shock. Survivors reported good long-term quality of life. Venoarterial extracorporeal membrane oxygenation might represent a valuable therapeutic option for adults in severe septic shock with refractory cardiac and hemodynamic failure.
authors.affiliation: Service de Réanimation Médicale, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre-et-Marie-Curie, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bréchot
authors.forename: Charles-Edouard
authors.initials: CE
authors.lastname: Luyt
authors.forename: Matthieu
authors.initials: M
authors.lastname: Schmidt
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Trouillet
authors.forename: Philippe
authors.initials: P
authors.lastname: Léger
authors.forename: Alain
authors.initials: A
authors.lastname: Pavie
authors.forename: Jean
authors.initials: J
authors.lastname: Chastre
authors.forename: Alain
authors.initials: A
authors.lastname: Combes
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000150:complications* / Q000401:mortality; D001774:Blood Chemical Analysis; D003430:Cross-Sectional Studies; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods* / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D006439:Hemodynamics; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D012772:Shock, Septic / Q000150:complications* / Q000401:mortality