title: Hospital survival and long term quality of life after emergency institution of venoarterial ECMO for refractory circulatory collapse.
abstract: BACKGROUND
  Thanks to significant technical improvements, VA-ECMO is increasingly used to reverse circulatory collapse refractory to standard treatments.
  
  
  METHODS
  We studied patients who underwent VA-ECMO due to primary cardiogenic shock or cardiac arrest between January 2008 and June 2011 at our institution. Variables related to hospital survival were analyzed. Long-term survival and health-related quality of life were checked.
  
  
  RESULTS
  VA-ECMO was instituted in 23 patients: 17 outpatients and 6 inpatients. Seven of the outpatients were admitted to hospital under ongoing CPR. In these pts, time to CPR was 7 min (6-8) and time to ECMO 93 min (74-107); after 20 hours (16-22), all these pts died. Among remaining 16 pts, 6 were bridged to heart transplant and 4 to heart recovery, 8 survived to hospital discharge and 7 were alive with high health-related quality of life after 46 months (36-54). Ongoing CPR, inotropic score and lactates at cannulation did not differ between survivors and non-survivors; duration of shock, SOFA score and serum creatinine at ECMO institution, and lactates and fluid balance after 36 hours were higher in non-survivors. Patients could be kept on spontaneous breathing for >30% of time while on VA-ECMO.
  
  
  CONCLUSIONS
  Emergency VA-ECMO institution can reverse refractory acute cardiovascular collapse, provided it is carried out before significant organ dysfunction occurs. Light sedation and spontaneous breathing while on VA-ECMO can be well tolerated by patients, but related clinical benefits should be proved. Patients successfully bridged to heart recovery or transplant are candidates for long-term good quality of life.
authors.affiliation: S. C. di Anestesia e Rianimazione I, Dipartimento di Emergenza Urgenza, Fondazione IRCCS Policlinico San Matteo, Pavia, Italia - francesco.mojoli@unipv.it.
authors.forename: F
authors.initials: F
authors.lastname: Mojoli
authors.forename: A
authors.initials: A
authors.lastname: Venti
authors.forename: C
authors.initials: C
authors.lastname: Pellegrini
authors.forename: G M
authors.initials: GM
authors.lastname: De Ferrari
authors.forename: M
authors.initials: M
authors.lastname: Ferlini
authors.forename: M
authors.initials: M
authors.lastname: Zanierato
authors.forename: M
authors.initials: M
authors.lastname: Maurelli
authors.forename: G A
authors.initials: GA
authors.lastname: Iotti
authors.forename: A M
authors.initials: AM
authors.lastname: D'Armini
authors.forename: A
authors.initials: A
authors.lastname: Braschi
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation; D004632:Emergency Medical Services; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000523:psychology / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012769:Shock / Q000401:mortality* / Q000523:psychology / Q000628:therapy*; D012770:Shock, Cardiogenic / Q000401:mortality / Q000523:psychology / Q000628:therapy; D013534:Survival; D017741:Survivors / Q000523:psychology*; D016896:Treatment Outcome; D015300:Ventilator Weaning