Towards a proactive therapy utilizing the modern spectrum of extracorporeal life support: a single-centre experience.
BACKGROUND
We describe a single-centre experience of extracorporeal life support (ELS) for patients with severe and refractory cardiogenic shock, refractory cardiac arrest and severe respiratory failure.


METHODS
Between September 2007 and September 2012, 56 intra-hospital and 10 inter-hospital adult patients were supported.


RESULTS
The median ELS duration was 3 (0.9 - 6) days in venoarterial and 9.2 (7.4 - 24.4) days in venovenous supported patients. At hospital discharge and follow-up (12 and 40 months), survival among the respiratory (venovenous) patients and cardiac (venoarterial) patients was 84% and 38%, respectively. Survival in severe refractory cardiogenic shock patients was related to early initiation of ELS (<8 hours of onset of failure). A delay in initiating venoarterial ELS (>8 hours) and increased pre-ELS pH and lactate levels were associated with death in all cardiomyopathy patients, independent of infarct size.


CONCLUSIONS
Our results exemplify the benefits of ELS as a bridge to initial stabilization of critically ill patients. Potentially, the early application of ELS technology can lower mortality and morbidity in patients with a regressive pathology.
Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.
A S
AS
Sharma
Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands P.Weerwind@maastrichtuniversity.nl.
P W
PW
Weerwind
Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.
Y M
YM
Ganushchak
Department of Intensive Care, Maastricht University Medical Centre, Maastricht, the Netherlands Department of Cardiology - Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands.
D W
DW
Donker
Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.
J G
JG
Maessen
D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008020:Life Support Care; D008297:Male; D008875:Middle Aged; D012770:Shock, Cardiogenic / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate
adult; extracorporeal life support; initiation time; survival rate