title: Extracorporeal life support in adults with hemodynamic collapse from fulminant cardiomyopathies: the chance of bridging to recovery.
abstract: Venoarterial extracorporeal life support (VA-ECLS) is a lifesaving circulatory support in hemodynamic collapse induced by miscellaneous etiologies. However, survival rates vary among etiologies. To investigate the therapeutic effectiveness of VA-ECLS in hemodynamic collapse induced by fulminant cardiomyopathy (CM), a retrospective chart review of 14 patients was conducted, among the 294 adults receiving VA-ECLS in a single institution from April 2006 to April 2013. All patients received echocardiography, coronary angiography, or computed tomography before or immediately after undergoing VA-ECLS to exclude anatomic cardiac diseases. Myocarditis (n = 12) and peripartum CM (n = 2) were the subcategories of fulminant CM. The median door-to-ECLS duration was 12 hours. Seven patients received cardiopulmonary resuscitation (CPR) before VA-ECLS, and three required ECLS-assisted CPR to regain circulation. Two patients were transplanted as a result of myocardial irreversibility and one survived. Nine of the nontransplant patients survived after a median VA-ECLS of 167 hours. All of the 10 survivors, including the five experiencing dialysis-dependent acute renal failure, had their cardiac and renal function return to normal within 6 months after the episode. The VA-ECLS was a practical therapeutic option in fulminant CM. It could provide expeditious hemodynamic support and preserve organ viability essential to recovery.
authors.affiliation: From the *Department of Cardiovascular Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan; †Department of Obstetrics and Gynecology, Wan Fang Hospital and Taipei Medical University, Taipei; and ‡Department of Medicine, Taipei Medical University, Taipei, Taiwan, R.O.C.
authors.forename: Ta-Wei
authors.initials: TW
authors.lastname: Su
authors.forename: Yuan-His
authors.initials: YH
authors.lastname: Tseng
authors.forename: Tzu-I
authors.initials: TI
authors.lastname: Wu
authors.forename: Pyng-Jing
authors.initials: PJ
authors.lastname: Lin
authors.forename: Meng-Yu
authors.initials: MY
authors.lastname: Wu
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D000328:Adult; D009202:Cardiomyopathies / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D016887:Cardiopulmonary Resuscitation; D005112:Extracorporeal Circulation; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D016027:Heart Transplantation; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012769:Shock / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D012770:Shock, Cardiogenic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D055815:Young Adult