title: Extracorporeal life support in cardiogenic shock: Impact of acute versus chronic etiology on outcome.
abstract: BACKGROUND
  The role of extracorporeal life support (ECLS) in primary cardiogenic shock (PCS) is well established. In this study, we evaluated the impact of etiology on outcomes.
  
  
  METHODS
  Between January 2009 and March 2013, we implanted a total of 249 patients with ECLS; we focused on 64 patients for whom peripheral ECLS was the treatment for PCS. Of these, 37 cases (58%) were "acute" (mostly acute myocardial infarction: 39%); 27 (42%) had an exacerbation of "chronic" heart failure (dilated cardiomyopathy: 30%; post-ischemic cardiomyopathy: 9%; and congenital: 3%).
  
  
  RESULTS
  In the group with chronic etiology, 23 patients were bridged to a left ventricular assist device (52%) or heart transplantation (33%). In the group with acute etiology, ECLS was used as a bridge-to-transplantation in 3 patients (8%), a bridge-to-bridge in 9 (24%), and a bridge-to-recovery in 18 (49%). One patient in each group was bridged to conventional surgery. Recovery of cardiac function was achieved in only the group with acute primary cardiogenic shock (18 vs 0 patients, P = .0001). A mean flow during support of ≤60% of the theoretic flow (body surface area × 2.4) was a predictor of successful weaning (P = .02). Median duration of ECLS support was 7 days (range: 2-11.5 days). Nine patients (14%) died during support; 30-day overall survival was 80% (51 of 64 patients); and 59% of patients were discharged, in whom survival at 48 months was 90%. Thirty-day survival was correlated with duration of ECLS support.
  
  
  CONCLUSIONS
  In "chronic" heart failure, ECLS represents a bridge to a ventricular assist device or heart transplantation, whereas in "acute" settings, it offers a considerable chance of recovery, and is often the only required therapy.
authors: Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy. Electronic address: v.tarzia@gmail.com.
authors: Vincenzo
authors: V
authors: Tarzia
authors: Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors: Giacomo
authors: G
authors: Bortolussi
authors: Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors: Roberto
authors: R
authors: Bianco
authors: Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors: Edward
authors: E
authors: Buratto
authors: Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors: Jonida
authors: J
authors: Bejko
authors: Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors: Massimiliano
authors: M
authors: Carrozzini
authors: Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors: Marco
authors: M
authors: De Franceschi
authors: Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors: Dario
authors: D
authors: Gregori
authors: Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors: Dario
authors: D
authors: Fichera
authors: Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors: Fabio
authors: F
authors: Zanella
authors: Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors: Tomaso
authors: T
authors: Bottio
authors: Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors: Gino
authors: G
authors: Gerosa
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005112:Extracorporeal Circulation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: ECMO; Extracorporeal membrane oxygenation; cardiomyopathy; circulatory temporary support; myocardial infarction; shock