title: Extracorporeal Life Support for Refractory Cardiac Arrest or Shock: A 10-Year Study.
abstract: We aimed to identify factors associated with hospital mortality among patients receiving extracorporeal life support (ECLS). All consecutive patients treated with ECLS for refractory cardiac arrest or shock in the Caen University Hospital in northwestern France during the last decade were included in a retrospective cohort study. Sixty-four patients were included: 29 with refractory cardiac arrest and 35 with refractory shock. The main reasons for ECLS were acute coronary syndrome (n = 23) and severe poisoning caused by drug intoxication (n = 19). At ECLS initiation, the left ventricular ejection fraction was 16% (±11). Initial blood test results were arterial pH = 7.19 (±0.20) and plasma lactate = 8.02 (±5.88) mmol/L. Forty (63%) patients died including 33 under ECLS. In a multivariate analysis, two factors were independently associated with survival: drug intoxication as the reason for ECLS (adjusted odds ratio [AOR], 0.07; 95% confidence intervals [CI], 0.01-0.28; p < 0.001) and arterial pH (an increase of 0.1 point [AOR, 0.013; 95% CI, <0.001-0.27; p < 0.01]). This study supports early ECLS as a last resort therapeutic option in a highly selected group of patients with refractory cardiac arrest or shock, in particular before profound acidosis occurs and when the cause is reversible.
authors.affiliation: From the *Department of Medical Intensive Care, †Department of Thoracic and Cardiovascular Surgery, ‡Department of Anesthesiology, and §Department of Cardiology, CHU de Caen, Caen, France; ¶UCBN, COMETE, Caen, France; ‖Inserm, U 1075 COMETE, Caen, France; #U2RM-EA 4655, Université de Caen Basse-Normandie, Caen, France; and **Department of Biostatistics and Clinical Research, CHU de Caen, Caen, France.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Brunet
authors.forename: Xavier
authors.initials: X
authors.lastname: Valette
authors.forename: Calin
authors.initials: C
authors.lastname: Ivascau
authors.forename: Philippe
authors.initials: P
authors.lastname: Lehoux
authors.forename: Bertrand
authors.initials: B
authors.lastname: Sauneuf
authors.forename: Yves
authors.initials: Y
authors.lastname: Dalibert
authors.forename: Romain
authors.initials: R
authors.lastname: Masson
authors.forename: Remi
authors.initials: R
authors.lastname: Sabatier
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Buklas
authors.forename: Amélie
authors.initials: A
authors.lastname: Seguin
authors.forename: Nicolas
authors.initials: N
authors.lastname: Terzi
authors.forename: Damien
authors.initials: D
authors.lastname: du Cheyron
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Parienti
authors.forename: Cedric
authors.initials: C
authors.lastname: Daubin
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications; D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000150:complications; D062787:Drug Overdose / Q000150:complications; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011041:Poisoning / Q000150:complications; D012189:Retrospective Studies; D012769:Shock / Q000209:etiology / Q000628:therapy*