Venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock post-cardiac arrest.
To describe the characteristics, outcomes, and risk factors associated with poor outcome of venoarterial extracorporeal membrane oxygenation (VA-ECMO)-treated patients with refractory shock post-cardiac arrest.



We retrospectively analyzed data collected prospectively (March 2007-January 2015) in a 26-bed tertiary hospital intensive care unit. All patients implanted with VA-ECMO for refractory cardiogenic shock after successful resuscitation from cardiac arrest were included. Refractory cardiac arrest patients, given VA-ECMO under cardiopulmonary resuscitation, were excluded.



Ninety-four patients received VA-ECMO for refractory shock post-cardiac arrest. Their hospital and 12-month survival rates were 28 and 27 %, respectively. All 1-year survivors were cerebral performance category 1. Multivariable analysis retained INR >2.4 (OR 4.9; 95 % CI 1.4-17.2), admission SOFA score >14 (OR 5.3; 95 % CI 1.7-16.5), and shockable rhythm (OR 0.3; 95 % CI 0.1-0.9) as independent predictors of hospital mortality, but not SAPS II, out-of-hospital cardiac arrest score, or other cardiac arrest variables. Only 10 % of patients with an admission SOFA score >14 survived, whereas 50 % of those with scores ≤14 were alive at 1 year. Restricting the analysis to the 67 patients with out-of-hospital cardiac arrest of coronary cause yielded similar results.



Among 94 patients implanted with VA-ECMO for refractory cardiogenic shock post-cardiac arrest resuscitation, the 24 (27 %) 1-year survivors had good neurological outcomes, but survival was significantly better for patients with admission SOFA scores <14, shockable rhythm, and INR ≤2.4. VA-ECMO might be considered a rescue therapy for patients with refractory cardiogenic shock post-cardiac arrest resuscitation.
Service de Réanimation Médicale, iCAN, Groupe Hospitalier La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.|Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France.
Marc
M
Pineton de Chambrun
Service de Réanimation Médicale, iCAN, Groupe Hospitalier La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.|Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France.
Nicolas
N
Bréchot
Service de Chirurgie Thoracique et Cardiovasculaire, Groupe Hospitalier La Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Paris, France.
Guillaume
G
Lebreton
Service de Réanimation Médicale, iCAN, Groupe Hospitalier La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.|Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France.
Matthieu
M
Schmidt
Service de Réanimation Médicale, iCAN, Groupe Hospitalier La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.|Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France.
Guillaume
G
Hekimian
Service de Chirurgie Thoracique et Cardiovasculaire, Groupe Hospitalier La Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Paris, France.
Pierre
P
Demondion
Service de Réanimation Médicale, iCAN, Groupe Hospitalier La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.|Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France.
Jean-Louis
JL
Trouillet
Service de Chirurgie Thoracique et Cardiovasculaire, Groupe Hospitalier La Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Paris, France.
Pascal
P
Leprince
Service de Réanimation Médicale, iCAN, Groupe Hospitalier La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.|Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France.
Jean
J
Chastre
Service de Réanimation Médicale, iCAN, Groupe Hospitalier La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.|Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France.
Alain
A
Combes
Service de Réanimation Médicale, iCAN, Groupe Hospitalier La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France. charles-edouard.luyt@aphp.fr.|Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France. charles-edouard.luyt@aphp.fr.
Charles-Edouard
0000-0001-7424-2705
CE
Luyt
D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications; D011446:Prospective Studies; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
Cardiac arrest; Cardiogenic shock·; Extracorporeal membrane oxygenation; Post-cardiac arrest syndrome
Intensive Care Med. 2016 May;42(5):897-907
27007107
Intensive Care Med. 2015 Apr;41(4):575-88
25810214
Resuscitation. 2011 Aug;82(8):1036-40
21524837
Intensive Care Med. 2004 Nov;30(11):2126-8
15365608
Intensive Care Med. 2013 Nov;39(11):1972-80
23942856
Eur Heart J. 2006 Dec;27(23):2840-5
17082207
Intensive Care Med. 2016 Jul;42(7):1128-36
27098348
J Am Coll Cardiol. 2002 Dec 18;40(12):2110-6
12505221
N Engl J Med. 2003 Jun 26;348(26):2626-33
12826637
Resuscitation. 2008 Dec;79(3):350-79
18963350
Intensive Care Med. 2014 Apr;40(4):609-12
24474528
N Engl J Med. 2012 Oct 4;367(14):1287-96
22920912
N Engl J Med. 2001 Apr 26;344(17):1304-13
11320390
Intensive Care Med. 2011 Nov;37(11):1738-45
21965097
Intensive Care Med. 2014 Jun;40(6):846-54
24658912
Crit Care Med. 2011 May;39(5):1029-35
21336134
Circulation. 2012 Sep 18;126(12):1478-83
22879369
Intensive Care Med. 2016 Mar;42(3):370-8
26825953
Int J Angiol. 2012 Sep;21(3):163-6
23997562
J Cardiothorac Vasc Anesth. 2015;29(3):637-45
25543217
Crit Care. 2011;15(1):R29
21244674
Eur Heart J. 2015 Sep 1;36(33):2246-56
26033984
Ann Intensive Care. 2011 Nov 03;1(1):45
22053891
N Engl J Med. 2002 Feb 21;346(8):557-63
11856794
N Engl J Med. 2002 Feb 21;346(8):549-56
11856793
Resuscitation. 2013 May;84(5):609-15
23069592
Resuscitation. 2005 Aug;66(2):175-81
16053943
N Engl J Med. 2012 Nov 15;367(20):1912-20
23150959
Crit Care Med. 2008 May;36(5):1404-11
18434909
Eur Heart J. 2013 Jan;34(2):112-20
22513777