title: Experience with Extracorporeal Life Support for Cardiogenic Shock in the Older Population more than 70 Years of Age.
abstract: The two main objectives of this single-center, retrospective study were to analyze the outcomes and to identify the independent predictors of 30 day and long-term mortality in case of cardiopulmonary resuscitation requiring extracorporeal life support (ECLS) in the elderly patients. From October 2004 to May 2014, 163 patients with a mean age of 75.5 years (range 70-91) required veno-arterial ECLS. The main indication was postcardiotomy cardiogenic shock (79.6%). Extracorporeal life support duration averaged 5.6 ± 4.3 days. Thirty-day mortality was 72% (n = 117) and follow-up survival rate was 14.1% with a median follow-up of 23.7 months (range 1.5-102.3). Lactatemia was identified as an independent risk factor of 30 day mortality. Previous stroke, lactatemia, bilirubinemia, and ECLS implantation under cardiac massage were identified as independent risk factors for long-term mortality. Extracorporeal life support after TAVI procedure and intra-aortic balloon pump support were identified as protective factors for both 30 day and long-term survival. The 23 patients, still alive at last follow up, have a good quality of life, doing well, and self-catering. Although mortality rate at 30 days is more than 70% in elderly patients requiring circulatory support with ECLS, survivors can pretend to an acceptable long-term survival with a good quality of life. Extracorporeal life support implantation in the elderly patients should remain scarce, but should still be considered as a therapeutic option in well-selected patients.
authors.affiliation: From the *Department of Thoracic & Cardio-Vascular Surgery, Pitié-Salpêtrière Hospital, Paris, France; and †Department of Biostatistics, Pitié-Salpêtrière Hospital, Paris, France.
authors.forename: Margaux
authors.initials: M
authors.lastname: Pontailler
authors.forename: Pierre
authors.initials: P
authors.lastname: Demondion
authors.forename: Guillaume
authors.initials: G
authors.lastname: Lebreton
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Golmard
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects; D008297:Male; D011788:Quality of Life; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000401:mortality / Q000523:psychology / Q000628:therapy*