title: Early Prediction of 3-month Survival of Patients in Refractory Cardiogenic Shock and Cardiac Arrest on Extracorporeal Life Support.
abstract: BACKGROUND
  Extracorporeal life support (ECLS) holds the promise of significant improvement of the survival of patient in refractory cardiogenic shock (CS) or cardiac arrest (CA). Nevertheless, it remains to be shown to which extent these highly invasive supportive techniques could improve long-term patient's outcome.
  
  
  METHODS
  The outcomes of 82 adult ECLS patients at our institution between January 2012 and December 2013 were retrospectively analyzed.
  
  
  RESULTS
  Patients were essentially men (64.7%) and are 54 years old. Preexisting ischemic (53.7%) and dilated cardiomyopathy (14.6%) were frequent. ECLS indications were shared equally between CA and CS. ECLS-specific adverse effects as hemorrhage (30%) and infection (50%) were frequent. ECLS was effective for 43 patients (54%) with recovery for 35 (43%), 5 (6%) heart transplant, and 3 (4%) left ventricular assist device support. Mortality rate at 30 days was 59.8%, but long-term and 3-month survival rates were similar of 31.7%. Initial plasma lactate levels >5.3 mmol/L and glomerular filtration rate <43 ml/min/1.73 m2were significantly associated with 3-month mortality (risk ratio [RR] 2.58 [1.21-5.48];P= 0.014; RR 2.10 [1.1-4];P= 0.024, respectively). Long-term follow-up had shown patients paucisymptomatic (64% New York Heart Association 1-2) and autonomic (activities of daily living [ADL] score 6 ± 1.5).
  
  
  CONCLUSIONS
  In case of refractory CA or CS, lactates and renal function at ECLS initiation could serve as outcome predictor for risk stratification and ECLS indication.
authors.affiliation: Intensive Care Unit, Department of Anesthesia and Critical Care, University Hospital of Toulouse, Toulouse, France; Department of Cardiology, University Hospital of Rangueil, Toulouse, France.
authors.forename: Clément
authors.initials: C
authors.lastname: Delmas
authors.affiliation: Intensive Care Unit, Department of Anesthesia and Critical Care, University Hospital of Toulouse, Toulouse, France.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Conil
authors.affiliation: Intensive Care Unit, Department of Anesthesia and Critical Care, University Hospital of Toulouse, Toulouse, France.
authors.forename: Simon
authors.initials: S
authors.lastname: Sztajnic
authors.affiliation: Intensive Care Unit, Department of Anesthesia and Critical Care, University Hospital of Toulouse, Toulouse, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Georges
authors.affiliation: Department of Cardiology, University Hospital of Rangueil, Toulouse, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Biendel
authors.affiliation: Department of Cardiovascular Surgery, University Hospital of Rangueil, Toulouse, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Dambrin
authors.affiliation: Department of Cardiology, University Hospital of Rangueil, Toulouse, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Galinier
authors.affiliation: Intensive Care Unit, Department of Anesthesia and Critical Care, University Hospital of Toulouse, Toulouse, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Minville
authors.affiliation: Intensive Care Unit, Department of Anesthesia and Critical Care, University Hospital of Toulouse, Toulouse, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Fourcade
authors.affiliation: Intensive Care Unit, Department of Anesthesia and Critical Care, University Hospital of Toulouse, Toulouse, France.
authors.forename: Stein
authors.initials: S
authors.lastname: Silva
authors.affiliation: Department of Cardiovascular Surgery, University Hospital of Rangueil, Toulouse, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Marcheix
keywords: Cardiac arrest; cardiogenic shock; extracorporeal life support; extracorporeal membrane oxygenation