Resuscitation of non-postcardiotomy cardiogenic shock or cardiac arrest with extracorporeal life support: The role of bridging to intervention

Background: To investigate the predictors of adverse outcomes of extracorporeal life support (ECLS) in rescuing adult non-postcardiotomy cardiogenic shock or cardiac arrest (non-PC CS/CA). Materials and methods: This retrospective study included 60 adult patients receiving ECLS for non-PC CS/CA in a single institution between June 2003 and June 2010. The exclusion criteria were (1) pre-ECLS cardiac surgeries in the same admission and (2) age < 18. years. Pre-ECLS and ECLS characteristics were compared in patients surviving to hospital discharge and those who did not. Mortalities after hospital discharge were also investigated. Results: Of the 38 patients weaned from ECLS, 32 survived to discharge. Acute myocardial infarction (AMI) and myocarditis were the most common aetiologies in this study. Forty patients experienced pre-ECLS conventional cardiopulmonary resuscitation (C-CPR) and 29 required an ECLS-assisted CPR (E-CPR). Thirteen patients who received E-CPR had profound anoxic encephalopathy later. In-hospital mortality was similar in AMI patients who underwent emergent coronary artery bypass grafting (CABG) after a failed percutaneous coronary intervention (PCI, 43%, 5/11) and those who underwent PCI only (58%, 7/12). Aetiologies other than myocarditis (odds ratio (OR) 11.0, 95% confidence interval (CI) 1.5-78.5), requirement for E-CPR (OR 5.6, 95% CI 1.5-22.0) and profound anoxic encephalopathy (OR 8.9, 95% CI 2.0-40.5) were predictors of in-hospital mortality. No risk factors of mortality after hospital discharge were identified. Conclusion: ECLS was effective in bridging adults with non-PC CS/CA to definite treatments. Their prognosis depended on the cause of collapse and the severity of the post-cardiac arrest syndrome.