Background: Extra-Circulatory Life Support (ECLS) is a vital therapeutic option in patients (pts) with refractory cardiogenic shock (CS). Few centers can assure optimal assistance to these delicate pts and early centralization in the context of regional networks is essential.
Methods: We enrolled all consecutive pts with ECLS for refractory CS admitted to our Intensive Cardiac Care Unit (ICCU) from January 2021 to November 2023. The primary endpoints evaluated were weaning from ECLS and in-hospital mortality. The secondary endpoints included neurological outcomes and major complications.
Results: We enrolled 21 consecutive pts (90% male, 55y median age) with refractory CS and indication for peripheral Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO), percutaneously or surgically positioned, with antegrade perfusion to avoid limb ischemia. Fourteen pts (67%) came from other hospitals, 8 (38%) of which already had been implanted with ECLS. Concerning the CS etiology, we observed 8 (38%) heart failure, 12 (57%) post-myocardial infarction, 1 (5%) adrenergic storm and 10 (48%) cardiac arrests. Six pts (28%) were deemed eligible for heart transplant (HT) list before the CS episode. In all pts we assured left ventricle unloading with IABP (9), Impella CP (3), Impella 5.5 (1). Five pts underwent apical left ventricular venting and escalation of mechanical support. The median duration of ECLS support was 10.1 days. Eleven pts (52%) were successfully weaned from VA-ECMO due to myocardial recovery (n=6; 29%) or HT (n=5; 24%); of the latter, 1 died due to peri-operative complication. Overall in-hospital mortality rate was 52%. Ten pts were discharged: 7 without neurological deficit (CPC 1), 2 with mildly impaired neurological function (CPC 2-3) and 1 with severe disability (CPC 4). During ECLS we observed the following complications: bleeding (28%), AKI (28%), infections (28%), neurological complications as acute ischemic stroke or intracerebral hemorrhage (19%); no limb ischemia occurred.
Conclusions: ECLS provides cardiac and respiratory support and serves as a bridge to recovery or heart replacement therapies (LVAD, HT). Tertiary Shock Centers in a Regional Network assure optimal assistance for this vital support.