Extracorporeal Membrane Oxygenation for Acute Decompensated Heart Failure.

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Extracorporeal Membrane Oxygenation for Acute Decompensated Heart Failure.

Crit Care Med. 2017 Aug;45(8):1359-1366

Authors: Dangers L, Bréchot N, Schmidt M, Lebreton G, Hékimian G, Nieszkowska A, Besset S, Trouillet JL, Chastre J, Leprince P, Combes A, Luyt CE

Abstract
OBJECTIVE: Long-term outcomes of patients treated with venoarterial-extracorporeal membrane oxygenation for acute decompensated heart failure (i.e., cardiogenic shock complicating chronic cardiomyopathy) have not yet been reported. This study was undertaken to describe their outcomes and determine mortality-associated factors.
DESIGN: Retrospective analysis of data prospectively collected.
SETTING: Twenty-six-bed tertiary hospital ICU.
PATIENTS: One hundred five patients implanted with venoarterial-extracorporeal membrane oxygenation for acute decompensated heart failure.
INTERVENTION: None.
MEASUREMENTS AND MAIN RESULTS: From March 2007 to January 2015, 105 patients were implanted with venoarterial-extracorporeal membrane oxygenation for acute decompensated heart failure in our ICU (67% of them had an intraaortic balloon pump to unload the left ventricle). Their 1-year survival rate was 42%; most of the survivors were transplanted either directly or after switching to central bilateral centrifugal pump, ventricular-assist device, or total artificial heart. Most deaths occurred early after multiple organ failure. Multivariable analyses retained (odds ratio [95% CI]) pre-extracorporeal membrane oxygenation Sequential Organ Failure Assessment score of more than 11 (3.3 [1.3-8.3]), idiopathic cardiomyopathy (0.4 [0.2-1]), cardiac disease duration greater than 2 years pre-extracorporeal membrane oxygenation (2.8 [1.2-6.9]), and pre-extracorporeal membrane oxygenation blood lactate greater than 4 mmol/L (2.6 [1.03-6.4]) as independent predictors of 1-year mortality. Only 17% of patients with pre-extracorporeal membrane oxygenation Sequential Organ Failure Assessment scores of 14 or more survived, whereas 52% of those with scores less than 7 and 60% of those with scores 7 or more and less than 11 were alive 1 year later.
CONCLUSIONS: Among this selected cohort of 105 patients implanted with venoarterial-extracorporeal membrane oxygenation for acute decompensated heart failure, 1-year survival was 42%, but better for patients with pre-extracorporeal membrane oxygenation Sequential Organ Failure Assessment scores of less than 11. Venoarterial-extracorporeal membrane oxygenation should be considered for patients with acute decompensated heart failure, but timing of implantation is crucial.

PMID: 28471885 [PubMed - indexed for MEDLINE]

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