Out-of-Center ECLS Implantation: Extended Experience of an Interdisciplinary Team Approach

Background: Extracorporeal life support (ECLS) is an established treatment option for patient in refractory cardiogenic shock. This study describes the outcome of patients who treated with ECLS in cardiogenic shock at remote hospitals.

Methods: During a 32-month period, 38 consecutive patients have been treated with out-of-center ECLS Implantations due to cardiogenic shock (65.8% myocardial infarction) by an interdisciplinary team (cardiac surgeon, anesthesiologist, perfusionist). The mean age was 53 years (range: 6–80 years) and 79% were male. 24 out of the 38 patients have undergone prior CPR (mean time: 25.3 ± 23.2 minutes). The mean duration of ECLS support was 12.1 (± 6.4) days.

Results: 16 patients (42%) died on support due to multi organ failure. Two patients showed insufficient left ventricular unloading and were treated with Impella 2.5 implantation (1 survived to hospital discharge). 8 patients were bridged to VAD implantation and 7 of them (87%) survived to hospital discharge. Another 11 patients underwent primary weaning from the ECLS and 9 of them (81%) survived to hospital discharge. 6 other patients were bridged to subsequent short term MCS (Impella 2.5/5.0) of which 3 (50%) survived to hospital discharge (1 of them changed to HM II LVAD).

There was no difference within the pre-implantation blood gas analyzing samples (lactate, base excess, pH, pO₂ all n.s.) of the discharged and expired patients. However the expired patients showed higher creatinine (2.3 ± 1.16 vs. 1.26 ± 0.39, p = 0.005), GOT (1,486.43 ± 1,969.56 vs. 197.75 ± 223.43, p = 0.021), GPT (98.93 ± 104.73 vs. 766.88 ± 1,122.01, p = 0.032) and LDH values (1,177.35 ± 1,227.77 vs. 410.83 ± 233.84; p = 0.002) prior to implantation compared with those patients who survived to hospital discharge.

The overall 30-day survival rate was 50% and hospital discharge was achieved in 18patients (47%).

Conclusion: In this cohort out-of-center ECLS Implantation results in hospital discharge of 47% of all patients. This is the highest published rate of out-of-hospital ECLS for cardiogenic shock. Within primary weaning group the mortality up to hospital discharge was 18 and 12.5% within the group of patients bridged to durable VAD systems. The pre implantation end-organ parameters were predictive for the outcome, whereas the parameters from the blood gas analyzer were not different between the outcome groups.