Author + information
- Received February 10, 2016
- Revision received March 18, 2016
- Accepted March 26, 2016
- Published online September 1, 2016.
- Hug Aubin, MDa,
- George Petrov, MDa,
- Hannan Dalyanoglu, MDa,
- Diyar Saeed, MDa,
- Payam Akhyari, MDa,
- Gerrit Paprotny, Dipl.-Ing.a,
- Maximillian Richter, Cand. Med.a,
- Ralf Westenfeld, MDb,
- Hubert Schelzig, MDc,
- Malte Kelm, MDb,
- Detlef Kindgen-Milles, MDd,
- Artur Lichtenberg, MDa,∗ ( and )
- Alexander Albert, MDa
- aDepartment of Cardiovascular Surgery, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- bDepartment of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- cDepartment of Vascular and Endovascular Surgery, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- dDepartment of Anesthesiology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- ↵∗Reprint requests and correspondence:
Dr. Artur Lichtenberg, Department of Cardiovascular Surgery, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany.
Objectives This study sought to evaluate patient outcome within the Düsseldorf Extracorporeal Life Support (ECLS) Network, a suprainstitutional network for rapid-response remote ECLS and to define survival-based predictors.
Background Mobile venoarterial extracorporeal membrane oxygenation (vaECMO) used for ECLS has become a treatment option for a patient population with an otherwise fatal prognosis. However, outcome data remain scarce and institutional standards required to manage these patients are still poorly defined.
Methods This retrospective cohort study analyzes the outcome of 115 patients consecutively treated between July 2011 and October 2014 within the Düsseldorf ECLS Network due to refractory circulatory failure.
Results Of the 115 patients (56 ± 15 years of age, vaECMO initiation under cardiopulmonary resuscitation [CPR] 77%, CPR duration 45 [range 5 to 90] min), 50 patients (44%) survived to primary discharge and 38 patients (33%) were alive after a median follow-up of 1.5 years (95% confidence interval [CI]: 1.2 to 1.7). Thirty-seven (97%) of the long-term survivors showed a favorable neurological outcome. Risk factors associated with mortality during vaECMO were CPR duration (hazard ratio [HR]: 1.006; 95% CI: 1.00 to 1.01) and ischemic stroke (HR: 2.63; 95% CI: 1.52 to 4.56). Risk factors associated with mortality after vaECMO weaning were renal failure (HR: 6.60; 95% CI: 2.72 to 16.01) and sepsis (HR: 3.6; 95% CI: 1.50 to 8.69). Visceral ischemia had a negative impact (HR: 0.30; 95% CI: 0.11 to 0.84) whereas assist device implantation promoted successful vaECMO weaning (HR: 2.95; 95% CI: 1.65 to 5.25). Further, 3 distinct risk groups with significant differences in survival could be identified, demonstrating that in patients with no or short CPR mortality was not conditioned by age, whereas in patients with prolonged CPR young age was associated with increased survival.
Conclusions This study illustrates the implementation of a suprainstitutional ECLS Network. Further, our data suggest that mobile vaECMO is beneficial for a larger patient population than actually expected, especially regarding young patients presenting with prolonged CPR or patients regardless of age with no or short CPR.
- acute circulatory failure
- cardiogenic shock
- extracorporeal cardiopulmonary resuscitation
- extracorporeal life support
- extracorporeal membrane oxygenation
The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Lichtenberg and Albert contributed equally to this work.
- Received February 10, 2016.
- Revision received March 18, 2016.
- Accepted March 26, 2016.
- American College of Cardiology Foundation