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Central extracorporeal circulatory life support (cECLS) in selected patients with critical cardiogenic shock
BACKGROUND: Percutaneous extracorporeal life support (pECLS) is increasingly applied in cardiogenic shock (CS) despite a lack of evidence from randomized trials. The in-hospital mortality rate of pECLS still reaches up to 60%, while vascular access site complications remain a shortcoming. Surgical a...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10150085/ https://www.ncbi.nlm.nih.gov/pubmed/37139128 http://dx.doi.org/10.3389/fcvm.2023.1142953 |
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author | Schmack, Leonie Schmack, Bastian Papathanasiou, Maria Al-Rashid, Fadi Weymann, Alexander Pizanis, Nikolaus Kamler, Markus Ruhparwar, Arjang Rassaf, Tienush Luedike, Peter |
author_facet | Schmack, Leonie Schmack, Bastian Papathanasiou, Maria Al-Rashid, Fadi Weymann, Alexander Pizanis, Nikolaus Kamler, Markus Ruhparwar, Arjang Rassaf, Tienush Luedike, Peter |
author_sort | Schmack, Leonie |
collection | PubMed |
description | BACKGROUND: Percutaneous extracorporeal life support (pECLS) is increasingly applied in cardiogenic shock (CS) despite a lack of evidence from randomized trials. The in-hospital mortality rate of pECLS still reaches up to 60%, while vascular access site complications remain a shortcoming. Surgical approaches with central cannulation for ECLS (cELCS) have emerged as a bail-out option. To date, no systematic approach exists that allows a definition of inclusion or exclusion criteria for cECLS. METHODS AND RESULTS: This single-center, retrospective, case-control study includes all patients fulfilling criteria for CS at the West German Heart and Vascular Center Essen/Germany between 2015 and 2020 who underwent cECLS (n = 58), excluding post-cardiotomy patients. Seventeen patients received cECLS (29.3%) as a first-line treatment strategy and 41 patients as a second-line strategy (70.7%). The main complications leading to the use of cECLS as a second-line strategy were limb ischemia (32.8%) and ongoing insufficient hemodynamic support (27.6%). The first-line cECLS cohort showed a 30-day mortality rate of 53.3% that was constant during follow-up. The 30-day mortality rate of secondary cECLS candidates was 69.8% and the rate at 3 and 6 months was 79.1%. Younger patients (<55 years) were more likely to exhibit survival benefit with cECLS (p = 0.043). CONCLUSION: Surgical cECLS in CS is a feasible therapy for highly selected patients with hemodynamic instability, vascular complications, or peripheral access site limitations as complementary strategy in experienced centers. |
format | Online Article Text |
id | pubmed-10150085 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-101500852023-05-02 Central extracorporeal circulatory life support (cECLS) in selected patients with critical cardiogenic shock Schmack, Leonie Schmack, Bastian Papathanasiou, Maria Al-Rashid, Fadi Weymann, Alexander Pizanis, Nikolaus Kamler, Markus Ruhparwar, Arjang Rassaf, Tienush Luedike, Peter Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: Percutaneous extracorporeal life support (pECLS) is increasingly applied in cardiogenic shock (CS) despite a lack of evidence from randomized trials. The in-hospital mortality rate of pECLS still reaches up to 60%, while vascular access site complications remain a shortcoming. Surgical approaches with central cannulation for ECLS (cELCS) have emerged as a bail-out option. To date, no systematic approach exists that allows a definition of inclusion or exclusion criteria for cECLS. METHODS AND RESULTS: This single-center, retrospective, case-control study includes all patients fulfilling criteria for CS at the West German Heart and Vascular Center Essen/Germany between 2015 and 2020 who underwent cECLS (n = 58), excluding post-cardiotomy patients. Seventeen patients received cECLS (29.3%) as a first-line treatment strategy and 41 patients as a second-line strategy (70.7%). The main complications leading to the use of cECLS as a second-line strategy were limb ischemia (32.8%) and ongoing insufficient hemodynamic support (27.6%). The first-line cECLS cohort showed a 30-day mortality rate of 53.3% that was constant during follow-up. The 30-day mortality rate of secondary cECLS candidates was 69.8% and the rate at 3 and 6 months was 79.1%. Younger patients (<55 years) were more likely to exhibit survival benefit with cECLS (p = 0.043). CONCLUSION: Surgical cECLS in CS is a feasible therapy for highly selected patients with hemodynamic instability, vascular complications, or peripheral access site limitations as complementary strategy in experienced centers. Frontiers Media S.A. 2023-04-17 /pmc/articles/PMC10150085/ /pubmed/37139128 http://dx.doi.org/10.3389/fcvm.2023.1142953 Text en © 2023 Schmack, Schmack, Papathanasiou, Al-Rashid, Weymann, Pizanis, Kamler, Ruhparwar, Rassaf and Luedike. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Cardiovascular Medicine Schmack, Leonie Schmack, Bastian Papathanasiou, Maria Al-Rashid, Fadi Weymann, Alexander Pizanis, Nikolaus Kamler, Markus Ruhparwar, Arjang Rassaf, Tienush Luedike, Peter Central extracorporeal circulatory life support (cECLS) in selected patients with critical cardiogenic shock |
title | Central extracorporeal circulatory life support (cECLS) in selected patients with critical cardiogenic shock |
title_full | Central extracorporeal circulatory life support (cECLS) in selected patients with critical cardiogenic shock |
title_fullStr | Central extracorporeal circulatory life support (cECLS) in selected patients with critical cardiogenic shock |
title_full_unstemmed | Central extracorporeal circulatory life support (cECLS) in selected patients with critical cardiogenic shock |
title_short | Central extracorporeal circulatory life support (cECLS) in selected patients with critical cardiogenic shock |
title_sort | central extracorporeal circulatory life support (cecls) in selected patients with critical cardiogenic shock |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10150085/ https://www.ncbi.nlm.nih.gov/pubmed/37139128 http://dx.doi.org/10.3389/fcvm.2023.1142953 |
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