METHODS: This is a retrospective cohort study of 17 patients admitted over a 10-year period for prolonged cardiac arrest or refractory shock following a drug overdose and not responding to optimal conventional treatment. Patients were evaluated in the medical ICU and cardiovascular surgery department of a university hospital. ECLS implantation used a centrifugal pump connected to a hollow-fiber membrane oxygenator and was performed in the operating room (n=13), intensive care unit (n=3), or emergency department (n=1). ECLS was employed for refractory shock and prolonged cardiac arrest in 10 and 7 cases, respectively.
RESULTS: The mean duration of external cardiac massage was 101+/-55 minutes. Fifteen patients had ingested cardiotoxic drugs, including 11 cases of drugs with membrane stabilizing activity. Time from hospital admission to initiation of ECLS was 6.4+/-7.0 hours. Time to ECLS implant was 58+/-11 minutes. The mean ECLS flow rate was 3.45+/-0.45 L/min. The average ECLS duration was 4.5+/-2.4 days. Early complications included limb ischemia (n=6), femoral thrombus (n=1), cava inferior thrombus (n=1), and severe bleeding at the site of cannulation (n=2). Fifteen patients were weaned off ECLS support and 13 (76%) were discharged to hospital without sequelae.
CONCLUSIONS: Based on our experience, we consider ECLS as a last resort, efficient, and relatively safe therapeutic option in this population. However, the uncontrolled nature of our data requires careful interpretation.
Fulltext weblink here