Introduction: Out-hospital survival after ECLS support is rarely reported. We retrospectively reviewed our institutional data over a15-year experience of ECLS. We analyzed patient survival and risk factor of late death during ECLS support.
Methods: Between 2002 to 2016, 311 consecutive ECLS were implanted for refractory cardiogenic shock, 159 patients (51.1%) could be successfully weaned. To analyze the predictors of one-year survival, we included patient variables, ECLS complications, etiologies of shock and weaning modality (Recovery, LVAD implantation or heart transplantation) in a multivariate analysis with a cox regression.
Results: Mean age was 48 +/- 16 years, 64% were male. Main etiologies of shock were post-cardiotomy (33.9%), ischemic cardiomyopathy (23.2%), and acute decompensated end stage heart failure (16.4%). We had 139 (47.6%) deaths, 60% occurred before the 4th postoperative day. The mean duration of ECLS support was 7+/-18 days. 50% of the patients experienced severe bleeding complications before the 7th postoperative day. From 159 patients who survived under support, 112 recovered (36.01%), 26 underwent heart transplantation (8.36%) and 21 patients (6.75%) underwent LVAD implantation. One year survival was 83.3%,73.1% and 75.0% respectively. Independent risks factor for death at one year were age (HR = 1.021; p=0.05) and early mechanical ventilation weaning during ECLS support (HR = 0.314; p = 0.001). One-year survival was not significantly different when comparing HTX and LVAD implantation (HR-1.069 ; P= 0.89). Bleeding complications significantly impaired survival during ECMO support, 77% for “non bleeders” patient and 60% for “bleeders” (p=0.03) respectively.
Conclusions: Overall survival after ECLS was 51%. One year survival reached 83% when patients recovered satisfactory cardiac function. For those patients who did not recover under ECLS, HTX or LVAD support offer an excellent outcome. Bleeding under ECLS remained a severe complication and impaired significantly patient survival.