Experience with Extracorporeal Life Support for Cardiogenic Shock in the Older Population more than 70 Years of Age

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Abstract

The two main objectives of this single-center, retrospective study were to analyze the outcomes and to identify the independent predictors of 30 day and long-term mortality in case of cardiopulmonary resuscitation requiring extracorporeal life support (ECLS) in the elderly patients. From October 2004 to May 2014, 163 patients with a mean age of 75.5 years (range 70–91) required veno-arterial ECLS. The main indication was postcardiotomy cardiogenic shock (79.6%). Extracorporeal life support duration averaged 5.6 ± 4.3 days. Thirty-day mortality was 72% (n = 117) and follow-up survival rate was 14.1% with a median follow-up of 23.7 months (range 1.5–102.3). Lactatemia was identified as an independent risk factor of 30 day mortality. Previous stroke, lactatemia, bilirubinemia, and ECLS implantation under cardiac massage were identified as independent risk factors for long-term mortality. Extracorporeal life support after TAVI procedure and intra-aortic balloon pump support were identified as protective factors for both 30 day and long-term survival. The 23 patients, still alive at last follow up, have a good quality of life, doing well, and self-catering. Although mortality rate at 30 days is more than 70% in elderly patients requiring circulatory support with ECLS, survivors can pretend to an acceptable long-term survival with a good quality of life. Extracorporeal life support implantation in the elderly patients should remain scarce, but should still be considered as a therapeutic option in well-selected patients.

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