Venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock post-cardiac arrest

Marc Pineton de Chambrun (1) , Nicolas Bréchot (1) , Guillaume Lebreton (2) , Matthieu Schmidt (1) , Guillaume Hekimian (1) , Pierre Demondion (1) , Jean Trouillet (1) , Pascal Leprince (2) , Jean Chastre (1) , Alain Combes (1) , Charles-Edouard Luyt (1)

1 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
2 CHU Pitié-Salpêtrière [AP-HP]

Purpose: To describe the characteristics, outcomes, and risk factors associated with poor outcome of venoarterial extracorporeal membrane oxygenation (VA-ECMO)-treated patients with refractory shock post-cardiac arrest. Methods: We retrospectively analyzed data collected prospectively (March 2007–January 2015) in a 26-bed tertiary hospital intensive care unit. All patients implanted with VA-ECMO for refractory cardiogenic shock after successful resuscitation from cardiac arrest were included. Refractory cardiac arrest patients, given VA-ECMO under cardiopulmonary resuscitation, were excluded. Results: Ninety-four patients received VA-ECMO for refractory shock post-cardiac arrest. Their hospital and 12-month survival rates were 28 and 27 %, respectively. All 1-year survivors were cerebral performance category 1. Multivariable analysis retained INR >2.4 (OR 4.9; 95 % CI 1.4–17.2), admission SOFA score >14 (OR 5.3; 95 % CI 1.7–16.5), and shockable rhythm (OR 0.3; 95 % CI 0.1–0.9) as independent predictors of hospital mortality, but not SAPS II, out-of-hospital cardiac arrest score, or other cardiac arrest variables. Only 10 % of patients with an admission SOFA score >14 survived, whereas 50 % of those with scores ≤14 were alive at 1 year. Restricting the analysis to the 67 patients with out-of-hospital cardiac arrest of coronary cause yielded similar results. Conclusion: Among 94 patients implanted with VA-ECMO for refractory cardiogenic shock post-cardiac arrest resuscitation, the 24 (27 %) 1-year survivors had good neurological outcomes, but survival was significantly better for patients with admission SOFA scores <14, shockable rhythm, and INR ≤2.4. VA-ECMO might be considered a rescue therapy for patients with refractory cardiogenic shock post-cardiac arrest resuscitation.

Mots clés: Cardiac arrest; Cardiogenic shock; Extracorporeal membrane oxygenation; Post-cardiac arrest syndrome

Domaines: Cardiologie et système cardiovasculaire

Marc Pineton de Chambrun, Nicolas Bréchot, Guillaume Lebreton, Matthieu Schmidt, Guillaume Hekimian, et al.. Venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock post-cardiac arrest. Intensive Care Medicine, 2016, ⟨10.1007/s00134-016-4541-y⟩. ⟨hal-01393802⟩