RISK FACTORS FOR DEATH AND OUTCOME AFTER PROMPT EXTRACORPOREAL LIFE

SUPPORT IN ACUTE MYOCARDIAL INFARCTION WITH CARDIOGENIC SHOCK

MD Ciro Mastroianni and Pr Pascal LeprinceInstitut de cardiologieChirurgie cardiaque

Groupe Hospitalier Pitié-SalpêtrièreAssistance Publique Hôpitaux de Paris

Paris, France

Between February 2006 and November 2009

745 ECLS V-V and V-A 77 ECLS support for AMI with CS

- 59 peripheral - 18 central

67% after PCA or cardiac surgery

Demographics and comorbidity

Age (years) (mean ± SD) 56.05 ± 0.70

Male gender % (n) 75.32 (58)

Body mass index (mean ±

SD)

25.81 ± 4.82

Diabetes mellitus % (n) 28.94 (22)

Hypertension % (n) 26.30 (20)

Current smoking % (n) 46.05 (35)

Hypercholesterolemia % (n) 34.20 (26)

Previous cardiac surgery %

(n)

5.30 (4)

Haemodynamics data

Left ventricular ejection fraction (%)

(mean ± SD)

17 ± 7

Mean blood pressure (mmHg) (mean ±

SD)

52.4 ±

14.10

Intra-aortic balloon pump support % (n) 55.80 (43)

Previous cardiopulmonary resuscitation %

(n)

40.30 (31)

ECLS implantation under cardiac massage

% (n)

18.20 (14)

Laboratory data pre-implantation

Creatinine (µmol/l) (mean ± SD) 158.07 ±

81.57

SGOT (UI/l) (mean ± SD) 1339.35 ±

2233.52

Prothrombin time (%) (mean ± SD) 50,02 ± 21.13

Lactate (mmol/l) (mean ± SD) 8.38 ± 4.87

Peak level of Troponin-I (µg/l) (mean

± SD)

286.08 ±

706.37

Inotropes at ECLS implantation

Strategy

ECLS implantation to provide immediate circulatory support for hemodynamic stabilization

Patients who had no signs of recovery after 3 weeks were considered candidates for:

transplantation LVAD implantation

ECLS weaning

pulsatile arterial waveform MBP >60 mmHg while receiving no or low-

dose vasoactive agents good pulmonary blood oxygenation

ECLS flow decreased progressively

LVEF ≥ 25%ITV ≥ 12 cm

Causes of death

Causes of death

Multivariate analysis of 30 days mortality risk factors

Pneumonia % (n) 51.31% (39)

Acute renal failure necessiting hemofiltration % (n) 46.05% (35)

Pulmonary edema % (n) 31.57% (24)

Major bleeding % (n) 21.33% (16)

Leg ischemia % (n) 9.21% (7)

Surgical wound infection % (n) 8% (6)

Stroke % (n) 2.63% (2)

Traitement of pulmonary edema during peripheral ECLS

Inotropes IABP

Impella LP 2.5 and 5.0

Central ECLS

Double Central ECLS

Conclusions

Prompt ECLS support is an effective management and provides a reasonable chance of survival in much compromised patient with AMI associated with profound CS

Reducing the duration of end organs ischemia is the keystone of management for these patients