Pagani F D, Aaronson K D, Swaniker F, Bartlett R H
Section of Cardiac Surgery, University of Michigan, Ann Arbor 48109, USA.
Ann Thorac Surg. 2001 Mar;71(3 Suppl):S77-81; discussion S82-5. doi: 10.1016/s0003-4975(00)02620-5.
Extracorporeal life support (ECLS) is an effective technique for providing emergent circulatory assistance, and may represent a life-saving option in patients who might not initially be considered a candidate for other forms of circulatory support (extracorporeal or implantable left ventricular assist device [LVAD]). In the setting of cardiac arrest, ECLS represents the only viable method of initiating circulatory support. However, ECLS has a number of disadvantages that include high complication rates (eg, stroke, bleeding) and a limited duration of potential support, which have prevented its widespread acceptance, particularly in the adult population. With the increased successful application of long-term implantable LVADs as a bridge to transplant, the major limitation of ECLS could be overcome by bridging patients to a long-term implantable LVAD ("bridge to bridge"), thereby reducing the reluctance to utilize ECLS when indicated. After acquisition of the HeartMate LVAD (Thermo Cardiosystems, Inc, Woburn, MA) we investigated the use of ECLS as a bridge to an implantable LVAD and subsequent transplantation in selected high-risk patients.
From Oct 1, 1996 to Sept 30, 2000, 33 adult patients presenting with cardiac arrest or severe hemodynamic instability were placed on ECLS for the bridge to bridge indication. Of the 33 patients, 10 patients survived to LVAD implant, 1 was bridged directly to transplant, 5 weaned from ECLS, and 16 died on ECLS. Overall, 12 patients survived to discharge. One-year actuarial survival from the initiation of ECLS was 36%. One-year actuarial survival from the time of LVAD implant, conditional on surviving ECLS, was 80%.
The 1-year survival of adult patients placed on ECLS and who subsequently survived to an implantable LVAD was favorable. These data support a strategy of ECLS to implantable LVAD bridge to heart transplant in adult patients who are in need of circulatory support and who are not initially candidates for other forms of mechanical support. The favorable results of this strategy support utilization of ECLS even in situations where myocardial recovery is thought to be unlikely.
体外生命支持（ECLS）是一种提供紧急循环辅助的有效技术，对于那些最初可能不被视为其他形式循环支持（体外或植入式左心室辅助装置[LVAD]）候选者的患者而言，可能是一种挽救生命的选择。在心脏骤停的情况下，ECLS是启动循环支持的唯一可行方法。然而，ECLS存在许多缺点，包括高并发症发生率（如中风、出血）以及潜在支持时间有限，这阻碍了其广泛应用，尤其是在成年人群体中。随着长期植入式LVAD作为移植桥梁的成功应用增加，通过将患者过渡到长期植入式LVAD（“桥到桥”）可以克服ECLS的主要局限性，从而减少在有指征时使用ECLS的顾虑。在获得HeartMate LVAD（Thermo Cardiosystems公司，马萨诸塞州沃本）后，我们研究了在选定的高危患者中使用ECLS作为植入式LVAD及后续移植桥梁的情况。
1996年10月1日至2000年9月30日，33例出现心脏骤停或严重血流动力学不稳定的成年患者因桥到桥指征接受ECLS治疗。33例患者中，10例存活至LVAD植入，1例直接过渡到移植，5例脱离ECLS，16例在ECLS治疗期间死亡。总体而言，12例患者存活出院。从开始ECLS起的1年预期生存率为36%。以在ECLS治疗中存活为条件，从LVAD植入时起的1年预期生存率为80%。
接受ECLS治疗且随后存活至植入式LVAD的成年患者1年生存率良好。这些数据支持在需要循环支持且最初不适合其他形式机械支持的成年患者中，采用ECLS至植入式LVAD桥接至心脏移植的策略。这一策略的良好结果支持即使在认为心肌恢复不太可能的情况下也使用ECLS。
