Schmack Bastian, Seppelt Philipp, Weymann Alexander, Alt Christina, Farag Mina, Arif Rawa, Doesch Andreas O, Raake Philip W, Kallenbach Klaus, Mansur Ashham, Popov Aron-Frederik, Karck Matthias, Ruhparwar Arjang
Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany.
Medical Clinic III, Department of Cardiology, University Hospital Frankfurt, Frankfurt, Germany.
PeerJ. 2017 Sep 29;5:e3813. doi: 10.7717/peerj.3813. eCollection 2017.
Extracorporeal life support (ECLS) is a life-saving procedure used in the treatment of severe cardiogenic shock. Within this retrospective single centre study, we examined our experience in this critically ill patient cohort to assess outcomes and clinical parameters by comparison of ECLS with or without selective left ventricular decompression.
Between 2004 and 2014 we evaluated 48 adult patients with INTERMACS level 1 heart failure (age 49.7 ± 19.5 years), who received either central ECLS with ( = 20, 41.7%) or ECLS without ( = 28, 58.3%, including 10 peripheral ECLS) integrated left ventricular vent in our retrospective single centre trial.
Follow up was 100% with a mean of 0.83 ± 1.85 years. Bridge to ventricular assist device was feasible in 29.2% ( = 14), bridge to transplant in 10.4% ( = 5) and bridge to recovery in 8.3% ( = 4). Overall 30-day survival was 37.5%, 6-month survival 27.1% and 1-year survival 25.0%. ECLS support with left ventricular decompression showed favourable 30-day survival compared to ECLS without left ventricular decompression ( = 0.034). Thirty-day as well as long-term survival did not differ between the subgroups (central ECLS with vent, ECLS without vent and peripheral ECLS without vent). Multivariate logistic regression adjusted for age and gender revealed ECLS without vent as independent factor influencing 30-day survival.
ECLS is an established therapy for patients in severe cardiogenic shock. Independent of the ECLS approach, 30-day mortality is still high but with superior 30-day survival for patients with ECLS and left ventricular venting. Moreover, by unloading the ventricle, left ventricular decompression may provide an important time window for recovery or further treatment, such as bridge to bridge or bridge to transplant.
体外生命支持（ECLS）是用于治疗严重心源性休克的一种挽救生命的治疗方法。在这项回顾性单中心研究中，我们通过比较采用或不采用选择性左心室减压的ECLS，来审视我们在这一危重症患者队列中的经验，以评估治疗结果和临床参数。
在2004年至2014年期间，我们评估了48例患有INTERMACS 1级心力衰竭的成年患者（年龄49.7±19.5岁），在我们这项回顾性单中心试验中，这些患者接受了带有（n = 20，41.7%）或不带有（n = 28，58.3%，包括10例外周ECLS）一体式左心室引流管的中心ECLS治疗。
随访率为100%，平均随访时间为0.83±1.85年。过渡到心室辅助装置可行的比例为29.2%（n = 14），过渡到移植可行的比例为10.4%（n = 5），过渡到恢复可行的比例为8.3%（n = 4）。总体30天生存率为37.5%，6个月生存率为27.1%，1年生存率为25.0%。与未进行左心室减压的ECLS相比，进行左心室减压的ECLS显示出良好的30天生存率（P = 0.034）。各亚组（带有引流管的中心ECLS、不带有引流管的ECLS和不带有引流管的外周ECLS）之间的30天及长期生存率无差异。经年龄和性别调整的多因素逻辑回归分析显示，不带有引流管的ECLS是影响30天生存率的独立因素。
ECLS是治疗严重心源性休克患者的一种既定疗法。无论采用何种ECLS方法，30天死亡率仍然很高，但对于接受ECLS和左心室引流治疗的患者，其30天生存率更高。此外，通过减轻心室负荷，左心室减压可为恢复或进一步治疗（如过渡到桥接或过渡到移植）提供重要的时间窗口。
