Extra Corporeal Life Support for Cardiac ARrest patients with post-cardiac arrest syndrome: the ECCAR study

Adrien Bouglé (1, 2) , Arthur Le Gall (3, 2) , Florence Dumas (4, 2) , Guillaume Geri (5, 2, 4) , Isabelle Malissin (6) , Sebastian Voicu (6) , Bruno Mégarbane (6) , Alain Cariou (7, 2, 4) , Nicolas Deye (6)

1 CHU Pitié-Salpêtrière [AP-HP]
2 UPD5 - Université Paris Descartes - Paris 5
3 M3DISIM - Mathematical and Mechanical Modeling with Data Interaction in Simulations for Medicine
4 PARCC - UMR-S U970 - Paris-Centre de Recherche Cardiovasculaire
5 I3 - Immunologie - Immunopathologie - Immunothérapeutique
6 Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière]
7 Unité de Soins Intensifs [CHU Cochin]

Purpose: Post-Cardiac Arrest Shock (PCAS) occurring after resuscitated cardiac arrest (CA), is a main cause of early death. Extra-Corporeal Life Support (ECLS) could be useful pending recovery of myocardial failure. We aimed to describe our PCAS population, and factors associated with ECLS initiation. Materials and Methods: This analysis included 924 patients admitted in two intensive care units (ICU) between 2005 and 2014 for CA and PCAS, and, of those patients, 43 patients for whom an ECLS was initiated. Neurological and ECLS-related outcomes were gathered retrospectively. Results: The 43 ECLS patients were predominantly young males with evidence of myocardial infarction on coronary angiography (70%). ECLS was initiated in patients suffering from severe cardiovascular dysfunction (Left Ventricular Ejection Fraction: 15 [10 -25] %), with a median delay of 9 [6 -16] hours following CA. At one year, 8 patients survived (19%) without neurological disability. Blood lactate and coronary etiology were associated with neurological outcomes. Logistic regression conducted using 878 PCAS controls identified age, sex, current smoking, location of CA, blood lactate and creatinine levels as risk factors for initiation of ECLS. Conclusions: ECLS, as a salvage therapy for PCAS, could represent an acceptable alternative for highly selected patients.

Domaines: Cardiologie et système cardiovasculaire

Adrien Bouglé, Arthur Le Gall, Florence Dumas, Guillaume Geri, Isabelle Malissin, et al.. Extra Corporeal Life Support for Cardiac ARrest patients with post-cardiac arrest syndrome: the ECCAR study. Archives of cardiovascular diseases, In press. ⟨hal-01942222⟩