Extracorporeal Life Support for Cardiogenic Shock or Cardiac Arrest Due to Acute Coronary Syndrome

Abstract

Few data are available on the clinical outcome of patients with acute coronary syndrome (ACS) complicated by refractory cardiogenic shock or cardiac arrest who receive percutaneous extracorporeal life support (ECLS). We investigated the in-hospital outcome and predictors of mortality in these patients. The investigation was a single-center, retrospective cohort study of 98 ACS patients who received ECLS to reverse hemodynamic collapse refractory to conventional treatment. Circulatory status before ECLS introduction was cardiogenic shock in 34, ventricular fibrillation or pulseless ventricular tachycardia in 23, and asystole or pulseless electrical activity in 41. Ninety-four patients (95.9%) underwent emergency revascularization, including 92 who received percutaneous coronary intervention and 2 who received isolated coronary artery bypass grafting. Successful angioplasty was achieved in 65 of 92 patients (70.7%). Fifty-four patients (55.1%) were weaned from ECLS, and ECLS-related complications occurred in 35 (35.7%). All-cause in-hospital mortality rate was 67.3%, and the survival rate to hospital discharge was 32.7%. Multivariate analysis revealed that independent predictors of in-hospital mortality were unsuccessful angioplasty, asystole or pulseless electrical activity before ECLS introduction, and ECLS-related complications. Despite hemodynamic support with ECLS, patients with ACS complicated by cardiogenic shock or cardiac arrest refractory to conventional treatment had high mortality. However, the higher than 30% in-hospital survival rate in this extremely critical population indicates that ECLS might improve outcomes in ACS by saving the lives of patients in this specialized category. Unsuccessful angioplasty, asystole or pulseless electrical activity before ECLS introduction, and ECLS-related complications were predictors of in-hospital mortality.