OC22 ECLS IN PRIMARY REFRACTORY CARDIOGENIC SHOCK: IMPACT OF SHORT-TERM EXTRACORPOREAL MECHANICAL CIRCULATORY SUPPORT ON SURVIVAL

Abstract

Abstract Background/Aim: Previous studies have demonstrated dubious results of ECMO for the treatment of refractory cardiogenic shock (RCS) after 9 days of support. The use of short-term extracorporeal mechanical circulatory support (ST-MCS) has emerged in the last years. We therefore evaluate the outcome of patients that needed prolonged support and underwent ST-MCS implantation compared to conventional ECMO implantation. Methods: Between January 2009 and October 2017, 183 patients were treated with extracorporeal life support (ECLS) in our centre for primary RCS; we selected the 101 patients that exceed the 9 days of ECLS. 44 cases (44%) were treated exclusively with ECMO implantation (Group 1), while 57 cases (56%) underwent left ventricular or biventricular extracorporeal ST-MCS implantation (Group 2). Among these last patients, in 42 cases the ST-MCS was intended as upgrade of ECMO support. Results: Average duration of the support was 17 ± 9 days in the Group 1 and 13 ± 9 days in the Group 2 (p = 0.08), while mean rates support of the maximal theoretic flow were 62 ± 15% and 79 ± 20% (p < 0.01), respectively. 12 patients of first group and 9 patients of second one died during ECLS support (p = 0.12); 30-days survivals were 61% and 70% (p = 0.24) and rates of hospital discharge were 43% and 61% (p = 0.04), respectively. Kaplan-Meier analysis (Fig.1) demonstrates a better survival in Group 2 rather than in Group 1 (p = 0.04) at median follow-up of 16 ± 24 months. Conclusions: ST-MCS has proved to increase the survival respect single-stage ECMO in patients with primary RCS who need prolonged ECLS and full hemodynamic support.