Oxigenación con membrana extracorpórea venoarterial en reanimación cardiopulmonar intrahospitalaria como puente a trasplante cardiaco

Abstract

ObjectiveTo evaluate the functional and neurological outcome of patients in whom extracorporeal cardiopulmonary resuscitation E-CPR was used as a bridge to heart transplantation. DesignThis is a retrospective, observational study. ParticipantsAn evaluation was performed on adult patients who were treated with extracorporeal life support for cardiopulmonary arrest between 2007 and 2014. ResultsFrom 2007 to 2014, 168 patients received some form of extracorporeal support (112 neonatal or pediatric and 56 adults). From the adult group, 45 (80%) had a cardiac mechanical support (45 V-A ECMO, three short-term VADs, and one long-term VAD). Among this group, 15 received the support as E-CPR, and in 9 patients it was used as a bridge to heart transplantation. In the use of E-CPR as a bridge to heart transplantation, the median age was 56, the mean time of CPR before full flow was 54±15min, and the median duration of ECMO support before heart transplant was 1.5 days. Of the 6 out of 9 patients transplanted (66%), 5 of 6 survived with good functional and neurological outcome. An intention-to-treat analysis showed an overall survival of 55% (5 of 9). ConclusionThe use of E-CPR for the management of refractory in-hospital cardiac arrest in patients with severely impaired left ventricular systolic function, candidates for heart transplant, may increase the likelihood of survival to hospital discharge without neurological sequelae.