Partial Flow Extracorporeal Life Support Strategy for Refractory Cardiogenic Shock

Abstract

<h3>Purpose</h3> There is a paucity of evidence on cannulation and flow strategy for extracorporeal life support (ECLS). Our center employs a partial flow ECLS strategy for cardiogenic shock (CS) in which patients on peripheral ECLS are managed with partial flow using a 15F-17F arterial cannula regardless of patient body size to minimize cannula-related complications. Here we describe our clinical experience of partial flow ECLS strategy for CS. <h3>Methods</h3> We retrospectively reviewed 145 cases who developed CS requiring ECLS insertion between January 2019 and June 2021. We excluded 6 cases who were cannulated at outside hospital and 29 cases of central ECLS. <h3>Results</h3> Etiology for cardiogenic shock was as follows (including 6 cases of extracorporeal cardiopulmonary resuscitation): Post-cardiotomy shock 15, acute on chronic heart failure 25, acute ischemic cardiogenic shock 20, primary graft dysfunction 6, distributive shock 10, acute myocarditis 7, acute right ventricular failure 4, arrhythmia 5, and other 14. Mean age was 57.3 years and length of ECLS support was 7.2 days. Left ventricular venting strategy was used in 63% (67/106) of cases (IABP 50, Impella 17). Arterial cannula size: 15Fr 92%, 17Fr 7% and distal perfusion catheter was placed in 30% of cases. Average ECLS flow was 1.57L/min/m2 (3.0L/min). 53% (57/106) recovered and were decannulated, 28% (30/106) were bridged to advanced therapy (extracorporeal VAD 11, Impella 7, durable LVAD 6, transplant 6). ECLS related complications were as follows: Vascular injury 1, toe necrosis 1, leg ischemia required fasciotomy 0, bleeding from cannulation site 2, pseudoaneurysm 1, permanent neurodeficit 1, transient neurodeficit 2, Groin complication (dehiscence/infection/lymphocele) 11. The rate of survival to discharge was 61% (65/106). <h3>Conclusion</h3> Partial flow strategy is a feasible approach with a low rate of fatal complications and can effectively bridge patients to recovery or other advance therapy. Cannula-related complications complications remain a problem with this strategy.