Objectives :
Percutaneous Extracorporeal life support system(p-ECLS) becomes widely used in medical and surgical emergent situation, such as refractory cardiogenic shock, cardiac arrest and acute respiratory failure. We reviewed our ECLS experience and tried to analyze the clinical outcomes, factors for survival for improving weaning and survival rate especially focusing on surgical or non-surgical background.
Method :
From January 2002 to December 2008, a total of 110 patients(mean age 64.5±7.5, 71 male and 39 female) inevitably underwent p-ECLS in ICU. 48(43.6%) patients were post-operative state of cardiac or vascular surgery(Group A; surgery group) and the other 62(56.4%) patients equipped the p-ECLS because of sudden prolonged cardiac arrest, refractory cardiogenic shock, acute respiratory failure and other causes(Group B; medical group). 18(16.4%) patients underwent veno-veno type p-ECLS. Veno-arterial p-ECLS was performed 92(83.6%) patients. Combined Continuous Renal Replacement Theraphy(CRRT), modified ultra-filteration, transesophageal or transthoracic echocardiography and Intra-aortic balloon pump(IABP) were actively used and specialized team approach was performed in every case.
Results;
Mean ICU and hospital stay time of survivors was 16±8.5day and 75±34.2 days, respectively. p-ECLS weaning rate and survival rate were 55.4%(61 pts) and 31.8%(35 pts), respectively. Mean p-ECLS time was 5.5±4.3 days(1-28days). There were no statistical differences between survivors and non-survivors in terms of insertion place (Angio room vs. ICU), preoperative diagnosis, gender. Survival rate was higher in medical disease group(Group B). Multivariated analysis showed the risk factors for mortality were different between the two group in term of anticoagulation.
Conclusions;
p-ECLS showed improved survival rate than conventional CPCR in our study. However, different management strategy in term of ACT control should be applied for improving clinical outcomes. Even though 31.8% of patients were survived, their hospital stay time was extremely long and quite a number of patients were dead even if they weaned from p-ECLS because of other morbidity. Thorough care should be warranted in ICU.
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