Ten other patients also received ECLS, including two after the restoration of spontaneous circulation following a brief period of asystole, selleck chem during refractory shock. The mean duration of external cardiac massage was 101 �� 55 minutes.Table 2Baseline characteristics at the time of ECLS implantation*Before the initiation of ECLS support, a severe decrease in cardiac contractility was documented by echocardiography in 14 cases. All patients were mechanically ventilated and received vasopressor. Four patients needed temporary external transthoracic electrostimulation. Six patients required continuous venovenous hemofiltration or conventional dialysis for acute renal failure before or immediately after ECLS implantation. Before connection to ECLS, the median arterial pH was 7.37 (7.34 to 7.
41), partial presure of arterial oxygen/fraction of inspired oxygen ratio was 239 (180 to 261), serum bicarbonate concentration was 19.0 mmol/L (17.7 to 20.6), plasma lactate concentration was 5.9 mmol/L (3.7 to 9.7), and serum creatinine concentration was 160 ��mol/L (114 to 204).ECLS feasibilityECLS feasibility, assessed with respect to time from admission to ECLS initiation, and the percentage of successful procedures (i.e. flow rate > 2.5 L/m2 and mean blood pressure > 60 mmHg) is shown in Table Table3.3. Time from hospital admission to initiation of ECLS was 6.4 �� 7.0 hours, and the time to ECLS implant was 58 �� 11 minutes. The mean ECLS flow rate was 3.45 �� 0.45 L/min. The average ECLS duration was 4.5 �� 2.4 days. In one patient (no.
17), an atrial balloon septostomy was performed to accomplish mechanical decompression of the left heart.Table 3ECLS feasibility, duration and complicationsECLS complicationsSignificant cannulation-related injuries of femoral vessels were reported in 10 patients: six patients with limb ischemia requiring urgent revascularization in three cases, one femoral thrombus, one cava inferior thrombus, and two cases of severe bleeding at the site of cannulation Dacomitinib requiring a surgical revision.Clinical outcomeFifteen patients were weaned off ECLS support and two patients withdrawn from support because of refractory multiorgan failure and cerebral death (Table (Table3).3). Thirteen patients survived and were discharged to hospital without significant cardiovascular or neurological sequelae (CPC 1 n = 9 and CPC 2 n = 4). Two patients died of septic shock and cerebral death during the hospital stay.DiscussionWe report one of the largest series of drug-induced cardiac arrest and refractory shock managed with ECLS. The high survival rate (76%) reported in this setting supports ECLS as an efficient rescue treatment in a subset of patients with drug-induced circulatory failure not responding to optimal conventional treatment.