Extracorporeal Life Support (ECLS) has been Applied Increasingly in Recent Years in Patients Suffering from Cardiogenic Shock. If Myocardial Recovery does not Occur, ECLS becomes a Bridge to Decision with Subsequent Left Ventricular Assist Device (LVAD) Implantation

Methods: Between 2012 and 2016 574 patients were supported at our institution with an implantable long-term continuous flow VAD. Of these, 100 received implantation while on ECLS, which had been installed in accordance with our institutional policy. Severe neurological deficits and evident hepatic failure are excluding criteria for VAD support. We retrospectively analyzed data collected during ECLS therapy before LVAD implantation, using multivariate analysis, and compared patients regarding survival.

Results: The mean age was 53.6 ±11.7 years, 68 male; mean time on ECLS was 6.2 ± 4.9 days. Thirty-one patients were resuscitated before and 78 were still on respirator at the time of VAD implantation. The 30-day and 1-year survival after VAD implantation was 61.3 and 41.1% resp. In 33 patients a temporary right ventricular assist device (tRVAD) was necessary postoperatively. There were no differences between patients who survived and those who died in laboratory parameters representing end-organ function (including serum bilirubin, INR, blood urea nitrogen, creatinine lactate and pH). The predictors for 30-day mortality were older age (OR 1.05 (5% CI 1.01–1.1), p = 0.0178), body mass index >30 kg/m² (OR 3.1 (CI 1.15–8.79), p = 0.0278), elevated CVP (OR 1.1 (CI 1.0–1.3), p = 0.047) and need for tRVAD (OR 4.1 (CI 1.5–11.8), p = 0.005. The need for tRVAD remained a sole predictor for 6-month mortality (OR 2.89 (CI 1.12–7.43), p = 0.028).

Conclusion: Patients on ECLS without neurological deficit and evident hepatic failure should be transferred to LVAD if ECLS weaning or HTx is not an option. LVAD implantation from ECLS remains high risk surgery, while age > 65 years and obesity carry additional risk. It is not possible to predict survival using laboratory parameters in patients under ECLS prior to LVAD therapy, while biventricular failure indicates poor outcome.