Secondary Interventions after Transportation in Patients after ECLS Implantation in Referring Centers

Objective: Extracorporeal life support (ECLS) is an established and recommended treatment modality in patients with acute carcinogenic shock. Safety and feasibility of this technique increased this treatment to out of hospital implantation and transportation. However, in this very sick patient cohort further treatment remains challenging and complicated. We here present our treatment algorithms and describe the need of secondary interventions after arterial-venous ECLS implantation outside our own center.

Methods: Between October 2014 and March 2017 a total number of 47 consecutive patients (mean age 53 years, range 37 to 74) underwent ECLS implantation in a referring institution. Of those 29 (61.7%) received arterial-venous ECLS implantation using a femoral percutaneous approach. Prospective collected data were retrospectively analyzed for survival and weaning depending on secondary interventions and their association with survival.

Results: 30day survival in V-A ECLS patients was 51.8%. 14 patients (48.3%) were in need of any kind of re-intervention during ECLS support. 10 patients (34.8%) received an additional Impella 2.5 to unload the LV. 5 patients (17.2%) needed an additional leg perfusion cannula that has not been initially implanted. Another 5 patients (17.2%) experienced a bleeding complication requiring surgical intervention. Additional LV unloading was associated with better survival after 30days. (70.0% versus 42.1%, p = 0.02). 50% of LV unloaded patients have been weaned from MCS versus 36.8% without additional LV unloading (p = 0.08). Four patients on ECLS and Impella 2.5 support were successfully bridged to Impella 5.0 support.

Conclusion: Secondary interventions in patients who have successfully been implanted an ECLS in a referring hospital and transported in our center are frequent. Close monitoring of potential complications and next treatment steps improved survival in transported ECLS patients.

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