Organ Recovery and Functional Status in Survivors of ECLS Therapy for Cardiogenic Shock

Objectives: Extracorporeal life support (ECLS) is increasingly being used as therapy for refractory cardiogenic shock and circulatory arrest with favorable early survival rates. Nonetheless, potential for functional recovery is often debatable in highly impaired patients in whom ECLS is employed as ultima ratio measure. Hence, data on functional recovery and quality of life after ECLS therapy are strongly warranted. Here, we report on organ recovery and functional status in survivors of ECLS therapy for refractory cardiogenic shock.

Methods: Between May 2011 and December 2016, 246 consecutive, nonsurgical patients received ECLS therapy for refractory cardiogenic shock in our center. All surviving patients were contacted and invited for a comprehensive follow-up (FU) examination including clinical, neurological, and physiological assessment.

Results: Out of 59 surviving patients (24%), a complete comprehensive FU examination could be completed in 39 patients (66%) (mean age 49 ± 16 years, 80% male) with a mean FU time of 2.7 ± 1.3 years (range 0.8–5.4 years). In those patients, initial clinical status at ECLS initiation was highly impaired with mean lactate of 8.5 ± 6.0 mmol/L, circulatory failure requiring CPR in 18%, shock liver in 33%, and renal failure requiring dialysis in 46% of the patients. Four patients (10%) could not be weaned from the ECLS requiring permanent ventricular assist device support, which however could be discontinued in all patients either due to left ventricular recovery (25%) or heart transplantation (75%). Tracheotomy for pulmonary weaning was necessary in 36%. At comprehensive FU examination, left ventricular EF was >50, 40 to 50, and < 40% in 63, 20, and 17% of the patients, respectively. No patient (0%) was in need of dialysis with a mean creatinine of 1.4 ± 0.6 mg/dL. Freedom of severe neurological disability (modified Rankin scale ≤3) was 95%. Freedom from depression was 93% (Becks Depressions-Inventory II). Subjective complete reintegration into former social and working life was achieved by 56 and 28%, respectively.

Conclusion: Organ recovery and functional status in survivors after ECLS therapy for refractory cardiogenic shock seems to be highly satisfactory with regard to the initial clinical status and otherwise fatal prognosis of this profoundly impaired patient collective.