• F Mojoli, A Braschi, A Venti, C Pellegrini, G M De Ferrari, M Ferlini, M Zanierato, M Maurelli, G A Iotti, and A M D'Armini.
• S. C. di Anestesia e Rianimazione I, Dipartimento di Emergenza Urgenza, Fondazione IRCCS Policlinico San Matteo, Pavia, Italia - francesco.mojoli@unipv.it.
• Minerva Anestesiol. 2013 Oct 1;79(10):1147-55.

BackgroundThanks to significant technical improvements, VA-ECMO is increasingly used to reverse circulatory collapse refractory to standard treatments.MethodsWe studied patients who underwent VA-ECMO due to primary cardiogenic shock or cardiac arrest between January 2008 and June 2011 at our institution. Variables related to hospital survival were analyzed. Long-term survival and health-related quality of life were checked.ResultsVA-ECMO was instituted in 23 patients: 17 outpatients and 6 inpatients. Seven of the outpatients were admitted to hospital under ongoing CPR. In these pts, time to CPR was 7 min (6-8) and time to ECMO 93 min (74-107); after 20 hours (16-22), all these pts died. Among remaining 16 pts, 6 were bridged to heart transplant and 4 to heart recovery, 8 survived to hospital discharge and 7 were alive with high health-related quality of life after 46 months (36-54). Ongoing CPR, inotropic score and lactates at cannulation did not differ between survivors and non-survivors; duration of shock, SOFA score and serum creatinine at ECMO institution, and lactates and fluid balance after 36 hours were higher in non-survivors. Patients could be kept on spontaneous breathing for >30% of time while on VA-ECMO.ConclusionEmergency VA-ECMO institution can reverse refractory acute cardiovascular collapse, provided it is carried out before significant organ dysfunction occurs. Light sedation and spontaneous breathing while on VA-ECMO can be well tolerated by patients, but related clinical benefits should be proved. Patients successfully bridged to heart recovery or transplant are candidates for long-term good quality of life.

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